Gonad Dose Assessment of Patients Undergoing Pelvic Radiotherapy

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1.This study is a retrospective analysis, which may have potential selection bias or inconsistencies in data collection. It is recommended that the authors provide a detailed explanation of the patient grouping criteria in the methods section, as well as how potential bias factors were controlled to ensure the accuracy and representativeness of the study results.

2.The article mentions that future investment should be made in the training and research of oncofertility. It is suggested that the authors provide a detailed list of specific research questions and methods in the future directions section, such as how to assess the clinical efficacy of different fertility preservation techniques or explore new methods to further reduce gonadal doses.

3.Although the dose differences between 3DCRT and VMAT techniques did not show statistical significance, the article does not explore the advantages and disadvantages of these two techniques in specific clinical applications, such as treatment time, precision, patient comfort, and other factors.

4. Although this paper provides valuable insights into fertility preservation in cancer treatment, its limitations, including the retrospective study design, small sample size, lack of long-term follow-up data, and insufficient comprehensive evaluation of treatment techniques, may affect its scientific rigor and the broader clinical applicability.

Author Response

The authors really appreciate your comments.

Please see the attachment where you can see our responses.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The authors analyzed the impact of radiotherapy on gonad dose exposure. This subject is relevant in radiology due to potential effects on the fertility conservation in case of younger patients. This study used well defined cohort with measured data information’s.  Results can be important for improving radiotherapy planning.  

The subgroup of female patients with ovarian transport is too small (n=5) and authors should comment applicability of their findings and impact of results of such small sample. In case of male patients another information could be of great importance. That is the distance of tumor position to testicles, since this parameter can directly influence on delivered dose to testicles. No information is given on projections of fertility outcomes for long periods. This would greatly enhance the manuscript.

Paper consists of systematic investigation of empirical results. On the other hand, this manuscript needs stronger support of the conclusions that can be derived from the authors’ findings. It is necessary for the authors to give stronger support to the conclusion part and discuss the relevant things mentioned above.

This study is a good contribution to literature and with minor revisions, I would recommend it for publication.

Author Response

The authors really appreciate your comments.

Please see the attachment where you can see our responses.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The research article “Gonads dose assessment in patients undergoing pelvic radiotherapy” by Ribeiro and coworkers presents results on the dose assessment in patients undergoing radiotherapy. The authors used available results for 70 patients. Although there are plenty of results presented and discussed, there are some additional points that the authors should address. Therefore, my recommendation is a MINOR REVISION.

 

1. Change 1,25 to 1.25 in the Abstract
2. The authors should use the decimal point, not the decimal comma, for the representation of results
3. The discussion of results should be compared to similar articles in the literature. The manuscript lacks a comparison, as only a descriptive explanation is given in the Discussion section.
4. The manuscript lacks a deeper explanation, except for stating the results. The authors should discuss the underlying mechanism.
5. Some of the study's limitations should be mentioned, as the number of patients in each category is somewhat limited.

Author Response

The authors really appreciate your comments.

Please see the attachment where you can see our responses.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

1.The authors attempt to draw conclusions based on a very limited number of ovarian transposition cases. Without adequate sample size, methodological rigor, or supporting analysis of complications and clinical feasibility, the generalization of these findings is unsubstantiated and potentially misleading.

2.The total sample size consists of 70 cases; however, the core analysis—particularly the ovarian transposition group—includes only 5 patients, which is far from sufficient to support statistically meaningful conclusions and cannot form the basis for any clinically generalizable recommendations.

Author Response

The authors really appreciate your comments.

Please see the attachment where you can see our responses.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have answered all of the questions properly. The manuscript is suitable for publication in the present form. 

Author Response

Thank you very much for reviewing my work and for your comments, which helped to improve it.

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

The extremely limited sample size undermines the statistical foundation of the analysis, leading to significant concerns regarding the scientific rigor and reproducibility of the study. As a result, the conclusions drawn lack sufficient reliability and fail to offer meaningful insights.