Response to Harreld re: “Response assessment in medulloblastoma and leptomeningeal seeding tumors: recommendations from the Response Assessment in Pediatric Neuro-Oncology Committee”

What is lost in the letter by Harreld is the mandate of the RAPNO committee and the purpose of the proposed recommendations. Our goal, as a committee, was to develop consensus recommendations on the response assessment for use in clinical trials of patients with medulloblastoma and other seeding tumors, which could then be tested prospectively. Committee recommendations were based on scientific justification where this exists in peer-reviewed literature, or based upon the extensive experience of leaders in the field who are members of this group. Rather than recommend advanced imaging sequences utilized in limited institutions, we proposed recommendations that can be utilized at most institutions and that will allow uniformity and quality data collection. This approach is also in line with the Brain Tumor Drug Development Coalition Imaging Standardization Steering Committee and their recommendations. ¹ As such, it required compromise from the committee members in order to be applicable and feasible for the majority of institutions.