RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High-and Low-Grade Gliomas in Adults

Sep 20, 2026

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Response Assessment in Neuro-Oncology (RANO) criteria for high-grade (RANO-HGG) and low-grade (RANO-LGG) gliomas were created to improve reliability of response assessment in glioma trials. Limitations later emerged, especially in integrating features of modified RANO (mRANO) and immunotherapy RANO (iRANO). RANO 2.0 proposes updated criteria informed by trial-evaluation data, recommending standardized assessment across treatment modalities.

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UCLA UCLA Previously Published Works Title RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for Highand Low-Grade Gliomas in Adults Permalink [https://escholarship.org/uc/item/1zv2z6bg](https://escholarship.org/uc/item/1zv2z6bg) Journal Journal of Clinical Oncology, 41(33) ISSN 0732-183X Authors Wen, Patrick Y van den Bent, Martin Youssef, Gilbert et al. Publication Date 2023-11-20 DOI 10.1200/jco.23.01059 Peer reviewed [eScholarship.org](eScholarship.org) Powered by the California Digital Library University of California Special Articles RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High-and Low-Grade Gliomasin Adults Patrick Y. Wen, MD1 ; Martin van den Bent, MD2 ; Gilbert Youssef, MD1 ; Timothy F. Cloughesy, MD3 ; Benjamin M. Ellingson, PhD4 ; Michael Weller, MD5 ; Evanthia Galanis, MD6; Daniel P. Barboriak, MD7 ; John de Groot, MD8 ;Mark R. Gilbert, MD9; Raymond Huang, MD, PhD10 ; Andrew B. Lassman, MD11 ; Minesh Mehta, MD12 ; Annette M. Molinaro, PhD13 ; Matthias Preusser, MD14 ; Rifaquat Rahman, MD15 ; Lalitha K. Shankar, MD, PhD16; Roger Stupp, MD17 ; Javier E. Villanueva-Meyer, MD18 ; Wolfgang Wick, MD19 ; David R. Macdonald, MD20; David A. Reardon, MD1 ; Michael A. Vogelbaum, MD, PhD21 ; and Susan M. Chang, MD8 DOI [https://doi.org/10.1200/JCO.23.01059](https://doi.org/10.1200/JCO.23.01059) | ABSTRACT | | | --- | --- | | PURPOSE | The Response Assessment in Neuro-Oncology (RANO) criteria for high-grade gliomas (RANO-HGG) and low-grade gliomas (RANO-LGG) were developed to improve reliability of response assessment in glioma trials. Over time, some limitations of these criteria were identiﬁed, and challenges emerged regarding integrating features of the modiﬁed RANO (mRANO) or the immunotherapy RANO (iRANO) criteria. | | METHODS | Informed by data from studies evaluating the different criteria, updates to the RANO criteria are proposed (RANO 2.0) . | | RESULTS | We recommend a standard set of criteria for both high-and low-grade gliomas, tobe used for all trials regardless of the treatment modalities being evaluated. In the newly diagnosed setting, the postradiotherapy magnetic resonance imaging (MRI), rather than the postsurgical MRI, will be used as the baseline for comparison with subsequent scans. Since the incidence of pseudoprogression is high in the 12 weeks after radiotherapy, continuation of treatment and conﬁrmation of progression during this period with a repeat MRI, or histopathologic evidence of unequivocal recurrent tumor, are required to deﬁne tumor progression. However, conﬁrmation scans are not mandatory after this period nor for the evaluation of treatment for recurrent tumors. For treatments with a high likelihood of pseudoprogression, mandatory conﬁrmation of progression with a repeat MRI is highly recommended. The primary measurement remains the maximum cross-sectional area of tumor (two-dimensional) but volumetric measurements are an option. For IDH wild-type glioblastoma, the nonenhancing disease will no longer be evaluated except when assessing response to antiangiogenic agents. In IDH-mutated tumors with a signiﬁcant nonenhancing component, clinical trials may require evaluating both the enhancing and nonenhancing tumor components for response assessment. | | CONCLUSION | The revised RANO 2.0 criteria reﬁne response assessment in gliomas. | ACCOMPANYING CONTENT Data Supplement Accepted August 10, 2023 Published September 29, 2023 J Clin Oncol 41:5187-5199 © 2023 by American Society of Clinical Oncology View Online Article BACKGROUND Gliomas are the most common type of malignant primary brain tumor.1 Despite extensive research, progress in developing effective therapies has been unacceptably slow.2-4 The Response Assessment in Neuro-Oncology (RANO) Working Group published response criteria for high-grade gliomas (RANO-HGG) in 2010,5 and low-grade gliomas (RANO-LGG) in 2011,6 on the

FAQs

What problem does RANO 2.0 address in glioma trials?

RANO 2.0 addresses limitations in earlier RANO criteria and emerging challenges when integrating features from mRANO and iRANO, particularly around reliable response and progression assessment.

What is the baseline imaging used in newly diagnosed settings?

RANO 2.0 recommends using postradiotherapy MRI rather than postsurgical MRI as the baseline for comparison with subsequent scans.

How should tumor progression be confirmed during the 12 weeks after radiotherapy?

Because pseudoprogression incidence is high, RANO 2.0 requires continuation of treatment and confirmation of progression during this period using a repeat MRI or histopathologic evidence of unequivocal recurrent tumor.

Sep 20, 2026

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