Metabolism-Guided LATTICE Radiotherapy in an Elderly Patient with Locally Advanced Head and Neck Cancer Treated with Curative Aim: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript is of interest; however, I consider it appropriate to raise a few observations.

I would recommend enriching the text with additional information on spatially fractionated radiotherapy, including a description of the delivery methods and the most recent data available in the literature.

In addition, it would be helpful to clarify the meaning attributed to the term “curative intent” and to specify the duration of the patient’s follow-up.

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The chosen topic is interesting and relevant. Lattice radiotherapy is a novel spatially fractionated radiotherapy tehnique specifically designed   fot treating large  tumors and presents notable advantages  through its distinctive heteroneous dose distribution.

The presented case is well documented.  The study is original considering that the presented case was treated with a curative intent.
Please provide additional clarifications regarding discussion of the case in the multidisciplinary committee, the patient's performance status, further details about mucositis treatment, and weight curve during the treatment. The paper is valuable considering the lack of randomized studies comparing lattice RT with standard treatments.
Please specify the doses for OAR, namely spinal cord, mandible, parotid glands, esophagus.
  Please also provide additional clarifications regarding the post-therapeutic head and neck MRI, specifying tumor regression, and a descriptive examination.

I recommend, under the discussion section, to further develop it with data from the literature regarding studies published to date on Lattice RT. Please add information on ongoing clinical studies, such as Clinical Trial NCT06416007.

Congratulations to the authors for the content, presentation, dosimetric study, and we look forward to the results at 6-12 months.

 

 

 

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

This case report is a valuable work in itself, but its results cannot be generalized and necessary corrections should be made from this perspective.

Author Response

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Author Response File: Author Response.docx

Reviewer 4 Report

Comments and Suggestions for Authors 1. Regarding mucositis, indicate the type of medication and the duration of treatment.
2. In Figure 2, review the figure caption. The images presented correspond to the RT dosages, not PET-CT.
3. In Figure 4, improve the figure caption. There are 4 images; each image should be described individually.
4. In Figure 5, improve the figure captions and indicate the date of each image.
5. There is evidence that the SFRT protocol can induce immunomodulation. In this case, no additional studies were performed to determine changes in the aforementioned cells. This could be considered a limitation of the study that could be discussed.

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I am satisfied with the authors' answers

Reviewer 2 Report

Comments and Suggestions for Authors

 

Thank you to the authors for the additions and substantial changes made.

I have read the revised article and  I believe  that authors have completed , reformulated and revised all observation mentioned.

They have completed dosimetry data, nutritional status during radiotherapy and in discussion chapter they have added ongoing studies.

I  recommend that  the article  can be published.

Reviewer 3 Report

Comments and Suggestions for Authors

Can be published with modifications made.

Reviewer 4 Report

Comments and Suggestions for Authors

Review the format of the figure caption in Figure 3 and unify the location of sections a and b.