Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 2 Date: 11 Jan 2025
Reviewer's report:
Dear authors,
Thank you for your efforts to answer the reviewer's question. A few minor comments and one
major:
Minor:
Page 13: TGR correct would be TRG
"In particular, recently published prospective studies have shown that NAC is not inferior to
NACRT in terms of pCR or TRG." -> Reference
"In patients with stage IV disease, NACRT remains the preferred treatment option."
-> Do you mean AJCC stage IV -> In metastatic disease NACRT is not the right treatment
choice!
Major:
"NAC is a reasonable alternative to NACRT for patients with stage II/III disease. For patients
with stage IV disease, NACRT remains the preferred treatment option".
-> I disagree with your conclusion.
-> Comment on the Prospect study: "First, we would like to emphasise that this study does not
represent a patient population with truly locally advanced disease by international standards. In
particular, the study excluded all patients with cT4 or cN2 disease or disease within 3 mm of
the mesorectal fascia. The cT3 and nodal subgroups were not reported in line with international
consensus, and it is concerning that just over 15% of patients were not staged by MRI. "10.1016/
j.ctro.2023.100672
-> The Prospect trial is a good example of the fact that patients treated in trials comparing NAC
and NCRT are highly selected, excluding patients with risk features (e.g. CRM infiltration, cT3c/
d, ...). So your statement without mentioning that patients with high risk features were excluded
(this needs to be checked in the individual trials) is not correct, at least from my point of view.
Stage II or III disease is too wide a definition. And please clarify what you mean with stage IV.
Title: Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant
chemoradiotherapy for locally advanced rectal cancer: An updated meta-analysis
Version: 2 Date: 11 Jan 2025
Reviewer's report:
Dear authors,
Thank you for your efforts to answer the reviewer's question. A few minor comments and one
major:
Minor:
Page 13: TGR correct would be TRG
"In particular, recently published prospective studies have shown that NAC is not inferior to
NACRT in terms of pCR or TRG." -> Reference
"In patients with stage IV disease, NACRT remains the preferred treatment option."
-> Do you mean AJCC stage IV -> In metastatic disease NACRT is not the right treatment
choice!
Major:
"NAC is a reasonable alternative to NACRT for patients with stage II/III disease. For patients
with stage IV disease, NACRT remains the preferred treatment option".
-> I disagree with your conclusion.
-> Comment on the Prospect study: "First, we would like to emphasise that this study does not
represent a patient population with truly locally advanced disease by international standards. In
particular, the study excluded all patients with cT4 or cN2 disease or disease within 3 mm of
the mesorectal fascia. The cT3 and nodal subgroups were not reported in line with international
consensus, and it is concerning that just over 15% of patients were not staged by MRI. "10.1016/
j.ctro.2023.100672
-> The Prospect trial is a good example of the fact that patients treated in trials comparing NAC
and NCRT are highly selected, excluding patients with risk features (e.g. CRM infiltration, cT3c/
d, ...). So your statement without mentioning that patients with high risk features were excluded
(this needs to be checked in the individual trials) is not correct, at least from my point of view.
Stage II or III disease is too wide a definition. And please clarify what you mean with stage IV.
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: 2 Date: 11 Jan 2025
Reviewer's report:
Dear authors,
Thank you for your efforts to answer the reviewer's question. A few minor comments and one
major:
Minor:
Page 13: TGR correct would be TRG
"In particular, recently published prospective studies have shown that NAC is not inferior to
NACRT in terms of pCR or TRG." -> Reference
"In patients with stage IV disease, NACRT remains the preferred treatment option."
-> Do you mean AJCC stage IV -> In metastatic disease NACRT is not the right treatment
choice!
Major:
"NAC is a reasonable alternative to NACRT for patients with stage II/III disease. For patients
with stage IV disease, NACRT remains the preferred treatment option".
-> I disagree with your conclusion.
-> Comment on the Prospect study: "First, we would like to emphasise that this study does not
represent a patient population with truly locally advanced disease by international standards. In
particular, the study excluded all patients with cT4 or cN2 disease or disease within 3 mm of
the mesorectal fascia. The cT3 and nodal subgroups were not reported in line with international
consensus, and it is concerning that just over 15% of patients were not staged by MRI. "10.1016/
j.ctro.2023.100672
-> The Prospect trial is a good example of the fact that patients treated in trials comparing NAC
and NCRT are highly selected, excluding patients with risk features (e.g. CRM infiltration, cT3c/
d, ...). So your statement without mentioning that patients with high risk features were excluded
(this needs to be checked in the individual trials) is not correct, at least from my point of view.
Stage II or III disease is too wide a definition. And please clarify what you mean with stage IV.
assistant