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: 1 Date: 13 Nov 2022
Reviewer:  Hironaga Satake
Reviewer's report:
Please consider the following revisions
Major
Title:
Since this analysis is primarily a safety evaluation, please change the title to ‘Safety and Efficacy
Analysis of …’.
Since this is a retrospective analysis, please consider stating that it is a “retrospective analysis”
in the title.
Results, 1. Characteristics:
The authors describe the dose intensity of RT, but please describe the dose intensity of concurrent
chemotherapy.
Discussion:
The following is just a REVIEW of the existing report, please consider deleting it.
“The incidence of #Grade-3 toxicities during treatment was 31.5% (17/54) in our study, which
is comparable to or even lower than the figures reported in previous studies. Suzuki et al.[23]
studied elderly patients with oesophageal carcinoma who were treated with radiotherapy alone
and reported a 50% incidence of adverse reactions, which was significantly higher than in our
research. Liang et al.[24] reported the incidence of #Grade-3 adverse reactions in 42 patients
treated with nimotuzumab combined with radiotherapy to be 21.4%, which was lower compared
with our research; however, in Liang et al.’s study, no patients were treated with concurrent
chemotherapy, and the enrolled patients were younger (45–74 years) than those in our research.
In a study by Ma et al.[14], 66 patients (45–88 years) with ESCC were treated with nimotuzumab
combined with radiotherapy or chemotherapy in a regimen similar to that used in our research,
and the incidence of #Grade-3 adverse reactions was 50% (33/66).
In addition, the incidence of Grade-1–2 radiation pneumonitis in our study was 46.2% (25/54),
which was relatively high and may have been related to factors such as the stage of the enrolled
patients (74.1% of patients were Stage III/IV), lesion length (mean length was 7.0 cm) and
radiotherapy dose (85.2% of patients received a total dose of #60 Gy). Over 90% of the patients
in our study had albumin reduction, and 40.7% of patients (22/54) had two degrees of reduction:
a side effect that has been rarely reported in previous studies. Albumin can reflect the nutritional
status of patients, which can influence their treatment response to some extent. Further research
is required to investigate the association between albumin reduction and treatment response.”
More importantly, Table 1 shows that you are choosing between NCRT and NRT depending on
‘age, PS, and primary site’, so please describe that in the discussion part.
The authors consider “NCRT group were in better condition than those in the NRT group at the
beginning of the study, and the addition of chemotherapy to NRT for these patients prolonged
their survival.”, but as shown in Table 1, NCRT and NRT have different targets (age, PS, primary
tumor location) for treatment introduction. Isn't it hard to generalize because of the different
backgrounds?
Conclusion:
The authors concluded " In summary, it is indicated that nimotuzumab in combination with
chemoradiotherapy or radiotherapy can achieve a good treatment response and better survival
in elderly patients with ESCC.", but since the primary purpose of this analysis is to evaluate
safety, please change the conclusion to one regarding safety.