PONE-D-21-19775

Multi-criteria optimization in volumetric-modulated arc therapy planning for prostate cancer

PLOS ONE

Dear Dr. Park,

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PLOS ONE

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Korean government (MSIT). supported by the the National Research Foundation of Korea [NRF2019M3E5D1A02068143]”

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NRF-2019M3E5D1A02068143

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In this manuscript authors compared the VMAT plans, with or without Multi-criteria optimization (MCO), in patients with prostate cancer. For the comparison, authors assessed the dosimetry parameters of target volumes and the surrounding normal tissues. VMAT plan for prostate cancer treatment using MCO is of interest and novel.

Comments to authors:

1. Please explain ORAs in the abstract

2. Authors should perform some histopathology / immunohistochemistry (IHC) to rule out the possibility of surrounding normal tissue toxicities.

Overall the manuscript is well structured. The paper is written very well, and the interpretation of the results is easily understandable. The information provided in this article are of significant interest and novel. I believe that this article is a grave concern to the readership of PLoS ONE after minor revision.

Reviewer #2: My overall impression:

- This is a new study which presumably has not been done before. So this would score good points and would add value to the literature

- The authors need to thoroughly revise the grammar of this manuscript. I would not accept it for publication in the current state

- Need to tidy up the conclusion to link it with the overall aim of the paper which was to compare VMAT plans for prostate treatments etc

- I would accept this for publication pending Major revisions

Specific comments:

Results

Regarding the Results section, they are explaining the values obtained by placing them inside brackets. You don’t do this in a paper.

For example, this is a small section they wrote for the Target volume:

“However, the MCO significantly reduced the Dmax (7399, 7363, and 7367 cGy in MCO, re-optimization, and recalculation, respectively)”

The use of brackets here is confusing to the reader. It cannot make sense which value was obtained with MCO or which value was obtained with re-optimization or which value was obtained with recalculation. They are better off removing the brackets and providing a specific description. Maybe something like this:

However, the MCO significantly reduced the Dmax value from 7339 cGy to 7367 cGy in comparison to the recalculation value. The Dmax for the re-optimization was reduced from 7363 to 7367.

They did the same thing (ie including brackets) for their explanation of the Bladder and Rectum.

They need to write something similar to what they wrote in the Bilateral femoral heads.

Discussion

The discussion is much improved.

Conclusion

I think the conclusion can be improved. This is what I would suggest:

In conclusion, our results demonstrate that the MCO algorithm in Eclipse 15.6 can improve the OAR doses without compromising the target-dose coverage for VMAT plans……etc etc... Further investigation, through a prospective clinical study, is needed to validate that the dose reductions to the bladder and rectum by the MCO planning can result in less side effects with morbidity as an endpoint.

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Reviewer #1: Yes: ANIS AHMAD

Reviewer #2: Yes: Leily Rezaei

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Multi-criteria optimization for planning volumetric-modulated arc therapy for prostate cancer

PONE-D-21-19775R1

Dear Dr. Park,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Henry Woo

Academic Editor

PLOS ONE