Review for 10.1186/s12876-022-02396-6 (2022)

Title: ECONOMIC EVALUATIONS OF RADIOEMBOLIZATION WITH ITRIUM-90
MICROSPHERES IN HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW
Version: 1 Date: 26 May 2022
Reviewer's report:
SPECIFIC COMMENTS
This manuscript is pleasurable and flowing; no major issues are appreciable.
Although language used is appropriate, I (I am not a native English speaker) recommend to
Authors to obtain a certified native speaker with proficiencies in the scientific-medical field to
complete properly this paper (if not yet done). Moreover, I recommend making a further revision
of the manuscript to fix some small typing/language errors.
ABSTRACT
The abstract is well structured in all its section and, therefore, it properly reflects the main text
highlighting the most important aspects of this paper. Consequently, adjustments are not needed.
KEYWORDS
Authors did not correctly reported keywords from MeSH Browser. In particular, I checked for
example “Radioembolization” and “TARE” on MeSH Browser and they were not KW. This
is important, in my personal opinion, in order to increase the traceability of this paper (and
consequently the possibility of the Journal to be cited by Readers and Stakeholders). I suggest
the check of all KW.
INTRODUCTION
Although the introduction appears concise and interesting to read, I believe that the authors could
enrich this section adding some important clarifications.
It is well known that the decision on whether a HCC patient is a responder or progressor
may vary among different operators, especially in case of a non-specifically trained radiologist
and, therefore, regardless of the adopted criteria, patients should be evaluated by experienced
radiologists to minimize variability in this critical instance [Eur Radiol. 2018;28(9):3611-3620.
doi:10.1007/s00330-018-5393-3] Due to the associated technical difficulties, in fact, the theme
of experienced operator still represents a hot topic in literature and, therefore, should be
mentioned here or in the Discussion section.
Lines 80-83. Other intra-arterial methods, such as TACE, have the limitations of being
non-standardized [Ann Hepatol. 2021 May-Jun;22:100278. doi: 10.1016/j.aohep.2020.10.006].
Could TARE be standardizable? In addition to the choice of particles, it is also important to
discuss the standardization of dosimetry to avoid the limitations of other intraarterial treatments
[Ann Hepatol. 2021 May-Jun;22:100278. doi: 10.1016/j.aohep.2020.10.006]. Could the authors
please extend this part concerning the standardization of TARE and cite the aforementioned
paper?
MATERIALS & METHODS
Material and Methods are satisfactory, and they correctly match the quality standard of this
Journal.
RESULTS
Results remain clear and well-structured, and no further adjustments are needed.
DISCUSSION
In my opinion, the topics of the discussion are very beautiful but overall, the discussion is too
long. The authors must decide to reduce the text which otherwise becomes difficult to read.
The present review suggests that 90Y-TARE for the treatment of patients with liver neoplasms
or HCC in the intermediate and advanced-stages contributes to the reduction of the hospital
resources utilization and therefore reduces costs, improves patient outcomes, and improves
the value and efficiency in hospitals. However, the introduction of new diagnostic algorithms
for HCC in the near future [J Gastroenterol Hepatol. 2016 Jan;31(1):69-80. doi: 10.1111/
jgh.13150  --  J Hepatol. 2020;72(4):718-724. doi:10.1016/j.jhep.2019.12.001] will allow to
identify smaller and smaller lesions and therefore also in earlier stages. Do the Authors think
that TARE will still have an important role in these future scenarios and what could possibly
imply the reduction of its execution in terms of costs?
In other intra-arterial treatments many scores were proposed to predict the treatment response
before and immediately after treatment such as that in J Pers Med. 2021;11(10):1041. Published
2021 Oct 17. doi:10.3390/jpm11101041. Considering the difficulty in evaluating treatment
response after radiotherapy, please, could the authors discuss if also in TARE procedure are
usable transaminase for treatment response such as after TACE [J Pers Med. 2021;11(10):1041.
Published 2021 Oct 17. doi:10.3390/jpm11101041].
TABLES & FIGURES
Tables & Figures are, satisfactory, and they correctly match the quality standard of this Journal.