To the Editor,
We are pleased to submit this revised manuscript for consideration in BMC
Cancer.
The use of locoregional treatments for breast cancer patients with metastatic
disease at diagnosis is a relevant area for clinical investigation. Several
retrospective studies suggest that surgical excision of the primary tumor
improves survival, and two prospective studies are currently comparing the
benefits of locoregional therapy versus systemic therapy alone in this setting.
Exclusive locoregional radiotherapy may represent an effective alternative to
surgery in this setting. Here we discuss current issues regarding exclusive and
adjuvant locoregional radiotherapy in breast cancer patients with synchronous
metastases.
Corrections have been made in response to the reviewers’ comments.
Thank you for considering our resubmission.
Yours sincerely,
Romuald Le Scodan, M.D.
Breast Cancer Group of Institut Curie-René Huguenin Cancer Center.
Response to reviewers
Reviewer's report
Title: Exclusive and adjuvant radiotherapy in breast cancer patients with
synchronous metastases
Version: 1 Date: 14 September 2010
Reviewer: Michael Milano
Reviewer's report:
Overall, this is a very well written review of the use of radiation to the breast for
patients presenting with synchronous metastases.
I have no major criticisms or suggestions for changes.
Minor suggestions/criticisms are as follows:
There are no page numbers in the manuscript
change "a angiogenic" to "an angiogenic"
Corrected.
In the senetence describing the Ovvvergaard and Ragaz trials (references 37-39)
it should be clearly stated that these women did not have apparent distant
metastatic disease.
The reviewer is correct and we have added this sentence to the manuscript:
Prospective randomized trials of postmastectomy radiotherapy have shown that
local therapy in the form of chest wall and lymph node irradiation prolongs
survival in node-positive non-metastatic women
receiving tamoxifen or
chemotherapy [37-39].
kahn needs to capitalized
Corrected.
In discussing the Gnerlich study, it shold be mentioned that the SEER database
does not provide information about the site which received radiation (i.e. breast
vs. distant site).
We do agree with this comment; corrections have been made.
but the authors did not state whether irradiation was delivered to the breast and
regional lymphatics or to treat metastatic sites.
In discussing hypofractionated whole breast radiation (references 56-57), it
should be explicitly mentioned that these are patients with non-metastatic,
node-negative disease.
We do agree with this comment; corrections have been made.
Thus, the possible benefit of post-operative radiotherapy is unclear. Several
randomized trials have supported the use of hypofractionned whole breast
radiotherapy and have shown good results in breast cancer patients with nonmetastatic, node-negative disease [56,57].
local is mispelled as locat in the last section
Corrected.
/12, 000 should be changed to 12,000
Corrected.
Discretionary revision
Potential selection biases probably play a major factor in the retrospective
studies discussed. In fact, an entire section is approporaitely dedicated to this
discussion. I would suggest making a brief comment about this in the first
section
describing the hypothesis, with a parenthetical remark that it will be discussed in
greater detial later in the mauscript.
Relevant questions:
1. Does the debate present a novel argument, or a novel insight into existing
work?
Absolutely. Breast radiation for metastatic disease is an emerging concept
2. Does the debate address an important problem of interest to a broad
biomedical audience?
Yes.
3. Is the piece well argued and referenced?
Yes.
4. Has the author used logical arguments and sound reasoning?
Yes.
5. Is the piece written well enough for publication? (nb. Since we do not charge
for access to published research, we cannot undertake the costs of editing poorly
written manuscript. If you tell us that the writing is not acceptable for
publication,
we will ask the authors to find someone, or an editing service, to help them
rewrite it. If you tell us that the manuscript is too poorly written for it to be peer
reviewed, we will ask them to rewrite it now.)
Yes.
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title: Exclusive and adjuvant radiotherapy in breast cancer patients with
synchronous metastases
Version: 1 Date: 21 September 2010
Reviewer: Celine Bourgier
Reviewer's report:
Le Scodan and colleagues did a large overview regarding the part of locoregional
treatment in stage IV breast cancer, especially the place of exclusive
radiotherapy in this setting.
Quality of written English: Needs some language corrections before being
published
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Thank you for considering our resubmission.
Yours sincerely,
Romuald Le Scodan, M.D.
Breast Cancer Group of Institut Curie-René Huguenin Cancer Center.