Everything You Always Wanted to Know about Sarcopenia but Were Afraid to Ask: A Quick Guide for Radiation Oncologists (impAct oF saRcopeniA In raDiotherapy: The AFRAID Project)
, Milly Buwenge 1, Alessandra Arcelli 3, Martina Ferioli 1, Gabriella Macchia 4, Francesco Deodato 4, Savino Cilla 5, Pierandrea De Iaco 6,7, Anna Myriam Perrone 6,7, Silvia Strolin 8, Lidia Strigari 8, Gloria Ravegnini 9, Alberto Bazzocchi 10,† and Alessio G. Morganti 1,3,†
Round 1
Reviewer 1 Report
This is an excellent review written by the team of professionals in the areas of Oncology and Radiology leading by Drs Bazzocchi and Morganti. The review is well organized in a question-answer style and give comprehensive information about sarcopenia and related problems of skeletal muscle, the impact of patient-, disease- and treatment-related factors to the pathogenesis of such conditions. The review will be an important source of up-to-date knowledge for oncologists and radiologists. I have read it with a great interest.
A minor point – as myself being a pharmacologist - I would like to see in the chapter of “Future studies” also an answer to the following questions – since in the pathophysiology of the disease you indicated the role of hormones, microcirculation and inflammation (Fig.1), 1) is there any drugs were ever tested for prevention or treatment of sarcopenia (except diet and protein intake you mentioned), i.e. anti-inflammatory or other? 2) is there a good experimental model of sarcopenia where such drugs can be studied?
I am not asking to add such info to this review since it is directed mostly to the clinicians, but it would be nice to see your answers in your future papers.
A very minor point – change Figure 1 to Figure 2 in lines 205-206.
Author Response
REVIEWER 1
Comment 1:
This is an excellent review written by the team of professionals in the areas of Oncology and Radiology leading by Drs Bazzocchi and Morganti. The review is well organized in a question-answer style and give comprehensive information about sarcopenia and related problems of skeletal muscle, the impact of patient-, disease- and treatment-related factors to the pathogenesis of such conditions. The review will be an important source of up-to-date knowledge for oncologists and radiologists. I have read it with a great interest.
Answer 1:
Thank you very much for your positive comments.
Comment 2:
A minor point – as myself being a pharmacologist - I would like to see in the chapter of “Future studies” also an answer to the following questions – since in the pathophysiology of the disease you indicated the role of hormones, microcirculation and inflammation (Fig.1), 1) is there any drugs were ever tested for prevention or treatment of sarcopenia (except diet and protein intake you mentioned), i.e. anti-inflammatory or other? 2) is there a good experimental model of sarcopenia where such drugs can be studied? I am not asking to add such info to this review since it is directed mostly to the clinicians, but it would be nice to see your answers in your future papers.
Answer 2:
Thank you very much for your comment. According to your suggestion we added to the conclusions section of our manuscript the following sentence: “In this regard, circulating (microRMNA) and tissue specific factors may represent both potential biomarkers and therapeutic targets of SP."
Comment 3:
A very minor point – change Figure 1 to Figure 2 in lines 205-206.
Answer 3:
Thank you for your comment. The manuscript was corrected accordingly.
Reviewer 2 Report
A useful review of the field. Well written and with good reference list
It is a general review article and so does not add any new data or perform a meta-analysis of existing trials. As the authors say, sarcopenia is not well studied in radiotherapy although they do reference some Australian papers in Head and Neck cancer where malnutrition is well described. The literature review is extensive but I have no special knowledge in this area so do not know if any important papers have been omitted. Recent reviews by Ganju and Mallet are included. Table 3 is a good summary of the information and easy to read if someone wants a quick overview of the subject. The authors point out the obvious fact that more work is needed and that the metabolic changes in sarcopenia have more effect than just weight loss. I agree that more research is needed into the effect of chronic inflammation in radiotherapy as it has been studied more in the response to chemotherapy and its effect on drug metabolism. It is written by a group with an interest in the field and summarises their current thinking beyond Head and Neck cancer so would be of value to radiation oncologists if they are not familiar with the concept.Author Response
REVIEWER 2
Comment 1:
A useful review of the field. Well written and with good reference list. It is a general review article and so does not add any new data or perform a meta-analysis of existing trials. As the authors say, sarcopenia is not well studied in radiotherapy although they do reference some Australian papers in Head and Neck cancer where malnutrition is well described. The literature review is extensive but I have no special knowledge in this area so do not know if any important papers have been omitted. Recent reviews by Ganju and Mallet are included. Table 3 is a good summary of the information and easy to read if someone wants a quick overview of the subject. The authors point out the obvious fact that more work is needed and that the metabolic changes in sarcopenia have more effect than just weight loss. I agree that more research is needed into the effect of chronic inflammation in radiotherapy as it has been studied more in the response to chemotherapy and its effect on drug metabolism. It is written by a group with an interest in the field and summarizes their current thinking beyond Head and Neck cancer so would be of value to radiation oncologists if they are not familiar with the concept.
Answer 1:
Thank you very much for your positive comments.
