Prospective validation of a new imaging scorecard to assess leptomeningeal metastasis: A joint EORTC BTG and RANO effort

TY - JOUR

T1 - Prospective validation of a new imaging scorecard to assess leptomeningeal metastasis: A joint EORTC BTG and RANO effort

AU - Le Rhun, Emilie

AU - Devos, Patrick

AU - Winklhofer, Sebastian

AU - Lmalem, Hafida

AU - Brandsma, Dieta

AU - Kumthekar, Priya

AU - Castellano, Antonella

AU - Compter, Annette

AU - Dhermain, Frederic

AU - Franceschi, Enrico

AU - Forsyth, Peter

AU - Furtner, Julia

AU - Galldiks, Norbert

AU - Gállego Pérez-Larraya, Jaime

AU - Gempt, Jens

AU - Hattingen, Elke

AU - Hempel, Johann Martin

AU - Lukacova, Slavka

AU - Minniti, Giuseppe

AU - O'Brien, Barbara

AU - Postma, Tjeerd J

AU - Roth, Patrick

AU - Rudà, Roberta

AU - Schaefer, Niklas

AU - Schmidt, Nils O

AU - Snijders, Tom J

AU - Thust, Steffi

AU - van den Bent, Martin

AU - van der Hoorn, Anouk

AU - Vogin, Guillaume

AU - Smits, Marion

AU - Tonn, Joerg C

AU - Jaeckle, Kurt A

AU - Preusser, Matthias

AU - Glantz, Michael

AU - Wen, Patrick Y

AU - Bendszus, Martin

AU - Weller, Michael

N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

PY - 2022/10/3

Y1 - 2022/10/3

N2 - BACKGROUND: Validation of the 2016 RANO MRI scorecard for leptomeningeal metastasis failed for multiple reasons. Accordingly, this joint EORTC Brain Tumor Group and RANO effort sought to prospectively validate a revised MRI scorecard for response assessment in leptomeningeal metastasis.METHODS: Coded paired cerebrospinal MRI of 20 patients with leptomeningeal metastases from solid cancers at baseline and follow-up after treatment and instructions for assessment were provided via the EORTC imaging platform. The Kappa coefficient was used to evaluate the interobserver pairwise agreement.RESULTS: Thirty-five raters participated, including 9 neuroradiologists, 17 neurologists, 4 radiation oncologists, 3 neurosurgeons, and 2 medical oncologists. Among single leptomeningeal metastases-related imaging findings at baseline, the best median concordance was noted for hydrocephalus (Kappa = 0.63), and the worst median concordance for spinal linear enhancing disease (Kappa = 0.46). The median concordance of raters for the overall response assessment was moderate (Kappa = 0.44). Notably, the interobserver agreement for the presence of parenchymal brain metastases at baseline was fair (Kappa = 0.29) and virtually absent for their response to treatment. 394 of 700 ratings (20 patients x 35 raters, 56%) were fully completed. In 308 of 394 fully completed ratings (78%), the overall response assessment perfectly matched the summary interpretation of the single ratings as proposed in the scorecard instructions.CONCLUSION: This study confirms the principle utility of the new scorecard, but also indicates the need for training of MRI assessment with a dedicated reviewer panel in clinical trials. Electronic case report forms with "blocking options" may be required to enforce completeness and quality of scoring.

AB - BACKGROUND: Validation of the 2016 RANO MRI scorecard for leptomeningeal metastasis failed for multiple reasons. Accordingly, this joint EORTC Brain Tumor Group and RANO effort sought to prospectively validate a revised MRI scorecard for response assessment in leptomeningeal metastasis.METHODS: Coded paired cerebrospinal MRI of 20 patients with leptomeningeal metastases from solid cancers at baseline and follow-up after treatment and instructions for assessment were provided via the EORTC imaging platform. The Kappa coefficient was used to evaluate the interobserver pairwise agreement.RESULTS: Thirty-five raters participated, including 9 neuroradiologists, 17 neurologists, 4 radiation oncologists, 3 neurosurgeons, and 2 medical oncologists. Among single leptomeningeal metastases-related imaging findings at baseline, the best median concordance was noted for hydrocephalus (Kappa = 0.63), and the worst median concordance for spinal linear enhancing disease (Kappa = 0.46). The median concordance of raters for the overall response assessment was moderate (Kappa = 0.44). Notably, the interobserver agreement for the presence of parenchymal brain metastases at baseline was fair (Kappa = 0.29) and virtually absent for their response to treatment. 394 of 700 ratings (20 patients x 35 raters, 56%) were fully completed. In 308 of 394 fully completed ratings (78%), the overall response assessment perfectly matched the summary interpretation of the single ratings as proposed in the scorecard instructions.CONCLUSION: This study confirms the principle utility of the new scorecard, but also indicates the need for training of MRI assessment with a dedicated reviewer panel in clinical trials. Electronic case report forms with "blocking options" may be required to enforce completeness and quality of scoring.

KW - Brain Neoplasms/pathology

KW - Humans

KW - Magnetic Resonance Imaging

KW - Meningeal Carcinomatosis

KW - Oncologists

KW - Treatment Outcome

U2 - 10.1093/neuonc/noac043

DO - 10.1093/neuonc/noac043

M3 - SCORING: Journal article

C2 - 35157772

VL - 24

SP - 1726

EP - 1735

JO - NEURO-ONCOLOGY

JF - NEURO-ONCOLOGY

SN - 1522-8517

IS - 10

ER -