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After revisions, all reviewers agreed to publish the manuscript. I also reviewed the manuscript and found no obvious risks to publication. Therefore, I also approved the publication of this manuscript.
no comment
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The author answered my questions sincerely. I understand the situation after the recurrence.
English is very clear
Literature is sufficient
Experimental design is good enough to my scope of knowledge
Findings seem valid and and conclusions are well stated in the discussion along with the limitations of the study
The authors are requested to carefully revise the manuscript and answer the questions raised by the reviewers.
In the current manuscript, authors performed a retrospective study and evaluated the feasibility of radical chemoradiotherapy in 11 patients with superficial esophageal cancer and liver cirrhosis. The median age of subjects was 67 years. Complete response was seen in 90.9% of patients, with 1-year and 3-year overall survival rates at 90.9% and 72.7%, respectively. Common adverse events included hematotoxicity, radiation esophagitis (grade 3-4 in two patients), radiation dermatitis (grade 1-2 in four patients), and radiation pneumonia (grade 1-2 in two patients). Gastrointestinal bleeding occurred in two patients, with one resulting in death. The study accomplishes that while radical chemoradiotherapy is a potential treatment for these patient group, but it poses a noteworthy bleeding risk that needs to be tackled.
Overall, this is very important clinical study and could be of interest to cancer biologists and surgeons. I recommend this article to be published with the following revisions-
1.Need to include more on significance of the study in the introduction section.
2.Limitation of the study must be discussed, which I found missing.
3. More recent study must be cited as few of them are not listed.
This study is within the aims and cope of PeerJ.
Observation drawn from 11 human subjects.
no comment
This paper is a retrospective analysis of radical chemoradiotherapy for superficial esophageal carcinoma complicated by liver cirrhosis and it is considered to be an originative article.
There is one case of death due to rupture of esophageal varices, but I would appreciate further discussion regarding the location of the irradiation field and esophageal varices. Should background factors such as the death case and the location of the irradiation field and varices be contraindications to radical chemoradiotherapy?
Please add a description and discussion of post-treatment for cases with local recurrence and distant metastasis.
The study reports radical chemoradiotherapy as an alternative treatment strategy for a specific class of patients with superficial esophageal cancer and also liver cirrhosis. The treatments like surgical removal, ER, and CCRT, all have severe adverse effects on EC patients with liver cirrhosis as compared to the patients without cirrhosis; or the reports are inadequate for treatments like ESD. Here, the authors based on a pilot study with 11 patients have put forth radical CRT as an alternate treatment with better overall survival rates and a few management strategies for the adverse effects of the treatment.
English and interpretation of the results in excellent.
Literature references are well put too.
Background is thoroughly written for better and immediate understanding.
The experimental design is although appropriate, it includes very few patients to deduce practical helpful conclusions. Concrete conclusions can be achieved if the sample size is increased. The reasons for the increase in risk of internal bleeding can be studied as well as the extent of adverse effects in patients and their management can be better deduced.
Conclusions are well-stated and short comings of the study are also mentioned which shows the clarity in the authors reasoning.
Only the sample size if increased the treatment feasibility can be better concluded.
The report highlights an important area to be focused to device better treatment strategies for superficial EC patients complicated with cirrhosis. It is a good attempt and well written manuscript but the sample size being too small, the deductions seem debatable.
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