Immunotherapy Response Assessment in Neuro-Oncology
Summary
Immunotherapy has ushered in new therapeutic possibilities for central nervous system malignancies, yet its evaluation poses unique challenges in neuro-oncology. Conventional imaging criteria often struggle to distinguish true tumour progression from immune-related phenomena such as pseudoprogression or inflammatory flare. As immune checkpoint inhibitors, oncolytic viruses, vaccines and chimeric antigen receptor T-cell therapies gain traction in glioma and metastatic brain tumour management, tailored response assessment frameworks have emerged. These frameworks aim to integrate radiographic, clinical and immunological indicators to capture treatment efficacy and avoid premature cessation of beneficial therapies. Central nervous system immune surveillance, blood–brain barrier dynamics and treatment-induced vascular changes all influence imaging appearances and clinical interpretation. Consequently, advanced imaging modalities—perfusion MRI, diffusion MRI, molecular PET tracers and emerging artificial intelligence algorithms—are being refined to quantify physiological parameters of the tumour microenvironment. Standardised response assessment guidelines, including immune-adapted response criteria, are designed to guide decision-making, promote consistent reporting across trials and ultimately improve patient outcomes by distinguishing durable antitumour effects from transient inflammatory changes.
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Immunotherapy Response Assessment in Neuro-Oncology publication trend
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Technical terms
Pseudoprogression: A transient increase in lesion size or contrast enhancement on imaging caused by immune-mediated inflammation rather than genuine tumour growth.
iRANO criteria: Immunotherapy-adapted Response Assessment in Neuro-Oncology guidelines designed to account for immune-related imaging changes and to distinguish pseudoprogression from true progression.
Perfusion MRI: An imaging technique that quantifies blood flow and volume in tissue, used to characterise tumour vascularity and distinguish viable tumour from treatment effect.
Diffusion MRI: A method assessing water molecule movement in tissue, providing insights into cellular density and structural integrity within lesions.
Parametric Response Mapping: A voxel-wise analysis technique comparing sequential imaging scans to detect spatial changes in physiological parameters over time.
References
- A comprehensive neuroimaging review of the primary and metastatic brain tumors treated with immunotherapy: current status, and the application of advanced imaging approaches and artificial intelligence. Frontiers in Immunology (2024).
- Advanced Imaging Techniques for Differentiating Pseudoprogression and Tumor Recurrence After Immunotherapy for Glioblastoma. Frontiers in Immunology (2021).
- A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy. Frontiers in Oncology (2021).
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