# RANO 2.0 — RANO 2.0 response criteria for adult gliomas

> Adult glioma response framework integrating standardized MRI, bidimensional or prespecified volumetric tumor burden, enhancement phenotype, corticosteroid dose, clinical status and confirmation rules for pseudoprogression.

**Situação:** vigente · **Órgão:** Oncologia · **Órgão emissor:** Response Assessment in Neuro-Oncology Working Group · **Versão:** 2.0 · **Ano:** 2023

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI
- Fonte primária: Wen PY, van den Bent M, Youssef G, et al.. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10860967/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Use RANO 2.0 as the current adult-glioma framework, preserve the correct baseline and phenotype branch, and never collapse preliminary progression, confirmed progression and pseudoprogression into one undifferentiated PD label.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| CR | Complete response | RANO 2.0 complete response: all measurable target disease disappears, relevant nonmeasurable and nontarget disease resolves or remains nonprogressive as the applicable phenotype requires, no new lesion is present, corticosteroid exposure meets the protocol response condition, and the patient is clinically stable or improved. The radiographic response must persist for at least 4 weeks to be confirmed; an earlier CR is preliminary. | Report the target phenotype, baseline, 2D or 3D method, steroid dose, neurological status and confirmation state. CR does not prove cure or permit the API to stop antitumor or corticosteroid therapy; management remains with the neuro-oncology team and trial protocol. | CR is the most favorable RANO 2.0 response state but supplies no individualized survival or recurrence probability. Microscopic infiltrative tumor, treatment-related change and steroid effects can remain despite disappearance of measurable disease. | Wen et al. 2023, J Clin Oncol 41:5187-5199, DOI 10.1200/JCO.23.01059, PMC10860967, Tables 1-3 and sections Response Criteria, Confirmation of Response and Corticosteroid Use define complete response across enhancing, nonenhancing and mixed disease, the 4-week confirmation rule, new-lesion exclusion and clinical/steroid requirements. | ✓ |
| PR | Partial response | RANO 2.0 partial response: at least a 50% decrease in the 2D sum of products of perpendicular diameters or at least a 65% decrease in prespecified 3D tumor volume relative to baseline, with no qualifying progression in the other disease component, no new lesion, acceptable corticosteroid use and clinically stable or improved status. Sustain the response for at least 4 weeks to confirm it; do not mix 2D and 3D methods longitudinally. | Return the exact target set, baseline and current burden, percent change, disease phenotype, steroid and clinical states, and whether the response is preliminary or confirmed. PR is a standardized response observation, not an autonomous instruction to continue a regimen, taper steroids or change surgery or radiotherapy plans. | PR denotes substantial radiographic reduction but is not a patient-specific prognosis and does not exclude viable infiltrative tumor. Antiangiogenic therapy, corticosteroids and permeability change can reduce enhancement without equivalent cytoreduction, while acquisition differences can create false threshold crossing. | Wen et al. 2023, PMC10860967, Tables 1-3 and sections Determination of Radiographic Response and Confirmation of Response specify the at-least-50% 2D or at-least-65% volumetric reduction from baseline, complementary-component, new-lesion, steroid, clinical and 4-week requirements. | ✓ |
| MR | Minor response for nonenhancing disease | RANO 2.0 minor response applies only to protocols evaluating nonenhancing disease: a 2D decrease from 25% through less than 50%, or a prespecified volumetric decrease from 40% through less than 65%, relative to baseline, sustained for at least 4 weeks, with the enhancing component at least stable, no new lesion and no other progression trigger. Do not use MR for enhancing-only disease. | Identify MR explicitly as the RANO 2.0 nonenhancing-disease category and provide both the continuous change and confirmation state. Its presence may be relevant to trial benefit assessment, but it does not select therapy or authorize an autonomous treatment decision. | MR captures a smaller nonenhancing-burden reduction than PR and has no universal individualized prognostic probability. T2/FLAIR change is vulnerable to edema, seizures, ischemia, radiation effect, steroid change and acquisition differences, so causal attribution and technical comparability remain essential. | Wen et al. 2023, PMC10860967, Tables 2-3 and sections Evaluation of Nonenhancing Progression and Determination of Radiographic Response introduce MR for nonenhancing disease with 25% to below 50% 2D or 40% to below 65% volumetric reduction, plus confirmation and complementary-component safeguards. | ✓ |
| SD | Stable disease | Stable disease: an evaluable examination does not meet CR, PR, MR when applicable, or PD, while nontarget disease, neurological status and corticosteroid conditions do not establish progression. When only nonmeasurable disease is present at baseline, SD is the best radiographic response available under RANO 2.0; do not invent a measurable response. | Report actual target and nontarget change, phenotype, steroids, neurological status and technical limitations instead of using stable as a synonym for unchanged biology. Treatment decisions require longitudinal clinical, molecular and protocol context and are outside the category alone. | SD can represent treatment benefit, indolent disease, measurement noise or mixed treatment and tumor effects; it does not provide a universal progression or survival estimate. Nonenhancing progression can be missed if only contrast enhancement is reviewed in a context where T2/FLAIR assessment remains required. | Wen et al. 2023, PMC10860967, Tables 1-3 and sections Measurable Disease and Determination of Radiographic Response define SD residually and state that SD is the best response for patients without measurable disease at baseline. | ✓ |
| PD | Progressive disease | Progressive disease is established by at least a 25% increase in 2D SPD or at least a 40% increase in prespecified 3D volume from the smallest prior valid burden, a credible new measurable lesion, definite leptomeningeal disease, unequivocal qualifying nontarget or nonmeasurable progression, tumor-attributed clinical deterioration or disease-related inability to return. A corticosteroid increase alone is not PD. Suspected enhancing progression within 12 weeks after radiotherapy is preliminary unless histopathology or protocol-defined imaging confirmation establishes true progression. | Promptly communicate the exact PD mechanism, phenotype, comparison and confidence, and arrange protocol or multidisciplinary adjudication when pseudoprogression or another cause is plausible. Within the early post-radiotherapy window, preserve preliminary PD and obtain the required follow-up rather than allowing the API to stop or switch therapy by itself. | PD indicates qualifying radiographic or clinical progression but does not quantify survival or prove treatment resistance. Pseudoprogression, radiation injury, ischemia, seizure, infection, steroid change and antiangiogenic permeability effects can mimic or conceal tumor progression. | Wen et al. 2023, PMC10860967, Tables 1-3 and sections Determination of Progression, Confirmation of Progression, Evaluation in Newly Diagnosed Glioblastoma and Corticosteroid Use specify the at-least-25% 2D or at-least-40% volume increase from nadir, alternative progression triggers, steroid safeguard and early post-radiotherapy confirmation/backdating framework. | ✓ |

### Citações por categoria
- **CR**: Wen PY, van den Bent M, Youssef G, et al.. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10860967/ · Wen et al. 2023, J Clin Oncol 41:5187-5199, DOI 10.1200/JCO.23.01059, PMC10860967, Tables 1-3 and sections Response Criteria, Confirmation of Response and Corticosteroid Use define complete response across enhancing, nonenhancing and mixed disease, the 4-week confirmation rule, new-lesion exclusion and clinical/steroid requirements.
- **PR**: Wen PY, van den Bent M, Youssef G, et al.. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10860967/ · Wen et al. 2023, PMC10860967, Tables 1-3 and sections Determination of Radiographic Response and Confirmation of Response specify the at-least-50% 2D or at-least-65% volumetric reduction from baseline, complementary-component, new-lesion, steroid, clinical and 4-week requirements.
- **MR**: Wen PY, van den Bent M, Youssef G, et al.. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10860967/ · Wen et al. 2023, PMC10860967, Tables 2-3 and sections Evaluation of Nonenhancing Progression and Determination of Radiographic Response introduce MR for nonenhancing disease with 25% to below 50% 2D or 40% to below 65% volumetric reduction, plus confirmation and complementary-component safeguards.
- **SD**: Wen PY, van den Bent M, Youssef G, et al.. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10860967/ · Wen et al. 2023, PMC10860967, Tables 1-3 and sections Measurable Disease and Determination of Radiographic Response define SD residually and state that SD is the best response for patients without measurable disease at baseline.
- **PD**: Wen PY, van den Bent M, Youssef G, et al.. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults (2023) — https://pmc.ncbi.nlm.nih.gov/articles/PMC10860967/ · Wen et al. 2023, PMC10860967, Tables 1-3 and sections Determination of Progression, Confirmation of Progression, Evaluation in Newly Diagnosed Glioblastoma and Corticosteroid Use specify the at-least-25% 2D or at-least-40% volume increase from nadir, alternative progression triggers, steroid safeguard and early post-radiotherapy confirmation/backdating framework.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-24 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | dismissed |
| 2023-09-29 | revised | RANO 2.0 unified adult high- and low-grade glioma response, changed the newly diagnosed post-radiotherapy baseline, added optional volumetry and formalized confirmation rules. | confirmed |
| 2010-03-15 | published | RANO-HGG integrated enhancing burden, T2/FLAIR, corticosteroids and clinical status for high-grade glioma response. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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