The Role of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors review the current landscape of adjuvant radiotherapy for breast cancer management - this is highly clinically relevant in daily practice globally. While very detailed in relation to trial discussion and well illustrated related to figures I would like to have seen more discussion on the more challenging aspects of this are and also on advances

1. section 5 deals with radiotherapy after neo adjuvant therapy - this topic is of high interest at every breast multidisciplinary meeting - a figure highlighting the debate points and a table showing the current guideline documents eg esmo, nccn, asco would be of interest supplemented by discussion of where there is concordance and discordance with the documents. Most clinicians reading this paper willl focus on this section I feel as that is where they are looking for guidance.

2. there is no discussion of shorter treatment strategies eg the fast forward trial nor is there any discussion of new advances eg AI in treatment planning 

3. a table with ongoing pivotal trials whose results are awaited eg supremo would future proof the article as would a table of ongoing practice evolving trials which are at an earlier stage 

Comments on the Quality of English Language

this paper is well written minor english edits required in places 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The article titled "The role of adjuvant radiotherapy in the treatment of breast cancer" by Dominika Iveta Kolářová et al. offers valuable insights. However, there are several issues that need to be addressed:

1. The authors mention "high-risk patients" and "intermediate-risk patients" without adequately describing the measures used to determine these risk categories. It would be helpful if the authors provided specific criteria or guidelines used for classifying patients into these risk groups.

2. While the authors mention that the benefit of postmastectomy radiotherapy in intermediate-risk patients with T3N0 tumors is a matter of debate, they do not elaborate on the conflicting evidence or provide any insights into the ongoing dispute.

3. The authors should justify the relevance of their study independently, as previous publications have already explored the topic. They can reference some of these publications found in PubMed, such as Indian J Med Res. 2021 Aug;154(2):189-198, Surg Oncol Clin N Am. 2017 Jul;26(3):371-382, Radiat Oncol. 2020 Mar 30;15(1):71, Semin Oncol. 2020 Aug;47(4):209-216, Breast. 2023 Jun;69:299-305, J Geriatr Oncol. 2013 Oct;4(4):402-12, Cancer Radiother. 2016 Oct;20(6-7):583-6, Int J Radiat Oncol Biol Phys. 1988 Sep;15(3):519-35, among others. Therefore, the study does not provide any innovative information.

4. The authors state that patients with four or more positive lymph nodes or extracapsular extension should receive regional lymph node irradiation regardless of the surgery type, but they do not provide clear recommendations for patients with one to three involved lymph nodes.

5. The authors primarily focus on the indications for radiotherapy but fail to emphasize the possible side effects or risks associated with the treatment. Including a brief discussion on the potential adverse effects would provide a more balanced perspective on the topic.

6. The authors can provide specific criteria or guidelines for determining when radiotherapy should be administered as adjuvant therapy in patients treated with neoadjuvant systemic therapy.

Comments on the Quality of English Language

Moderate editing of English language required

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The revised version is improved and clearer due to addition of tables in the document complemented by radiotherapy planning figures

Reviewer 2 Report

Comments and Suggestions for Authors

Accept in present form

Comments on the Quality of English Language

Moderate editing of English language required