PT  - JOURNAL ARTICLE
AU  - Rodriguez, D.
AU  - Chambers, T.
AU  - Warmuth-Metz, M.
AU  - Aliaga, E. Sanchez
AU  - Warren, D.
AU  - Calmon, R.
AU  - Hargrave, D.
AU  - Garcia, J.
AU  - Vassal, G.
AU  - Grill, J.
AU  - Zahlmann, G.
AU  - Morgan, P.S.
AU  - Jaspan, T.
TI  - Evaluation of the Implementation of the Response Assessment in Neuro-Oncology Criteria in the HERBY Trial of Pediatric Patients with Newly Diagnosed High-Grade Gliomas
AID  - 10.3174/ajnr.A5982
DP  - 2019 Mar 01
TA  - American Journal of Neuroradiology
PG  - 568--575
VI  - 40
IP  - 3
4099  - http://www.ajnr.org/content/40/3/568.short
4100  - http://www.ajnr.org/content/40/3/568.full
SO  - Am. J. Neuroradiol.2019 Mar 01; 40
AB  - BACKGROUND AND PURPOSE: HERBY was a Phase II multicenter trial setup to establish the efficacy and safety of adding bevacizumab to radiation therapy and temozolomide in pediatric patients with newly diagnosed non–brain stem high-grade gliomas. This study evaluates the implementation of the radiologic aspects of HERBY.MATERIALS AND METHODS: We analyzed multimodal imaging compliance rates and scan quality for participating sites, adjudication rates and reading times for the central review process, the influence of different Response Assessment in Neuro-Oncology criteria in the final response, the incidence of pseudoprogression, and the benefit of incorporating multimodal imaging into the decision process.RESULTS: Multimodal imaging compliance rates were the following: diffusion, 82%; perfusion, 60%; and spectroscopy, 48%. Neuroradiologists' responses differed for 50% of scans, requiring adjudication, with a total average reading time per patient of approximately 3 hours. Pseudoprogression occurred in 10/116 (9%) cases, 8 in the radiation therapy/temozolomide arm and 2 in the bevacizumab arm (P < .01). Increased target enhancing lesion diameter was a reason for progression in 8/86 cases (9.3%) but never the only radiologic or clinical reason. Event-free survival was predicted earlier in 5/86 (5.8%) patients by multimodal imaging (diffusion, n = 4; perfusion, n = 1).CONCLUSIONS: The addition of multimodal imaging to the response criteria modified the assessment in a small number of cases, determining progression earlier than structural imaging alone. Increased target lesion diameter, accounting for a large proportion of reading time, was never the only reason to designate disease progression.BEVbevacizumabCRRCCentralized Radiologic Review CommitteeEFSevent-free survivalHGGhigh-grade gliomaMMmultimodalRANOResponse Assessment in Neuro-OncologyRTradiotherapyTMZtemolozomide