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Le Rhun E, Devos P, Winklhofer S, Lmalem H, Brandsma D, Kumthekar P, Castellano A, Compter A, Dhermain F, Franceschi E, Forsyth P, Furtner J, Galldiks N, Gállego Pérez-Larraya J, Gempt J, Hattingen E, Hempel JM, Lukacova S, Minniti G, O’Brien B, Postma TJ, Roth P, Rudà R, Schaefer N, Schmidt NO, Snijders TJ, Thust S, van den Bent M, van der Hoorn A, Vogin G, Smits M, Tonn JC, Jaeckle KA, Preusser M, Glantz M, Wen PY, Bendszus M, Weller M. Prospective validation of a new imaging scorecard to assess leptomeningeal metastasis: A joint EORTC BTG and RANO effort. Neuro Oncol 2022; 24:1726-1735. [PMID: 35157772 PMCID: PMC9527515 DOI: 10.1093/neuonc/noac043] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Emilie Le Rhun
- Corresponding Author: Emilie Le Rhun, MD, PhD, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland ()
| | | | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Priya Kumthekar
- Malnati Brain Tumor Institute of The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Antonella Castellano
- Neuroradiology Department, Vita-Salute San Raffaele University and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Annette Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Frederic Dhermain
- Radiation Oncology Department, Gustave Roussy University Hospital, Villejuif, France
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Peter Forsyth
- Department of NeuroOncology, Moffitt Cancer Center and University of South Florida, Tampa, USA
| | - Julia Furtner
- Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich; Center of Integrated Oncology (CIO) Aachen, Bonn, Cologne and Duesseldorf, University of Cologne, Cologne, Germany
| | - Jaime Gállego Pérez-Larraya
- Health Research Institute of Navarra (IdiSNA), Pamplona, Navarra, Spain,Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Navarra, Spain,Department of Neurology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jens Gempt
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurosurgery
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Johann Martin Hempel
- Department of Neuroradiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Slavka Lukacova
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Barbara O’Brien
- Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tjeerd J Postma
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Patrick Roth
- Department of Neurosurgery, Clinical Neuroscience Center University Hospital and University of Zurich, Zurich, Switzerland
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Niklas Schaefer
- Division of Clinical Neuro-oncology, Department of Neurology, University Hospital Bonn, Germany
| | - Nils O Schmidt
- Department of Neurosurgery, University Medical Center, Regensburg, Germany
| | - Tom J Snijders
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Steffi Thust
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK,Department of Brain Rehabilitation and Repair, UCL Institute of Neurology, London, UK
| | - Martin van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anouk van der Hoorn
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Guillaume Vogin
- IMoPA Ingénierie Moléculaire et Physiopathologie Articulaire UMR7365 CNRS-UL, Vandoeuvre les Nancy, France,Centre François Baclesse, Esch-sur-Alzette, Luxemborg
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joerg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany and German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | | | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Glantz
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts, USA
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center University Hospital and University of Zurich, Zurich, Switzerland
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