Prospective validation of a new imaging scorecard to assess leptomeningeal metastasis: A joint EORTC BTG and RANO effort. Issue 10 (14th February 2022)

• Record Type: Journal Article
• Authors: Le Rhun, Emilie; Devos, Patrick; Winklhofer, Sebastian; Lmalem, Hafida; Brandsma, Dieta; Kumthekar, Priya; Castellano, Antonella; Compter, Annette; Dhermain, Frederic; Franceschi, Enrico; Forsyth, Peter; Furtner, Julia; Galldiks, Norbert; Gállego Pérez-Larraya, Jaime; Gempt, Jens; Hattingen, Elke; Hempel, Johann Martin; Lukacova, Slavka; Minniti, Giuseppe; O'Brien, Barbara; Postma, Tjeerd J; Roth, Patrick; Rudà, Roberta; Schaefer, Niklas; Schmidt, Nils O; Snijders, Tom J; Thust, Steffi; van den Bent, Martin; van der Hoorn, Anouk; Vogin, Guillaume; Smits, Marion; Tonn, Joerg C; Jaeckle, Kurt A; Preusser, Matthias; Glantz, Michael; Wen, Patrick Y; Bendszus, Martin; Weller, Michael;
• Is Part Of: Neuro-oncology. Volume 24:Issue 10(2022)
• Page Start: 1726
• Page End: 1735
• Publication Date: 2022-02-14
• Subjects: brain -- feasibility -- MRI -- response -- validation; Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noac043
• Languages: English
• ISSNs: 1522-8517

Abstract

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.