Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 0 Date: 03 May 2024
Reviewer's report:
Dear authors,
I’ve reviewed with pleasure the article submitted to BMC Gastroenterology.
The article is a meta-analysis whose purpose is to evaluate short- and long-term outcomes of
neoadjuvant chemotherapy compared with neoadjuvant chemoradiotherapy for locally advanced
rectal cancer.
Below are my comments:
-INTRODUCTION:
-In this chapter you cite the randomized clinical trial of Schrag et al. (bibliographic item n°6)
like PROGISE trial but I think that the correct name of the trial is PROSPECT trial. So can you
please check and possibly correct it.
- MATERIALS AND METHODS:
-In this chapter when you speak about information extracted from the included studies, you state
that you have also evaluated grade 3/4 adverse event. Could you please specify which of the
classifications you are referring to? (Clavien-Dindo?)
-As you rightly said in the discussion, the neoadjuvant chemotherapy treatment regimens used
in each study were not identical and not always optimal. It would be interesting to include a
table showing what chemotherapy regimens were used in the different meta-analysis studies.
DISCUSSION:
-Although it was not the goal of this meta-analysis it would be important to develop in
the discussion a brief reference to how the type of surgery performed affects the previously
mentioned outcomes. Let me explain further: if we are talking about a tumor localized to the low
rectum, surgery is more likely to have worse functional outcomes and oncological outcomes in
terms of local recurrence than a high rectum regardless of the type of neoadjuvant therapy.
CONCLUSION:
-When you asses that NAC is a reasonable alternative to NACRT for patients with stage T2/
T3 disease, it is important to specify what you are referring to. Perhaps you are referring to
stage II/III (aka T3N0 or any T-N+) according to AJCC TNM Staging System for Rectal Cancer
8th edition. Indeed, in patients staged T2N0, and sometimes in selected patients staged T3N0
(adequately staged, low-risk, high rectal tumors) NCCN guidelines still recommend upfront
surgery. So, I think it would be more correct, when you talk about neoadjuvant therapy, to talk
about stage II and stage III instead of T2/T3 that can lead to confusion.
Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 0 Date: 03 May 2024
Reviewer's report:
Dear authors,
I’ve reviewed with pleasure the article submitted to BMC Gastroenterology.
The article is a meta-analysis whose purpose is to evaluate short- and long-term outcomes of
neoadjuvant chemotherapy compared with neoadjuvant chemoradiotherapy for locally advanced
rectal cancer.
Below are my comments:
-INTRODUCTION:
-In this chapter you cite the randomized clinical trial of Schrag et al. (bibliographic item n°6)
like PROGISE trial but I think that the correct name of the trial is PROSPECT trial. So can you
please check and possibly correct it.
- MATERIALS AND METHODS:
-In this chapter when you speak about information extracted from the included studies, you state
that you have also evaluated grade 3/4 adverse event. Could you please specify which of the
classifications you are referring to? (Clavien-Dindo?)
-As you rightly said in the discussion, the neoadjuvant chemotherapy treatment regimens used
in each study were not identical and not always optimal. It would be interesting to include a
table showing what chemotherapy regimens were used in the different meta-analysis studies.
DISCUSSION:
-Although it was not the goal of this meta-analysis it would be important to develop in
the discussion a brief reference to how the type of surgery performed affects the previously
mentioned outcomes. Let me explain further: if we are talking about a tumor localized to the low
rectum, surgery is more likely to have worse functional outcomes and oncological outcomes in
terms of local recurrence than a high rectum regardless of the type of neoadjuvant therapy.
CONCLUSION:
-When you asses that NAC is a reasonable alternative to NACRT for patients with stage T2/
T3 disease, it is important to specify what you are referring to. Perhaps you are referring to
stage II/III (aka T3N0 or any T-N+) according to AJCC TNM Staging System for Rectal Cancer
8th edition. Indeed, in patients staged T2N0, and sometimes in selected patients staged T3N0
(adequately staged, low-risk, high rectal tumors) NCCN guidelines still recommend upfront
surgery. So, I think it would be more correct, when you talk about neoadjuvant therapy, to talk
about stage II and stage III instead of T2/T3 that can lead to confusion.
Please review this paper.
user
Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 0 Date: 03 May 2024
Reviewer's report:
Dear authors,
I’ve reviewed with pleasure the article submitted to BMC Gastroenterology.
The article is a meta-analysis whose purpose is to evaluate short- and long-term outcomes of
neoadjuvant chemotherapy compared with neoadjuvant chemoradiotherapy for locally advanced
rectal cancer.
Below are my comments:
-INTRODUCTION:
-In this chapter you cite the randomized clinical trial of Schrag et al. (bibliographic item n°6)
like PROGISE trial but I think that the correct name of the trial is PROSPECT trial. So can you
please check and possibly correct it.
- MATERIALS AND METHODS:
-In this chapter when you speak about information extracted from the included studies, you state
that you have also evaluated grade 3/4 adverse event. Could you please specify which of the
classifications you are referring to? (Clavien-Dindo?)
-As you rightly said in the discussion, the neoadjuvant chemotherapy treatment regimens used
in each study were not identical and not always optimal. It would be interesting to include a
table showing what chemotherapy regimens were used in the different meta-analysis studies.
DISCUSSION:
-Although it was not the goal of this meta-analysis it would be important to develop in
the discussion a brief reference to how the type of surgery performed affects the previously
mentioned outcomes. Let me explain further: if we are talking about a tumor localized to the low
rectum, surgery is more likely to have worse functional outcomes and oncological outcomes in
terms of local recurrence than a high rectum regardless of the type of neoadjuvant therapy.
CONCLUSION:
-When you asses that NAC is a reasonable alternative to NACRT for patients with stage T2/
T3 disease, it is important to specify what you are referring to. Perhaps you are referring to
stage II/III (aka T3N0 or any T-N+) according to AJCC TNM Staging System for Rectal Cancer
8th edition. Indeed, in patients staged T2N0, and sometimes in selected patients staged T3N0
(adequately staged, low-risk, high rectal tumors) NCCN guidelines still recommend upfront
surgery. So, I think it would be more correct, when you talk about neoadjuvant therapy, to talk
about stage II and stage III instead of T2/T3 that can lead to confusion.
assistant