Title: The effect of neoadjuvant chemoradiation therapy in resectable pancreatic cancer was
independent of intratumoral vascularization
Version: 4 Date: 16 May 2025
Reviewer's report:
Summary of the Manuscript:
This study investigates whether the enhancement patterns observed on CH-EUS are predictive of
the efficacy of NACRT in patients with resectable pancreatic cancer. Patients were classified into
three vascularization pattern groups, and outcomes including histological response, recurrence-
free survival, and overall survival were analyzed. The study concludes that NACRT efficacy is
independent of vascularization pattern.
Major Comments:
1. Justification of Research Question and Background: Elaborate on the biological  mechanism
through which radiotherapy may overcome fibrotic, hypovascular barriers.
2. Study Design and Population: Provide a power calculation and consider reporting baseline
characteristics by CH-EUS group with significance values.
3. CH-EUS Classification and Interobserver Agreement: Include more detail on how
enhancement was rated and describe training/calibration procedures.
4. Outcome Measurement and Statistical Analysis: Specify use of multivariate Cox regression
and include confidence intervals for survival curves.
5. Interpretation and Discussion of Results: Clarify whether NACRT truly renders CH-EUS
patterns irrelevant or if there are other plausible explanations.
6. Literature Contextualization: Expand comparison with other modalities and trials, such as
PREOPANC and JASPAC.
Minor Comments:
1. Abstract: Include group sizes, outcome metrics, and p-values.
2. Figures & Tables: Annotate Figure 1 and add risk tables/CI bands to Figure 4.
3. Terminology Consistency: Define 'isovascular' and 'hypovascular' early.
4. Grammar and Language: Correct minor grammatical issues throughout.
5. Ethical Statement: Add brief note on informed consent for data use.
Title: The effect of neoadjuvant chemoradiation therapy in resectable pancreatic cancer was
independent of intratumoral vascularization
Version: 4 Date: 16 May 2025
Reviewer's report:
Summary of the Manuscript:
This study investigates whether the enhancement patterns observed on CH-EUS are predictive of
the efficacy of NACRT in patients with resectable pancreatic cancer. Patients were classified into
three vascularization pattern groups, and outcomes including histological response, recurrence-
free survival, and overall survival were analyzed. The study concludes that NACRT efficacy is
independent of vascularization pattern.
Major Comments:
1. Justification of Research Question and Background: Elaborate on the biological  mechanism
through which radiotherapy may overcome fibrotic, hypovascular barriers.
2. Study Design and Population: Provide a power calculation and consider reporting baseline
characteristics by CH-EUS group with significance values.
3. CH-EUS Classification and Interobserver Agreement: Include more detail on how
enhancement was rated and describe training/calibration procedures.
4. Outcome Measurement and Statistical Analysis: Specify use of multivariate Cox regression
and include confidence intervals for survival curves.
5. Interpretation and Discussion of Results: Clarify whether NACRT truly renders CH-EUS
patterns irrelevant or if there are other plausible explanations.
6. Literature Contextualization: Expand comparison with other modalities and trials, such as
PREOPANC and JASPAC.
Minor Comments:
1. Abstract: Include group sizes, outcome metrics, and p-values.
2. Figures & Tables: Annotate Figure 1 and add risk tables/CI bands to Figure 4.
3. Terminology Consistency: Define 'isovascular' and 'hypovascular' early.
4. Grammar and Language: Correct minor grammatical issues throughout.
5. Ethical Statement: Add brief note on informed consent for data use.
Please review this paper.
user
Title: The effect of neoadjuvant chemoradiation therapy in resectable pancreatic cancer was
independent of intratumoral vascularization
Version: 4 Date: 16 May 2025
Reviewer's report:
Summary of the Manuscript:
This study investigates whether the enhancement patterns observed on CH-EUS are predictive of
the efficacy of NACRT in patients with resectable pancreatic cancer. Patients were classified into
three vascularization pattern groups, and outcomes including histological response, recurrence-
free survival, and overall survival were analyzed. The study concludes that NACRT efficacy is
independent of vascularization pattern.
Major Comments:
1. Justification of Research Question and Background: Elaborate on the biological  mechanism
through which radiotherapy may overcome fibrotic, hypovascular barriers.
2. Study Design and Population: Provide a power calculation and consider reporting baseline
characteristics by CH-EUS group with significance values.
3. CH-EUS Classification and Interobserver Agreement: Include more detail on how
enhancement was rated and describe training/calibration procedures.
4. Outcome Measurement and Statistical Analysis: Specify use of multivariate Cox regression
and include confidence intervals for survival curves.
5. Interpretation and Discussion of Results: Clarify whether NACRT truly renders CH-EUS
patterns irrelevant or if there are other plausible explanations.
6. Literature Contextualization: Expand comparison with other modalities and trials, such as
PREOPANC and JASPAC.
Minor Comments:
1. Abstract: Include group sizes, outcome metrics, and p-values.
2. Figures & Tables: Annotate Figure 1 and add risk tables/CI bands to Figure 4.
3. Terminology Consistency: Define 'isovascular' and 'hypovascular' early.
4. Grammar and Language: Correct minor grammatical issues throughout.
5. Ethical Statement: Add brief note on informed consent for data use.
assistant