A Multicentre Evaluation of Dosiomics Features Reproducibility, Stability and Sensitivity

Round 1

Reviewer 1 Report

General comments:

This is a topical paper resulted from a nation-wide collaboration between a large number of RT centres involved in radiomics / dosiomics that aims to evaluate the reproducibility, stability and sensitivity of dosiomic features using head and neck cancer phantom-based treatment planning and analysis.

The paper is generally well written and interesting. Below are my suggestions to further improve the readability of the manuscript:

Introduction: It would help the flow of the paper to add a short paragraph (before starting to present the concept behind dosiomics) on the role of DVHs in treatment planning interpretation / comparison and optimisation, while also mentioning the main shortcoming of DVHs – the lack of spatial dosimetric information. This is a good justification for the development of dosiomics that allow a volumetric assessment of dose distribution with the PTV and OARs.

Introduction – lines 86-87 “Placidi et al. evaluated the robustness of dosiomic signatures across grid resolution and algorithm for dose calculation in a monocentric setting” – and what was found in that study? A few summary sentences should be included here to justify the current, multi-centre study.

In Materials and Methods, the authors state that “Specifically, nine centres have contributed to this analysis” while table 3 is a “list of the 11 centres” – I believe this is a list of 11 treatment plans by the 9 centres. This should be corrected / clarified.

Section 2.2 – line 129 – “IMRT treatments with dose distributions 129 as equivalent as possible” – define / quantify ‘as equivalent as possible’. How were the treatment plans compared?

Discussion – the authors mention several studies that used dosiomics for prediction of clinical outcome. This idea should be continued by expanding on the true value of dosiomics – if we can talk about a ‘true value’ at this stage. How can dosiomics help to improve treatment outcome? What is the benefit of predicting acute toxicities? How would those toxicities be prevented / limited for future patients? Please add a few sentences on this idea.

Where multiple references are used in text in sequential order, please include the first and the last references only. For instance, replace the sequence [5] [6] [7] [8] [9] [10] [11] [12] with [5-12]. Change throughout the manuscript.

Specific comments:

1. The title should read ‘A multi-centre evaluation…’ (not A multi-centres…)
2. Figure 2. caption – remove from caption the final section: ‘2.3. Plan and dose prescription: different techniques, technologies and TPS.’
3. Page 5, line 164 – ‘defined as the smallest absolute…’

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Generally, it is interesting and worth publishing paper. I have rather few suggestions and questions rather than major comments. Please consider them during review process:

1. It is worthy to know why this paper is a multicentre article. Authors should add in the abstract and/or title that work has been done by nine Italian centres.
2. In keywords, please add: radiation dosimetry, radiotherapy etc. would be better visible during similar paper searching.
3. Figure 1 should be better described (not only in the main text of manuscript), i.e. what means ring etc. 

4. Please describe, why dose distribution computation has been performed from eight different centres, not nine?

5. Why authors chose almost similar LINACs  in this study?

6. In Table 2 Dmax=max dose. Do you mean total dose as a whole treatment or fractionated?

7. Table 4. Please explain how you calculated the dose prescription and constraints to organs at risk? Is it mean value from 7 centres.

8. In Results part, not sure if that sentence is needed: "This section may be divided into subheadings. It should provide a concise and pre- cise description of the experimental results, their interpretation, as well as the experi- mental conclusions that can be drawn".

    

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx