RANO Criteria (High-Grade Glioma)

The Response Assessment in Neuro-Oncology (RANO) criteria for high-grade glioma (Wen et al., JCO 2010) replaced Macdonald criteria by incorporating non-enhancing T2/FLAIR disease, steroid dose, and clinical status alongside contrast-enhancing bidimensional measurements. Measurable enhancing lesions are those with clearly defined margins and perpendicular diameters >=10 mm; the sum of the products of those diameters (SPD) is tracked from baseline and nadir. Complete and partial responses require stable or improved T2/FLAIR, no new lesions, appropriate steroid dosing, and clinical stability/improvement, and should be sustained >=4 weeks. Progressive disease may be declared for >=25% SPD increase, significant T2/FLAIR increase not explained by other causes, any new lesion, or clinical deterioration attributable to tumor alone - even without imaging progression. Within 12 weeks after chemoradiotherapy, PD inside the high-dose radiation field should be assigned cautiously because of pseudoprogression. RANO 2.0 (Wen et al., 2023) unifies high- and low-grade glioma assessment into one treatment-agnostic framework. Key differences from classic RANO implemented here: (1) for newly diagnosed disease treated with RT, the first post-RT MRI (~4 weeks / 21-35 days) is the preferred baseline rather than the immediate postoperative scan; (2) 3D volumetric measurements are allowed (PD >=40% volume increase as an alternative to >=25% SPD); (3) confirmation scan for PD is mandatory within 12 weeks after RT when pseudoprogression is plausible, and optional thereafter (unlike mRANO, which required dual confirmation more broadly); (4) for predominantly enhancing tumors such as IDH-wildtype glioblastoma, routine use of T2/FLAIR enlargement as a PD criterion is de-emphasized or removed; non-enhancing assessment remains important for IDH-mutant and non-enhancing-predominant gliomas; (5) standardized Brain Tumor Imaging Protocol (BTIP) acquisition is recommended. This calculator applies classic RANO categorical thresholds and clinical caveats; apply RANO 2.0 baseline/confirmation nuances in trial protocols as specified.