Outcomes and Economic Evaluation in Delayed Two-Stage Breast Reconstruction in Romania: The Influence of Radiotherapy

Round 1

Reviewer 1 Report

The Impact of External Radiation Therapy in Breast Cancer Treatment, evaluating cohorts on the correlation of radiation therapy with the risk of complications and cost. I find the data valuable and worth reporting. However, the results do not seem to show a clear difference in the impact of external radiation therapy on the risk of complications (p=0.161). In addition, it is premature to discuss a clear difference in cost burden, since it is necessary to take into account the differences in each case, including the possibility of secondary diagnosis and reoperation due to complications and the details of such reoperations. If you insist that radiation therapy after mastectomy, which is described in the conclusion, has a high risk of complications but should not be considered a contraindication to breast reconstruction, please clearly state the clear difference.

 

The explanation in Table 3 is missing.

The prefix of Table 4 is lower case and should be capitalized.

Author Response

Regarding the comment on presentation of the results: 

• We find it important to emphasize that, although not of statistical significance, our study showed a higher rate of complications in the RT group. Moreover, all the patients who suffered major postoperative complications received radiation therapy before the surgery.

   

• It is well known that the risk of complications may increase with the complexity of the surgery, duration of the intervention (e.g. alloplastic vs. autologous reconstruction) and the need for a donor site (for autologous flap harvest).

  In the RT group, we found that the type of reconstruction didn't significantly influence the rate of complications, but it did significantly impact the cost burden(p<0.001).

• Any of the complications we noted (haemorrhage, flap necrosis etc.) may have an impact on cost burden. However, as a limitation of the current study, we did not take into account the cost of any future possible reintervention or treatment needed for our mentioned complications.

   

• Considering all of the above, we find that the overall outcome and the cost burden when treating a pastmastectomy patient that received radiation therapy cand be improved by choosing an alloplastic breast reconstruction strategy.

We attached the article with our revisions.

Author Response File: Author Response.docx

Reviewer 2 Report

Review for the manuscript ID: Curroncol-2080537 peer review v.1.

OUTCOMES AND ECONOMIC EVALUATION IN DELAYED TWO-STAGE BREAST

RECONSTRUCTION IN ROMANIA: the influence of radiotherapy

Authors: Andrei Ludovic Porosnicu, Stefania Mihaela Riza *, Ioana Antonia

Stanculescu, Sorin Viorel Parasca, Cristian Radu Jecan, Ruxandra Diana

Sinescu-Baltateanu

     This paper review the effects of radiotherapy on the outcome and the costs of the delayed two-stage breast reconstruction in a representative cohort of patients in Bucharest, Romania.

     The manuscript is clearly and rationally written, but still needs some

minor technical corrections and especially general improvement of the references part.

Detailed list of required corrections is given in attached PDF file

Comments for author File: Comments.pdf

Author Response

Thank you for your constructive comments and suggestions.

We really appreciate it.

We attached the article with our revisions.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

I am satisfied with the author's responses to my concerns.