Title: Sphincter saving surgery for failed organ preservation after a Neoadjuvant therapy and
Radiation boost : A Surgeons Perspective
Version: 1 Date: 23 Jan 2025
Reviewer:  T. Vuong
Reviewer's report:
I read with interest this manuscript. It is an honest review from a single institution of the impact
of pre operative brachytherapy boost and external beam for patients with low rectal cancer versus
standard external beam either with long course or short course . The analysis is focus on the
functional impact after treatment. The authors acknowledged that there was very few (8 patients
in the brachytherapy boost arm versus 127 patients with no brachytherapy  boost. There were
also bigger tumours (T3-4) , CRM+ , N+ that might affect their conclusions. Brachytherapy is
a targeted modality that allow for dose escalation therefore to achieve more clinical complete
remission or organ preservation. On the other side, it is expected that patients with low tumours,
such an intervention  will expose the sphincter to more toxicities or dysfunction. It would be
interesting to add a paragraph on how the brachytherapy boost was done ( dosimetry) and
the technique of this institution because  it can explain part of these results. finally,  I like to
suggest while reporting on the LARS score, the addition of time evaluation as in our institution,
we observed a worsening of the rectal function between 6-12 months but there is a recovery
after 18-24 months in our brachytherapy boost patients treated with the objectives of organ
preservation
Title: Sphincter saving surgery for failed organ preservation after a Neoadjuvant therapy and
Radiation boost : A Surgeons Perspective
Version: 1 Date: 23 Jan 2025
Reviewer:  T. Vuong
Reviewer's report:
I read with interest this manuscript. It is an honest review from a single institution of the impact
of pre operative brachytherapy boost and external beam for patients with low rectal cancer versus
standard external beam either with long course or short course . The analysis is focus on the
functional impact after treatment. The authors acknowledged that there was very few (8 patients
in the brachytherapy boost arm versus 127 patients with no brachytherapy  boost. There were
also bigger tumours (T3-4) , CRM+ , N+ that might affect their conclusions. Brachytherapy is
a targeted modality that allow for dose escalation therefore to achieve more clinical complete
remission or organ preservation. On the other side, it is expected that patients with low tumours,
such an intervention  will expose the sphincter to more toxicities or dysfunction. It would be
interesting to add a paragraph on how the brachytherapy boost was done ( dosimetry) and
the technique of this institution because  it can explain part of these results. finally,  I like to
suggest while reporting on the LARS score, the addition of time evaluation as in our institution,
we observed a worsening of the rectal function between 6-12 months but there is a recovery
after 18-24 months in our brachytherapy boost patients treated with the objectives of organ
preservation
Please review this paper.
user
Title: Sphincter saving surgery for failed organ preservation after a Neoadjuvant therapy and
Radiation boost : A Surgeons Perspective
Version: 1 Date: 23 Jan 2025
Reviewer:  T. Vuong
Reviewer's report:
I read with interest this manuscript. It is an honest review from a single institution of the impact
of pre operative brachytherapy boost and external beam for patients with low rectal cancer versus
standard external beam either with long course or short course . The analysis is focus on the
functional impact after treatment. The authors acknowledged that there was very few (8 patients
in the brachytherapy boost arm versus 127 patients with no brachytherapy  boost. There were
also bigger tumours (T3-4) , CRM+ , N+ that might affect their conclusions. Brachytherapy is
a targeted modality that allow for dose escalation therefore to achieve more clinical complete
remission or organ preservation. On the other side, it is expected that patients with low tumours,
such an intervention  will expose the sphincter to more toxicities or dysfunction. It would be
interesting to add a paragraph on how the brachytherapy boost was done ( dosimetry) and
the technique of this institution because  it can explain part of these results. finally,  I like to
suggest while reporting on the LARS score, the addition of time evaluation as in our institution,
we observed a worsening of the rectal function between 6-12 months but there is a recovery
after 18-24 months in our brachytherapy boost patients treated with the objectives of organ
preservation
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