Does Systemic Chemotherapy Influence Skeletal Growth of Young Osteosarcoma Patients as a Treatment-Related Late Adverse Effect?

Round 1

Reviewer 1 Report

Growth is often a topic of discussion when treating osteosarcoma. This study shows that patients 11 and older do fine and if 10 or younger have minimal issues. The data was approached in a comprehensive manner and conclusions should be reassuring to parents, patients, and orthopedic surgeons. 

Author Response

To Reviewer 1

Growth is often a topic of discussion when treating osteosarcoma. This study shows that patients 11 and older do fine and if 10 or younger have minimal issues. The data was approached in a comprehensive manner and conclusions should be reassuring to parents, patients, and orthopedic surgeons. 

 

I really appreciate the comment this favorable comment. We hope this result will be useful information for the osteosarcoma patients, their families, and orthopaedic oncologists.

Author Response File: Author Response.docx

Reviewer 2 Report

The authors claim that chemotherapy influences skeletal growth in under 10 years old osteosarcoma patients. The study is interesting, however, I have some concerns to be discussed.

-I would say that the significance observed in the current study is due to the small cohort.

 - What do you think about the influence on the mental health of young osteosarcoma patients of lower height.

-It is interesting to investigate the influence on the skeletal in osteosarcoma patients around 30-40 years old osteosarcoma patients.

Author Response

To Reviewer 2

-I would say that the significance observed in the current study is due to the small cohort.

We agree to this critical suggestion. The number of the included patient is only 20. Then, we added some comments in the study limitation of the discussion section.

 

Revised version

Line 222-225: This study was retrospec­tive, and the small sample was comprised of patients of the same ethnicity (Japanese) from a single Japanese institution. Therefore, the results may not always be applicable to the general osteosarcoma patients.

 

- What do you think about the influence on the mental health of young osteosarcoma patients of lower height.

We appreciate this instructive comment. We agree to the fact that the disturbed brain function would affect the skeletal maturation. In this study we excluded the osteosarcoma patients with brain metastases, and physically and apparently, we did not find any mentally affected patients after chemotherapy, during follow-up. We added this comment in the discussion section.

Revised version

Line 215-216: During the follow-up, there were no patients with disturbed brain functions, including mental health.

 

-It is interesting to investigate the influence on the skeletal in osteosarcoma patients around 30-40 years old osteosarcoma patients.

We appreciate this instructive comment. The average interval from the diagnosis to last follow-up was 89.6 months, meaning midterm follow-up. If we follow the patients for longer follow-up of over 10 or 20 years, it might result in different result.

We added the comment to this study limitation in the discussion section.

 

Revised version

Line 236: The average interval from the diagnosis to last follow-up was 89.6 months, and the longer follow-up of over 10 or 20 years might find different results.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The authors replied well, so I think the manuscript is suitable for publication.