Sharing Mono-Institutional Experience of Treating Pancreatic Cancer with Stereotactic Body Radiation Therapy (SBRT)
, Sunita Ghosh 4,‡, Aswin Abraham 1, Kim Paulson 1, Keith Tankel 1, Nawaid Usmani 1, Diane Severin 1, Clarence Wong 5 and Kurian Joseph 1,*Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
Minor comments:
Line 50: add units.
Line 54: Conventional fractionation used to reduce toxicity.
Line 58: Abscopal effect is not clinically substantiated.
Major comments:
Line 110: please describe rationale for not using a CTV margin.
Line 131: For breath hold treatments, where CBCTs acquired with breath hold?
Please explain rational for omitting PRV volumes.
Please check staging and specify staging system. AJCC 8th edition would consider borderline patients as at least stage III disease.
In Table 2, should specify indication for SBRT.
Line 205: Please describe the patterns of progression.
Line 226: Please clarify why GI bleed at 6 months was not attributable to RT.
Line 299: Please discuss rationale for not including an elective nodal volume.
In this review of a single institutional experience in implementing SBRT, feasibility and outcomes were acceptable. However, given the relative lack of novel outcomes, it is important to carefully describe the methods and considerations on deciding on a certain treatment protocol.
Comments on the Quality of English Language
Proof reading required.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
The authors have set out to describe their experience with SBRT to pancreatic lesions in the borderline resectable and locally advanced setting. They have described the patient population and the outcomes of the treatment. It is important study to have been conducted as there continues to be the questions of the role of radiation and SBRT in pancreatic cancer. It is well written (though there are some grammatical miscues) and makes logical sense.
I have several questions that I think answered will help with the manuscript.
1. It would be good to define what locally advance and borderline PDAC is at your center. There are general definitions in the literature but it would be important for the reader to know how you defined it.
2. It would be good to know how many pancreatic cancer patients were seen in the institution over the time point so it can be determined what % of patients were actually offered. For example if 100 locally advance are seen in the province, and only 17 were offered, thats only 17%. Why were the other 83% not offered? There does not appear to be any discussion on how patients were chosen. Were all patients offered (and some declined) or was there particular criteria that needed to be met in order to proceed with SBRT. This will lead to a discussion of selection bias which needs to be further addressed.
3. It is mentioned 2 patients are Stage 1A. Since borderline and locally advance tend to be T3 or T4s I am curious how stage 1s would be borderline or locally advance?
4. there is mentioned that 2 patients did not have adenocarcinoma. Did they have neuroendocine, acinars or something else? Should the analysis be limited to just adenos? Most of the data sited in the intro is based on adenocarcinomas and not neuroendocrine for example. It does make the analysis confusing by having mixed pathology in the analysis.
Comments on the Quality of English Language
As mentioned above, there are some grammatical errors that will need to be reviewed and corrected.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
