Review for 10.1186/s12876-022-02602-5 (2022)

Title: Safety and Efficacy Analysis of Chemoradiotherapy/Radiotherapy Combined with
Nimotuzumab for Treating Advanced Unresectable Oesophageal Squamous Cell Carcinoma in
Elderly Patients: A Retrospective Analysis
Version: 0 Date: 01 Oct 2022
Reviewer:  Hironaga Satake
Reviewer's report:
Thank you for your submission.
Following aspects are missing that might improve the value of this article.
Major
P2 Abstract- Conclusion
I don't think this conclusion can be derived from the current abstract, since toxicity and treatment
effect are not listed separately for CRT and RT.
P8- Results 1.Characteristics
Please add patient background for NRT and NCRT, respectively, to Table 1.
Because of the relatively high frequency of radiation pneumonitis, a history of smoking is
important in addition to older age as a patient background. Please consider including the number
of patients with a history of smoking as patient background, if available.
P8- Results 3. Toxicities
For concomitant chemotherapy on RT, please indicate dose intensity and whether there is any
withdrawal or dose reduction.
Table2
Please add the toxicity status of each of NRT and NCRT along with the overall toxicity
information in Table 2.
Discussion
“Oesophageal carcinoma is predominantly adenocarcinoma in the West and squamous
carcinoma in East Asia.[26] Despite improvements in treatment, the five-year survival rate
for oesophageal cancer is still only about 20%,[27] and it is even lower in elderly patients.
RTOG85-01 laid the foundation for concurrent chemoradiotherapy in patients with advanced
oesophageal cancer,[28] but there are no approved targeted therapies. Patients in this study
were treated with combined nimotuzumab-targeted therapy, which is a humanised anti-EGFR
targeting agent with mild toxicity that is more suitable for elderly patients.[29] In this study,
one patient had a Grade 1 rash and one had an infusion reaction, both of which happened after
the first nimotuzumab treatment.”
Please consider deleting this segment as it is not a meaningful.
“It has been shown that nimotuzumab combined with chemotherapy has a better PFS and OS
compared to a paclitaxel + cisplatin regimen alone.[30] Guo et al.[31] found that nimotuzumab
combined with radiotherapy was effective in elderly ESCC patients, and the disease control
rate (DCR) was 93.8%. Yang et al.[11] found that the median survival time for nimotuzumab
combined with radiotherapy in elderly ESCC patients was 17 months, which was better than
the 12.5 months in RTOG85-01. Saumell et al.[32] showed that nimotuzumab combined with
chemoradiotherapy improved survival of patients with locally advanced or metastatic ESCC.
Based on these findings, the combination of nimotuzumab with radiotherapy or chemotherapy
improves treatment efficacy without increasing adverse reactions. “
Please consider deleting this segment, as it only describes a REVIEW of a previous report and
has nothing to do with the current study.
Minor
P2 Abstract- Results
Does Hypoproteinemia 94.4% describe the frequency of ANY grade? Please be consistent with
other methods of description.
The OS and PFS descriptions should be aligned with the other descriptions to one decimal place.
P4- Introduction
“and the results showed that nimotuzumab combined with chemoradiotherapy was well tolerated
in elderly patients with unresectable ESCC, while nimotuzumab combined with radiotherapy
was also safe and could also have good efficacy.”
There is no need to make conclusory statements in the background section, so please remove it.
P5 Materials and Methods
1. Patient Eligibility
The rejection criteria were: (1) refusal of treatment for various reasons (Most of the patients
who refused treatment in this study were unable to afford the cost of treatment); Please consider
changing 'Most' to begin with a lowercase letter.
P8- Results 2. Recent Response
Please consider changing the title to "Response" or "Best Response". In addition to the overall
results, please provide a table showing the anti-tumor effect of each of NRT and NCRT.