Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT

Round 1

Reviewer 1 Report

The Authors reported the cutaneous Management After Extravasation of High-concentrated Amino Acid Solution Administered for Renal Protection in peptide receptor radionuclide therapy (PPRT) in patients with neuroendocrine tumors (NETs).

The case report is well written and easy to read.

The major points that should be better addressed in the discussion are:

-the use of PPRT in NETs tumors (indications, mechanisms of action, alternative therapies and so on), along with the description of NET tumor epidemiology;

-the cutaneous management of this cutaneous side effects (guidelines, therapies, follow up, dermatologist advice), along with the etiopathology of the reported side effect;

-a proposal of the guidelines that should be followed to prevent and to early diagnose this side effect;

Author Response

Dear Reviewer,

Thank you for your comments and suggestions on the manuscript title “Cutaneous Management After Extravasation of High-concentrated Amino Acid Solution Administered for Renal Protection in PRRT”. We have revised our manuscript accordingly.

Review’s comment:

Comment 1: The use of PPRT in NETs tumors (indications, mechanisms of action, alternative therapies and so on), along with the description of NET tumor epidemiology.
Answer: More information about PRRT is added in the discussion.

Comment 2: The cutaneous management of this cutaneous side effects (guidelines, therapies, follow up, dermatologist advice), along with the etiopathology of the reported side effect.
Answer: More information about cutaneous treatment and follow-up is added in the discussion.

Comment 3: A proposal of the guidelines that should be followed to prevent and to early diagnose this side effect.
Answer: More information about general steps for management of extravasation and suggestions for prevention is added in the discussion.

 

Best regards,

Chaninart Sakulpisuti

Reviewer 2 Report

Dear Authors,

In general, the manuscript is an interesting study, nevertheless, some corrections and explanations are needed.

1. Whether the first patient underwent similar therapy as the second patient (any immunosuppressive drug, chemotherapy) before [¹⁷⁷Lu]177-DOTA-TATE administration? Please comment and add appropriate information to the manuscript. 
2. What about the serum creatinine level and eGFR in the case of patient 1. Is there any similarity with patient 2. Please add any information about this.
3. Lu-177 DOTATATE as well as Ga-68 DOTATATE is incorrect description and should be corrected. Please follow the EANM GUIDANCE; please see H.H. Coenen et al. Nuclear Medicine and Biology 55 (2017) v–xi; https://www.eanm.org/content-eanm/uploads/2019/12/EANM_GUIDANCE-_TRACER_NOMENCLATURE.pdf, or look at reference 2.
4. Reference 2 should be Nucl Med Biol instead of Necl Med Biol.

Author Response

Dear Reviewer,

Thank you for your comments and suggestions on the manuscript title “Cutaneous Management After Extravasation of High-concentrated Amino Acid Solution Administered for Renal Protection in PRRT”. We have revised our manuscript accordingly.

Review’s comment:

Q1: Whether the first patient underwent similar therapy as the second patient (any immunosuppressive drug, chemotherapy) before [¹⁷⁷Lu]177-DOTA-TATE administration? Please comment and add appropriate information to the manuscript. 

Answer: Appropriate information is added. PRRT is only a systemic treatment method after surgeries.

 

Q2: What about the serum creatinine level and eGFR in the case of patient 1. Is there any similarity with patient 2. Please add any information about this.

Answer: The serum creatinine level and eGFR (CKD-EPI) the case of in patient 1 are added. He continued to receive high-concentrated amino acid infusion during the third cycle of PRRT and his follow-up serum creatinine level and eGRF (CKI-EPI) were unchanged.

 

Comment 1: Lu-177 DOTATATE as well as Ga-68 DOTATATE is incorrect description and should be corrected. Please follow the EANM GUIDANCE; please see H.H. Coenen et al. Nuclear Medicine and Biology 55 (2017) v–xi; https://www.eanm.org/content-eanm/uploads/2019/12/EANM_GUIDANCE-_TRACER_NOMENCLATURE.pdf, or look at reference 2.

Action: Radiopharmaceutical’s description is corrected accordingly.

 

Comment 2: Reference 2 should be Nucl Med Biol instead of Necl Med Biol.

Action: It is corrected.

 

Best regards,

Chaninart Sakulpisuti

Round 2

Reviewer 1 Report

The case report is suitable for publication in Tomography.