Review for 10.1186/1471-230X-8-51 (2008)

Reviewer's report
Title:Scintigraphic evaluation of oesophageal motility during adjuvant
radiotherapy to the mediastinum
Version: 1Date:9 July 2008
Reviewer: Jeri Logemann
Reviewer's report:
The following portion of the review is publishable:
This manuscript attempts to examine the relationship between esophageal
motility changes during adjuvant radiotherapy to the mediastinum and any patient
complaints of dysphagia. The authors followed 11 patients through the third week
of thoracic radiotherapy and began their study prior to the onset of the
radiotherapy. They utilized two measures: peak and residual activity ratio
(ER-40s) and mean transit time. Results found that ER-40s from onset of the
study to the follow-up studies at 10 Gy and 30 Gy showed some significant
changes. Mean transit time was also measured. The authors found that ER-40s
from baseline to the two follow-up studies were seen to increase in 9 of 11
patients (82%). The differences in the measures made at baseline and the two
follow-up time points were statistically significant. Mean transit times, however,
did not change statistically significantly between the three time points. The
authors have concluded that the scintigraphic technique of the esophagus shows
early alterations in esophageal transit during the third week of thoracic
radiotherapy.
The reader must wonder why follow-up was not done at the end of radiotherapy
when it was likely to reveal greater changes. This type of study is quite important
in defining the functional effects of treatment for cancer and, whenever possible,
to relate these to patient complaints or quality of life. It is also important to
distinguish between quality of life, which are patient perceptions of problems, and
the functional measurement, which is the measurement of reality in functional
change. It is clear that these authors were attempting to look at functional
measurement as a primary goal. The authors have also reported that the
scintigraphic procedure was well tolerated by all patients, and all patients were
evaluable at all three of the time points. Interestingly, all of the patients
complained of slight to moderate dysphagia and/or odynophagia at the end of the
third week of the radiation course, but none of them developed a Grade II Acute
Toxicity, according to the RTOG criteria. There was no relationship found
between the symptoms patients reported and abnormal esophageal transit.
There was also no evidence of esophageal gastric reflux in any of these 11
patients. The authors were purposefully looking for early changes in the
esophagus with radiotherapy. However, it would have been interesting had they
also examined the early changes versus the later changes in terms of their
selective measurements. Unfortunately, because the patients had very small
changes in the severity of their acute esophagitis symptoms (Grade I but none
with Grade II), there was no ability to correlate scintigraphic findings with degree
of patient symptoms which might have been possible had they followed patients
for longer. The authors attempted to get a homogeneous patient sample which
perhaps results in the inability to answer the second focus of this study. The
introduction of chemoradiotherapy or concurrent radiotherapy and chemotherapy
has been reported to make significant changes in the oral and pharyngeal
aspects of swallow beginning at approximately 3 weeks into radiotherapy. It
would be helpful if the authors followed this study with one in which patients
received chemoradiotherapy to the mediastinum.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.