Review Reports

Round 1

Reviewer 1 Report

Dear authors,

 

Thank you for your submission.

 

Comments:

1. The technique of radiotherapy (3DCRT or IMRT) used would be addressed in the case report
2. The alternative title such as "diagnostic and therapeutic challenges in a patient with synchronous very high-risk prostate adenocarcinoma and anal carcinoma" may be more attractive.

Author Response

1. The technique of radiotherapy (3DCRT or IMRT) used would be addressed in the case report [We added "volumetric modulated arc therapy (VMAT)" to describe the technique, as well as "6 MeV en face electrons" to describe his earlier prophylactic breast bud radiotherapy; "stereotactic body radiotherapy" was also incorporated for his lung radiotherapy)
2. The alternative title such as "diagnostic and therapeutic challenges in a patient with synchronous very high-risk prostate adenocarcinoma and anal carcinoma" may be more attractive. [We changed the title per your suggestion]

Reviewer 2 Report

This is a case report of a patient with a synchronous anal squamous cell carcinoma and prostate gland adenocarcinoma, treated with combined chemoradiation, brachytherapy and androgen deprivation. The report is of interest. Few comments:

 

 

Introduction

 

• White man. Use caucasian
• Prostate cancer by Urology. Urologist?
• Why LDR brachytherapy was chosen for prostate BRT? Why not HDR for boost? Please explain
• Why did you use 2 cycles of MMC? Please explain (american standard as per RTOG 9811 standard arm; but not as per UK ACT II trial where sencod CT cycle is only 5FU and no MMC). Discuss this with respect to clinical staging cT1 disease. Consider MSKCC matched paired comparison 1 vs 2 cycles of MMC.
• Please discuss the need for the inclusion of inguinal groins for a cT1N0 anal SCC statge with computed tomography and PET.
• Why MR was not performed at diagnosis and then done at follow up?
• The report by Slavisa is actually by Tubin (last name). Slavisa is a first name.

Author Response

• White man. Use caucasian [Changed, per your suggestion]
• Prostate cancer by Urology. Urologist? [Changed, per your suggestion]
• Why LDR brachytherapy was chosen for prostate BRT? Why not HDR for boost? Please explain [We now explain the choice of LDR brachytherapy in the "Discussion and Conclusions"]
• Why did you use 2 cycles of MMC? Please explain (american standard as per RTOG 9811 standard arm; but not as per UK ACT II trial where sencod CT cycle is only 5FU and no MMC). Discuss this with respect to clinical staging cT1 disease. Consider MSKCC matched paired comparison 1 vs 2 cycles of MMC. [Per NCCN Guidelines Version 2.2021, Anal Carcinoma, Anal-B, page 1 of 2, 2 cycles of MMC remains a standard chemotherapy regimen for anal carcinoma]
• Please discuss the need for the inclusion of inguinal groins for a cT1N0 anal SCC statge with computed tomography and PET. [This is now explained in the "Discussion and Conclusions"]
• Why MR was not performed at diagnosis and then done at follow up? [We explain that he initially did not undergo an MRI due to concern for potential incompatibility of a prosthesis with the magnetic field at the time of work-up; we added that he underwent an MRI at follow-up because the Surgical Service ordered it after he presented with painless bleeding x1 day during follow-up] 
• The report by Slavisa is actually by Tubin (last name). Slavisa is a first name. [Agree, we changed it]

Reviewer 3 Report

This is a well-written case report describing the definitive treatment of a patent who presented with synchronous prostate and anal carcinoma. As the authors indicated, there is not enough published literature on how to manage these patients. In that context, this case report is valuable. I would support publishing this case report.

Author Response

Thank you for reviewing our manuscript and providing your feedback.

Round 2

Reviewer 2 Report

Please correct reference 9 (Tubin and not Slavisa).

Author Response

Please correct reference 9 (Tubin and not Slavisa).

-Modified, it shows that "Tubin" is the surname