Somatostatin Receptor Theranostics for Refractory Meningiomas

Round 1

Reviewer 1 Report

To editors and authors

Somatostatin receptor theranostics for refractory meningiomas

This is a very detailed and effective manuscript with clear content which is fitted with aims and scope of Current Oncology.

I suggested this manuscript for publication after some revisions below

1) Add IRB date.

2) Figures need to have arrow to indicate clearly lesion accompanied by appropriate legends.

3) Histological images need to have scale bar.

4) Please check and refer recent update documents about the diagnostic part in discussion (doi: 10.7150/ijms.73319).

5) In discussion, there should not be many subheadings. Please remove.

6) Limitation part belongs to discussion.

7) Conclusion is so long with many paragraphs. It should be more focused on main findings and introduced as one paragraph.

8) Citations and references should be revised cautiously as MDPI format.

9) Add histological images.

Sincerely

Author Response

#Reviewer 1

Somatostatin receptor theranostics for refractory meningiomas

This is a very detailed and effective manuscript with clear content which is fitted with aims and scope of Current Oncology.

I suggested this manuscript for publication after some revisions below

Thanks for all your suggestions, we have made some revisions based on yours.

1) Add IRB date.

Date of approval has also been added in the body of the text (line 94) in addition to the approval date already present line 470.

2) Figures need to have arrow to indicate clearly lesion accompanied by appropriate legends.

Arrows accompanied by appropriate legends have been added to Figures 1 and 2.

3) Histological images need to have scale bar.

The grey scale bar has been added in Figure  (PET imaging)

4) Please check and refer recent update documents about the diagnostic part in discussion (doi: 10.7150/ijms.73319).

A paragraph has been added on the diagnostic part in the introduction with this reference (line 74)

5) In discussion, there should not be many subheadings. Please remove.

Subheadings have been removed.

6) Limitation part belongs to discussion.

Some limits have been added to the pre-existing ones (lines 442-445 ; 457-467) :

- In order to detect early signals of anti-tumor drug activity or non-activity, we should have relied on the 3D MRI volume growth rate

- The adoption of the fifth edition of the WHO classification of CNS tumors in clinical practice, with the improved knowledge on the involvement of molecular alterations leads to tumor reclassifications.

7) Conclusion is so long with many paragraphs. It should be more focused on main findings and introduced as one paragraph.

The conclusion has been shortened and the main results highlighted.

8) Citations and references should be revised cautiously as MDPI format.

Thank you for your comment, all citations and references have been revised to MDPI format.

9) Add histological images.

Figure 2 has been added, showing the therapeutic evaluation by MRI fused to Ga DOTATOC of patient 2.

Sincerely

Reviewer 2 Report

Thank you very much for allowing me the opportunity to revise this manuscript.

The paper is well written.

I have some minor revisions to propose:

- please modify the grading of meningiomas according to the latest WHO classification;

- please clarify the inclusion criteria: I intend that all of them are independent criteria. If I am right please justify why the Authors treated patients without progression but with the expression of SSTR. This is not a recognized criterion for the treatment of meningiomas.

- in the results session the Authors mentioned 1 death after 3 months of progression of the disease: did they exclude a pseudoprogression?

- the quality of MRI needs to be improved (fig. 2)

- please carefully reads the manuscript for some edits (for example some extra spaces)

Author Response

#Reviewer 2

Thank you very much for allowing me the opportunity to revise this manuscript.

The paper is well written.

I have some minor revisions to propose:

Thanks for all your suggestions, we have made some revisions based on yours.

- please modify the grading of meningiomas according to the latest WHO classification;

Thank you for your suggestion. We have reclassified a grade I meningioma (classified according to the 2007 classification) to grade II meningioma (patient 3). We discuss the new classification and the need for studies to reclassify meningiomas diagnosed before 2021 according to the latest classification to allow better comparison of data lines 457-467

- please clarify the inclusion criteria: I intend that all of them are independent criteria. If I am right please justify why the Authors treated patients without progression but with the expression of SSTR. This is not a recognized criterion for the treatment of meningiomas.

Thank you for your suggestion, all inclusion criteria are not independent as only progressive meningiomas with no further surgical or EBRT treatment options and SSTR-positive lesions with equal or greater tumor uptake than liver on pre-therapy DOTATOC PET scans were treated (we reworded the sentence correctly line 95). The exclusion criteria are independent but we have been clearer on this point.

- in the results session the Authors mentioned 1 death after 3 months of progression of the disease: did they exclude a pseudoprogression?

Pseudo progression in patients treated with PRRT is debated in the community and is considered a rare phenomenon. Our first hypothesis is a progression. We add a sentence on this subject (line 340)

- the quality of MRI needs to be improved (fig. 2)

The quality of the MRI (panels c and d) can unfortunately not be improved as the patient did not have another one afterwards. We added a sentence to clarify that these kinetic movements were due to the patient's clinical deterioration in parallel with the radiological progression. No other patient has had this evolution we find it important in spite of the non-optimal quality of the MRI to show these images (lines 215-218).

- please carefully reads the manuscript for some edits (for example some extra spaces).

Thank you for your suggestion, we have carefully reviewed the manuscript for some edits.