Radiochemotherapy in Pancreatic Cancer

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Congratulations to the authors for a well written summary of the current state  and role of radiotherapy in the treatment of pancreatic cancer.

I have one small suggestion. There is some crossover and confusion in the description of locally advanced unresectable tumours and borderline resectable tumours. This is particularly true when looking at older studies as the definition of borderline resectable has changed over time with increased use of portal vein resections,  and many of what were regarded as unresectable tumours in those older studies would now be regarded as borderline resectable. I would suggest that this should be noted in the discussion and some clarity given when discussing

in particular in the line commencing 197, the authors refer to the Mcintyre et al paper. It should be noted that this paper defined Locally advanced pancreatic cancer as those including vascular abutment, encasing or invasion, definitions which also may cover many cases of what would normally be described as borderline resectable in many series and this may account for their R0 resection rate of 20%. Again i would suggest that this be clarified

Author Response

Dear Reviewer,
Thank you very much for taking the time to review this manuscript. Your comment regarding the criteria for resectibility in individual works has been taken into account - we have included appropriate comments in the section on unresectable pancreatic cancer. Additionally, a comment regarding resectability criteria was added in the discussion.

Reviewer 2 Report

Comments and Suggestions for Authors

This was a comprehensive review of many of the studies conducted evaluating the role of radiation in resectable, borderline and locally advanced pancreatic cancer. 

Was an outline provided to the authors for this review? I found the conclusion which critiqued the limitations of the studies available for each disease group. I would favor this approach versus the first multiple pages outlining each trial. An option would be to include the trials discussed in each section in a table, then critiquing each for why the available work/results leave us with mixed outcomes: (1) chemotherapy used, (2) radiation dose used, (3) radiation used, (4) radiographic assessment that determined resectable vs borderline vs locally advanced. 

I think also practice varies based on the country/continent. Why is that? in the meta-analyses did western cohorts (North American vs west european) achieve similar outcomes with chemotherapy and CRT? 

I think many have tackled the review of the current data in CRT for pancreatic cancer, i think this would be a more thought provoking review if the ideas discussed in the 'summary and discussion' section were discussed throughout. 

Author Response

Dear Reviewer,

Thank you for reading our article and review. We agree that in some cases, presenting research results in tables makes them more readable. But in the case of our article, we present a continuous and coherent text. We believe that introducing tables may cause information chaos. 

In our opinion, the analysis of differences in research results between populations from different continents should be the subject of a separate article.

Once again, thank you very much for your time and comments.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have met my comments to my satisfaction and is ready for publication

Reviewer 2 Report

Comments and Suggestions for Authors

I don't have any new suggestions.