Patients with Leptomeningeal Carcinomatosis and Hydrocephalus-Feasibility of Combined Ventriculoperitoneal Shunt and Reservoir Insertion for Intrathecal Chemotherapy

Round 1

Reviewer 1 Report

Dear Authors,

your manuscript talks about a topic with interesting clinical implications.

I ask you to answer the following questions:

1) Have you also selected patients with solid brain metastases?

2) In obstructive hydrocephalus, why did you perform the ventriculoperitoneal shunt?

3) Can you show at least one illustrative case with pre- and post-operative ct-scan?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors present a study about the simultaneous treatment of hydrocephalus and leptomeningeal metastasis. Despite the very interesting aim of the study, several issues should be solved for publishing these results.

Comments below

Introduction

If the patients should be treated with ITC, to access the real efficacy of the chemotherapy the patients should suffer the same tumor (just to reduce the bias with correlation of hydrocephalus). The authors cannot combine different kinds of systemic solid tumors. 

Methos 

Among 16 patients, the real combination of treatment for hydrocephalus and concomitant ITC is available only in 6 patients, with different kind of tumors. So data are not so much to prove something.

What is the final measure of outcome? how are the patients after ITC in the long term outcome? which is the measure of correlation with hydrocephalus?

I stress the fact that the study is really interesting, but on the ITC (for example on breast cancer which is the major treated with ITC) should be provided more data and more measures of outcome, to show results about the combination of treatments in terms of benefits from shunt and from ITC.

The picture of the shunt should be improvided with the latral skull reconstruction where is the valve reservoir: in this way the image looks like the reservoir has direct contact with the brain.

The authors should provide in a table and the text a summary of descriptive data of patients in the results.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

I want to congratulate the authors for considering all the suggestions from the revised old version of the manuscript.

The title is effective

The introduction is clear punctual and precise, emphasizing the real target of the manuscript.

In Materials and Method, the authors highlighted better the population characteristics, improving the figure and the statistical methods.

The results now are better explained in the text.

In the discussion section the explanation about the effect of chemotherapy are better explained, pointing out the role of carcinomatosis .

All the limitations of the study are reported.

The authors' responses are satisfying.