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    Roth, P. (Patrick)

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      Prospective validation of a new imaging scorecard to assess leptomeningeal metastasis: A joint EORTC BTG and RANO effort
      (Oxford University Press, 2022) Le-Rhun, E. (Emilie); Devos, P. (Patrick); Winklhofer, S. (Sebastian); Lmalem, H. (Hafda); Brandsma, D. (Dieta); Kumthekar, P. (Priya); Castellano, A. (Antonella); Compter, A. (Annette); Dhermain, F. (Frederic); Franceschi, E. (Enrico); Forsyth, P. (Peter); Furtner, J. (Julia); Galldiks, N. (Norbert); Gallego-Perez-Larraya, J. (Jaime); Gempt, J. (Jens); Hattingen, E. (Elke); Hempel, J.M. (Johann Martin); Lukacova, S. (Slavka); Minniti, G. (Giuseppe); O’Brien, B. (Barbara); Postma, T.J. (Tjeerd J.); Roth, P. (Patrick); Rudà, R. (Roberta); Schaefer, N. (Niklas); Schmidt, N.O. (Nils O.); Snijders, T.J. (Tom J.); Thust, S. (Steff); Van-Den-Bent, M. (Martin); van-der-Hoorn, A. (Anouk); Vogin, G. (Guillaume); Smits, M. (Marion)
      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.