Follow-Up Imaging Guidelines for Patients with Stage III Unresectable NSCLC: Recommendations Based on the PACIFIC Trial

Round 1

Reviewer 1 Report

This is a very well written manuscript which summarizes a key clinical question and lucidly provides robust guidelines on the issue of imaging after CTRT in patients with unresectable stage III NSCLC. 

Few queries to the authors:

1. The recommendation made by the panel for imaging is 3 monthly in year 1. Can the authors also make some comment regarding the timing of the first/response assessment scan (CT or whole body PETCT)? This is pertinent because, based on the PACIFIC data, patients are started on adjuvant durvalumab within 6 weeks of completion of CTRT - however, progression needs to be ruled out beforehand. However, PETCT is generally recommended to be performed 10-12 weeks post CTRT. Therefore, can the authors elaborate on any recommendation or discussion on the timing of the first response assessment imaging.

2. RT induced pneumonitis may be compounded by immunotherapy related pneumonitis, the need to differentiate between the two entities is important, as further management may change - did the radiologist in the panel have any recommendation in this regard? Also, would a HRCT be recommended in addition to the usual follow-up imaging protocol to detect early changes of pneumonitis?

3. Was a delphi methodology process followed during the process of consensus generation? The authors should also provide the google forms/initial questions as additional material.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Keywords

stage 3 should be stage III

 

ABSTRACT

1.     Clear and well-written.

 

INTRODUCTION

1.     The 2020 reference is old GLOBOCAN has updated data from 2021.

2.     Most of the references are not updated authors must review the novel publications and update their background part.

3.     The last paragraph of the introduction should be given to the aims of the study.

4.     What is the hypothesis of the study?

 

MATERIALS AND METHODS

1.     How the experts were chosen to be geographically representative more details must be added to clarify the designee of the consultation.

2.     The study timing must be specified from to instead of “early 2022”.

 

 

RESULTS

1.     Table 1 must be reorganized to be easier to read and to understand the link between every clinical question and its recommendations.

2.     Figure 1 quality must be improved.

3.     The authors must not only discuss their results with the guidelines, but they must discuss their results with similar studies from different countries if it is available.

4.      

CONCLUSION

 

conclusions are supported by the results.

Author Response

Please see the attachment.

Author Response File: Author Response.docx