Cyberknife Radiosurgery for Prostate Cancer after Abdominoperineal Resection (CYRANO): The Combined Computer Tomography and Electromagnetic Navigation Guided Transperineal Fiducial Markers Implantation Technique

Round 1

Reviewer 1 Report

Dear Authors,

Current Oncology: curroncol-2550220

CYberknife Radiosurgery for prostate cancer After abdominoperineal resection (CYRANO): the combined Computer. To mography and electromagnetic navigation guided transperineal fiducial markers implantation technique by Vavassori is an interesting article. The authors reporting technical development, they present the strategic placement of fiducial markers within the prostate under the guidance of computed tomography (CT) and electromagnetic navigation for the delivery of ultra-hypofractionated Cyberknife (CK) therapy with the localized prostate cancer (PCa) who had previously undergone chemo-radiotherapy for rectal cancer and subsequent abdominoperineal resection due to local recurrence. The patient was positioned in a prone position with a pillow under the pelvis to facilitate access, and an electromagnetic fiducial marker was placed on the patient's skin to establish a stable position. CT scans were performed to plan the procedure, mark virtual points, and simulate the needle trajectory using the navigation system. Local anesthesia was administered, and a 21G needle was used to place the fiducial markers according to the navigation system information. A confirmatory CT scan was obtained to ensure 30 proper positioning. The implantation procedure was safe, without any acute side effects such as pain, haematuria, dysuria, or haematospermia. Our report highlights the capabilities of using electromagnetic navigation systems to virtually navigate within a pre-acquired imaging dataset in the interventional room, allowing for non-conventional approaches and potentially revolutionizing fiducial marker positioning, offering new perspectives for PCa treatment in selected cases.

Positive comments

The authors apply fractionated radiation and it is more effective in cancer therapy.

Minor comment:

1.     Is there any biological markers correlates with the CT scan?

2.     The manuscript needs proof reading.

Proofreading needed

Author Response

Positive comments

R1.1: The authors apply fractionated radiation and it is more effective in cancer therapy.

A1.1: We extend our gratitude to the reviewer for the invaluable comments.

Minor comment:

R1.2: Is there any biological markers correlates with the CT scan?

A1.2: Regrettably, we did not explore any biological markers in this study. However, we acknowledge the potential benefits of conducting additional research with a larger sample size to facilitate a comparable analysis.

R1.3: The manuscript needs proof reading.

A1.3: We appreciate the reviewer's guidance and are pleased to inform them that our manuscript has undergone a thorough review by a native English speaker.

Reviewer 2 Report

Thank you for your paper!

First, just as a suggestion, using CAPS in the middle of the word in the title is not appropriate; putting the acronim in brackets should be enough for every reader to understand what you mean.

Second, since you only present one case, the scientific value is pretty low if trying to highlight the capabilities of the technique, as stated at the end of your paper.

Maybe a conclusions part would make a better ending for your paper. The total word count is low, same for the number of references.

The pictures "edited" by hand drawing over computer generated images are usually not welcome in prestigious journals.

If you have more cases using the same technique, I suggest you include them in your paper. If not, I think it's better to keep it as a case report, without drawing general conclusions about the technique itself.

I will gladly review a new version of your work if you decide to update it.

Author Response

R2.1: Thank you for your paper!
A2.1: We would like to express our gratitude to the reviewer for taking the time to engage with our paper. Your feedback and insights are greatly valued as we continue to refine and enhance our work.

R2.2: First, just as a suggestion, using CAPS in the middle of the word in the title is not appropriate; putting the acronim in brackets should be enough for every reader to understand what you mean.
A2.2: Thank you for your observation. The title has been revised to eliminate the use of CAPS in the middle of the word, and we have enclosed the acronym in brackets to enhance reader comprehension.

R2.3: Second, since you only present one case, the scientific value is pretty low if trying to highlight the capabilities of the technique, as stated at the end of your paper.
A2.3: We sincerely appreciate your astute observation. In light of your feedback, we recognize the limitations of presenting only one case in terms of effectively showcasing the capabilities of the technique, as indicated in the conclusion of our paper. We acknowledge the need to provide a more comprehensive dataset to enhance the scientific value and substantiate our claims.

R2.4: Maybe a conclusions part would make a better ending for your paper. The total word count is low, same for the number of references.
A2.4: We agree that such an addition would provide a more fitting ending to our paper, allowing us to summarize the key findings and insights more effectively. Furthermore, we expanded the manuscript and our reference list to encompass a broader range of relevant sources.

R2.5: The pictures "edited" by hand drawing over computer generated images are usually not welcome in prestigious journals.
A2.5: We recognize the importance of maintaining a high standard of visual presentation in our submission and we thank you for the valuable feedback. We reassessed our approach to image presentation to ensure alignment with the expected standards of the journal.

R2.6: If you have more cases using the same technique, I suggest you include them in your paper. If not, I think it's better to keep it as a case report, without drawing general conclusions about the technique itself.
A2.6: We have taken your recommendation into careful consideration. We acknowledge the wisdom in maintaining the focus of our paper as a case report, refraining from drawing overarching conclusions about the technique itself.

R2.7: I will gladly review a new version of your work if you decide to update it.
A2.7: We are grateful for your support in refining our work to meet the highest standards.

Round 2

Reviewer 2 Report

Thank you for making the changes I suggested.