Reviewer’s report
Title: 
Chemotherapy-based gonadotoxicity risk evaluation as a predictor of
reproductive outcomes in cancer survivors: A prospective cohort
Version: 
1 
Date: 
18 Jan 2021
Reviewer's report:
"PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: I believe the title is misleading. this study evaluated
only postpubertal women that underwent OTCP. it did not evaluate prepubertal
women, or women that underwent no, or other methods of fertility preservation.
Additionally, 27% of pts received chemotherapy prior to OTCP, which would
reduce the efficacy of the autotransplanted tissue.
REQUESTED REVISIONS: 
introduction: age of patient is very important. although this study only included
postpubertal pts.
with radiation, the dose and fields are very important
methods: cranial irradiation is not usually considered gonadotoxic per se. it has
effects on the ovaries, but not permanent like radiation and chemotherapy and
more easily correctable.
ovarian transposition should be listed as a method of fertility preservation in
women receiving pelvic radiation and low-med risk chemotherapy regimens.
the title should reflect the objectives and study population it was tested in. 
The authors have included 3-6 months of amenorrhea as an outcome. However,
it is not uncommon for women to have such effects due to stress, etc, including
cancer treatment that can sometimes be temporary and not permanent. 
In this case there is no control group of women that did not undergo OTCP.
Might these women differ from those that did not undergo the above?
leave out prepubertal girls in the definitions of risk scoring, as it doesn't apply to
this cohort.
results: The number of patients are relatively small, particularly if one eliminates
the chemotherapy prior to OTCP, allocates the patients into 3 risk categories,
etc. GnRH was used in only 10 pts, there is hardly any way a difference would
be noted is such as small number of pts.
ADDITIONAL REQUESTS/SUGGESTIONS: 
change title to reflect the objective and population studied
consider other comments made in section f"
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