Abstract
BACKGROUND: The Macdonald criteria and RANO criteria define radiologic parameters to classify therapeutic outcome among malignant glioma patients. While both scales specify that clinical status must be incorporated for overall assessment, neither provides specific parameters to do so. Furthermore, both scales prioritize clinical status over radiology in that response requires at least stable clinical status, while clinical deterioration is sufficient to declare progression. We hypothesized that a standardized metric to measure neurologic function will permit better overall response assessment in neuro-oncology. METHODS: An international group of neuro-oncologists convened bi- weekly for the past year to draft the Neurologic Assessment in Neuro-Oncology (NANO) criteria as an objective and quantifiable metric of neurologic function evaluable during a routine office examination. RESULTS: The NANO scale is a quick, clinician-friendly, and quantifiable evaluation of eight relevant neurologic domains based on direct observation/testing conducted during routine office visits. The score defines criteria for domain-specific and overall scores of response, progression, stable disease and not assessed. A given domain will be scored non-evaluable if it cannot be accurately assessed due to pre-existing conditions, co-morbid events, and/or concurrent medications. CONCLUSION: The NANO criteria aims to provide a more detailed and objective measure of neurologic function than currently exists. These criteria are designed to enable a consistent evaluation of neurologic function which will facilitate comparisons across clinical trials and therapeutic interventions. Implementation and validation of these criteria are planned, and future modifications are anticipated for further optimization.