In Curative Stereotactic Body Radiation Therapy for Prostate Cancer, There Is a High Possibility That 45 Gy in Five Fractions Will Not Be Tolerated without a Hydrogel Spacer
, Hideomi Yamashita 1,*, Mami Ogita 1, Taketo Kawai 2,3, Yusuke Sato 2,4 and Haruki Kume 2
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsI have read with great interest this article concerning the role of dose escalation for prostate SBRT. The authors report the results of a phase I trial enrolling 16 patients. The paper is well written and data are properly collected and presented. However, I have some observations. -How was performed staging for intermediate and high risk prostate cancer? please specify
-Why dorsal extracapsular invasion was considered as an exclusion criterion, while no impact of seminal vesicles invasion? please specify
-The bladder filling protocol seems quite open to heterogeneity, did the authors observe any trouble for bladder volume variations?
-Did the authors apply any kind of premedication with steroids or alpha blockers for the course of SBRT?
I think the Authors should provide a larger background on the role of SBRT in comparison with moderate hypofractionation (also citing the following studies --> doi: 10.1177/0300891619867846; doi: 10.1007/s40520-019-01243-1.) Moreover, they should also justify the need for entire gland dose-escalation, as several literature studies are reporting the safety and efficacy of boosting only the DIL, with the theoretical advantage of reducing the dose to the entire gland (doi: 10.1016/j.ijrobp.2024.03.009; doi: 10.1007/s00345-024-04876-8; doi: 10.1007/s00066-023-02189-0)
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsBoth MTD and DLT strongly depend on OAR doses. More detailed information on them "must" be provided.
Consider providing at least 2 tables:
Table 1 that summarizes the dose prescription and constraints (i.e., lines 107 to 114).
Table 2 that summarizes planned OAR doses & complications for each case.
A minor comment: In line 117, modify "a kilovoltage CT" to "a kilovoltage CBCT" if it was CBCT. Or "a kilovoltage FBCT" in case it was a fan beam for better communication.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsI thank the authors for the edits to the manuscript. I have no other observations.
