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Evans M, Smithson CW, Peak RM, Coyle V. Canine Oral Lymphoma: A Review and 3 Case Studies. J Vet Dent 2023; 40:358-367. [PMID: 36855316 DOI: 10.1177/08987564231158511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Canine oral lymphoma is an infrequently diagnosed malignancy in dogs and reports in the literature are lacking. Most cases are due to epitheliotropic lymphoma, in which lesions are often multifocal and involve the skin as well as the oral cavity. Epitheliotropic lymphoma is an uncommon form of lymphoma that is characterized by neoplastic T-lymphocyte tropism for epithelial tissues. However, not all cases of oral lymphoma are due to epitheliotropic lymphoma, and B-cell disease is also possible. This article describes very different cases of oral lymphoma in dogs including the history at presentation, examination and radiographic findings, treatments, and outcomes. The cases highlight the variability in signalment, examination findings, and clinical courses that are found with oral lymphoma.
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Affiliation(s)
- Matthew Evans
- The Pet Dentist at Tampa Bay, Wesley Chapel, FL, USA
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Bennett P, Williamson P, Taylor R. Review of Canine Lymphoma Treated with Chemotherapy-Outcomes and Prognostic Factors. Vet Sci 2023; 10:vetsci10050342. [PMID: 37235425 DOI: 10.3390/vetsci10050342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
While canine lymphoma is a relatively common and important disease seen by veterinarians, there are limited comprehensive reviews of the literature regarding the remission and survival times following chemotherapy, and the associated prognostic factors. This comprehensive thematic review covers the available veterinary literature covering treatment outcomes and identified prognostic factors. A lack of standardised approaches to evaluate and report the outcomes was identified, including factors that would alter the duration of responses by weeks, or occasionally months. After publication of the suggested reporting criteria, this has improved but is still not uniformly applied. The prognostic factors included for evaluation varied from as few as three to seventeen, with over 50 studies using only univariate analysis. Individual papers reported much longer outcomes than others, but assessing the outcomes overall, there has been minimal change over the last 40 years. This supports the belief that novel approaches for lymphoma therapy will be required to substantively improve outcomes.
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Affiliation(s)
- Peter Bennett
- The Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
- The University of Sydney Nano Institute, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Peter Williamson
- The Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Rosanne Taylor
- The Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
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Orthovoltage X-Ray Therapy of Large Cell Invasive Nasal Lymphoma in Cat. ACTA VET-BEOGRAD 2023. [DOI: 10.2478/acve-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Feline nasal lymphoma is generally a localized radiosensitive tumor. Treatment options include radiation therapy, chemotherapy, or a combination of both modalities. Radiation therapy (RT) in a combination with chemotherapy lead to median survival from 19 months to 955 days. The objective of this paper is to report a case of a large cell late stage invasive feline nasal lymphoma and to evaluate the results of orthovoltage radiation therapy and its side effects. A 12-year-old female mixed breed cat was presented with nasal discharge, sneezing and hyporexia. Definitive histopathology diagnosis was diffuse large cell lymphoma. Computed tomography revealed an advanced stage of the disease, an intranasal mass, bone lysis, invasion of the orbital space and central nervous system. A radical course of X-ray therapy was performed (SFD = 4 Gy, TSD = 40 Gy, 10 sessions, 3 times a week). Radiation side effects were well tolerated and resolved with supportive treatment. Lymphoma is a systemic process and requires a multidisciplinary approach. On most cases, the penetrating ability of radiation therapy of 3.5 cm in depth is enough for small domestic animals. A significant effect is noted in the middle of the treatment course. The fractionated regime did not cause early radiation damage. The relapse-free period was up to 8 months. The patient had a satisfying quality of life for 5 months. Orthovoltage X-ray therapy can be considered as a treatment choice for local nasal lymphoma. X-ray therapy is a widely used modality in veterinary medicine considering the price of machines and costs of treatment.
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Ko J, Kim J, Choi YK, Nahm SS, Kim J, Seo SM, Seo JS, Lee W, Chung WK, Eom K. Clinical evaluation of toll-like receptor-5 agonist for radiation-induced oral mucositis in beagle dogs. Front Vet Sci 2022; 9:839467. [PMID: 36032288 PMCID: PMC9412099 DOI: 10.3389/fvets.2022.839467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to evaluate the clinical safety and validate the radiomitigative effect of KMRC011, against radiation-induced oral mucositis in beagle dogs. Clinical safety was evaluated by assessing tolerability, complete blood tests, and plasma biochemistry after drug administration. The radiomitigative effect of KMRC011 was evaluated macropathologically and histopathologically after inducing oral mucositis iatrogenically using 20 Gy irradiation. The plasma concentration of interleukin-6 was measured via enzyme-linked immunosorbent assay, as a biomarker of KMRC011 bioreactivity. Decreased tolerability, increased neutrophil count, hepatic enzyme concentration, C-reactive protein concentration, and interleukin-6 concentration after the administration was observed and ceased within 24 h without additional treatment. Although all animals included in the present study developed severe mucositis in the late course of the study, animals administered KMRC011 showed less erythema, ulcer, inflammatory infiltration. These results suggest that KMRC011 may be used as an adjuvant for radiotherapy without severe adverse effects, especially during short-term radiotherapy, such as hypofractionated radiotherapy or stereotactic radiotherapy.
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Affiliation(s)
- Jaeeun Ko
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Yang-Kyu Choi
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Sang-Soep Nahm
- Department of Anatomy, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jayon Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Sun-Min Seo
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jin-Seok Seo
- Department of Anatomy, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | | | - Weon Kuu Chung
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- Weon Kuu Chung
| | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
- *Correspondence: Kidong Eom
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Ramos SC, Macfarlane MJ, Polton G. Isotretinoin treatment of 12 dogs with epitheliotropic lymphoma. Vet Dermatol 2022; 33:345-e80. [PMID: 35637167 DOI: 10.1111/vde.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epitheliotropic lymphoma is an uncommon cutaneous malignancy of T lymphocytes. Limited information is available regarding the treatment and outcome of dogs with this disease. OBJECTIVES To evaluate the treatment outcome and toxicity profile of isotretinoin in dogs with epitheliotropic lymphoma. ANIMALS Twelve dogs with a diagnosis of epitheliotropic lymphoma were included. MATERIALS AND METHODS A medical database was searched for dogs diagnosed with epitheliotropic lymphoma and treated with isotretinoin between 2010 and 2021. Diagnosis, treatment details and tumour response were recorded for 12 dogs. RESULTS All lesions resolved in four of 12 (33%) treated dogs. Lesions visibly improved in a further three dogs, giving a response rate of 58%. Two dogs' lesions remained unchanged and three progressed despite therapy. Adverse effects occurred in three dogs (25%), all of which were rapidly resolving or not affecting quality of life. CONCLUSION Isotretinoin treatment was a well-tolerated and effective treatment for canine epitheliotropic lymphoma.
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Affiliation(s)
- Sofia Chichorro Ramos
- North Downs Specialist Referrals, 3 & 4 The Brewerstreet Dairy Business Park, Bletchingley, UK
| | - Michael John Macfarlane
- North Downs Specialist Referrals, 3 & 4 The Brewerstreet Dairy Business Park, Bletchingley, UK
| | - Gerry Polton
- North Downs Specialist Referrals, 3 & 4 The Brewerstreet Dairy Business Park, Bletchingley, UK
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Niemiec B, Gawor J, Nemec A, Clarke D, McLeod K, Tutt C, Gioso M, Steagall PV, Chandler M, Morgenegg G, Jouppi R. World Small Animal Veterinary Association Global Dental Guidelines. J Small Anim Pract 2020; 61:E36-E161. [PMID: 32715504 DOI: 10.1111/jsap.13132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.
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Seo J, Son J, Cho Y, Park N, Kim DW, Kim J, Yoon M. Kilovoltage radiotherapy for companion animals: dosimetric comparison of 300 kV, 450 kV, and 6 MV X-ray beams. J Vet Sci 2018; 19:550-556. [PMID: 29649856 PMCID: PMC6070583 DOI: 10.4142/jvs.2018.19.4.550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/21/2018] [Accepted: 03/31/2018] [Indexed: 11/20/2022] Open
Abstract
Radiotherapy for the treatment of cancer in companion animals is currently administered by using megavoltage X-ray machines. Because these machines are expensive, most animal hospitals do not perform radiotherapy. This study evaluated the ability of relatively inexpensive kilovoltage X-ray machines to treat companion animals. A simulation study based on a commercial treatment-planning system was performed for tumors of the brain (non-infectious meningoencephalitis), nasal cavity (malignant nasal tumors), forefoot (malignant muscular tumors), and abdomen (malignant intestinal tumors). The results of kilovoltage (300 kV and 450 kV) and megavoltage (6 MV) X-ray beams were compared. Whereas the 300 kV and 6 MV X-ray beams provided optimal radiation dose homogeneity and conformity, respectively, for brain tumors, the 6 MV X-rays provided optimal homogeneity and radiation conformity for nasal cavity, forefoot, and abdominal tumors. Although megavoltage X-ray beams provided better radiation dose distribution in most treated animals, the differences between megavoltage and kilovoltage X-ray beams were relatively small. The similar therapeutic effects of the kilovoltage and 6 MV X-ray beams suggest that kilovoltage X-ray beams may be effective alternatives to megavoltage X-ray beams in treating cancers in companion animals.
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Affiliation(s)
- Jaehyeon Seo
- Department of Bio-Convergence Engineering, Korea University, Seoul 02841, Korea
| | - Jaeman Son
- Department of Bio-Convergence Engineering, Korea University, Seoul 02841, Korea
| | - Yeona Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Nohwon Park
- Korea Animal Cancer Center, Seoul 01684, Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Jinsung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Myonggeun Yoon
- Department of Bio-Convergence Engineering, Korea University, Seoul 02841, Korea
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Chan CM, Frimberger AE, Moore AS. Clinical outcome and prognosis of dogs with histopathological features consistent with epitheliotropic lymphoma: a retrospective study of 148 cases (2003-2015). Vet Dermatol 2017; 29:154-e59. [PMID: 28983988 DOI: 10.1111/vde.12504] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Catherine M. Chan
- Animal Referral Hospital; 250 Parramatta Road, Homebush West Sydney New South Wales 2140 Australia
| | - Angela E. Frimberger
- Veterinary Oncology Consultants; 379 Lake Innes Drive Wauchope New South Wales 2446 Australia
| | - Antony S. Moore
- Veterinary Oncology Consultants; 379 Lake Innes Drive Wauchope New South Wales 2446 Australia
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Alexander AB, Griffin L, Johnston MS. Radiation Therapy of Periorbital Lymphoma in a Blue-and-Gold Macaw (Ara ararauna). J Avian Med Surg 2017; 31:39-46. [DOI: 10.1647/2015-116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fu DR, Kato D, Endo Y, Kadosawa T. Apoptosis and Ki-67 as predictive factors for response to radiation therapy in feline nasal lymphomas. J Vet Med Sci 2016; 78:1161-6. [PMID: 27086717 PMCID: PMC4976272 DOI: 10.1292/jvms.15-0693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nasal lymphoma is the most common nasal tumor in cats and is generally a solitary and
radiosensitive tumor. We retrospectively evaluated the response to radiation and survival
time in relation to apoptosis and Ki-67 indices in feline nasal lymphomas treated with
radiation therapy. The apoptotic and Ki-67 indices were evaluated with TUNEL and
immunohistochemical staining in 30 biopsy tissues that were taken before any treatment.
These two indices were compared, and differences between different treatment response
groups were analyzed. The correlation between the median survival times (MST) and the
indices was estimated using the Kaplan Meier method, and statistical differences between
survival curves were analyzed using a log-rank method. With regard to apoptotic index, a
statistical difference was observed between the samples taken from cats with complete
response and stable disease (1.22% vs. 0.45%; P=0.045). The Ki-67 index
in cats with both complete response and partial response was significantly higher than in
cats with stable disease (44.4% and 39.6% vs. 16.3%; P<0.001 and
P=0.008, respectively). The cats with a high level of apoptosis
(>0.9%) nasal lymphoma were not significantly prolonged MSTs
(P=0.202), however, high Ki-67-positive (>40%) cats experienced a
statistically significant relationship with longer survival time
(P=0.015). Our results indicate that spontaneous apoptotic and Ki-67
indices are strong predictors for response to radiation therapy in feline nasal
lymphomas.
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Affiliation(s)
- Dah-Renn Fu
- Laboratory of Veterinary Clinical Oncology, Small Animal Clinical Sciences, Graduate School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
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Desmas I, Burton JH, Post G, Kristal O, Gauthier M, Borrego JF, Di Bella A, Lara-Garcia A. Clinical presentation, treatment and outcome in 31 dogs with presumed primary colorectal lymphoma (2001-2013). Vet Comp Oncol 2016; 15:504-517. [DOI: 10.1111/vco.12194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/28/2015] [Accepted: 10/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- I. Desmas
- Royal veterinary College; Hatfield UK
| | - J. H. Burton
- Flint Animal Cancer Center; Department of Clinical Sciences, Colorado State University; Fort Collins CO USA
| | - G. Post
- The Veterinary Cancer Center; Norwalk CT USA
| | - O. Kristal
- Chavat Daat Veterinary Speciality Center; Beit Berl Israel
| | - M. Gauthier
- Mississauga Oakville Veterinary Emergency Hospital and Referral Services; Oakville ON Canada
| | - J. F. Borrego
- School of Veterinary Medicine; University of Madison-Wisconsin; Madison WI USA
| | - A. Di Bella
- Vets Now Referrals; Medicine Service; Glasgow UK
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George R, Smith A, Schleis S, Brawner W, Almond G, Kent M, Wypij J, Borrego J, Moore A, Keyerleber M, Kraiza S. OUTCOME OF DOGS WITH INTRANASAL LYMPHOMA TREATED WITH VARIOUS RADIATION AND CHEMOTHERAPY PROTOCOLS: 24 CASES. Vet Radiol Ultrasound 2016; 57:306-12. [PMID: 26763938 DOI: 10.1111/vru.12318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 09/10/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022] Open
Abstract
Tumors of the nasal cavity comprise approximately 1% of all neoplasms in dogs. Canine intranasal lymphoma is rare and reports evaluating the outcome of treatment are lacking. The goal of this observational, descriptive, multi-institutional study was to evaluate the overall median survival times (MSTs) in a group of dogs with intranasal lymphoma that were treated with irradiation and/or chemotherapy. Dogs meeting these inclusion criteria were retrospectively recruited from medical archives at multiple institutions. Eighteen cases of intermediate to high grade intranasal lymphoma and six cases of low-grade intranasal lymphoma were identified. The date of diagnosis, method of diagnosis, treatment received (radiation and/or chemotherapy protocols), and date of death were recorded. Kaplan-Meier survival analysis was performed on the intermediate to high grade group to calculate overall MST. Log-rank tests were performed to compare effects of treatment with radiation therapy ± chemotherapy and chemotherapy alone. Kaplan-Meier survival analysis was performed separately on the low-grade group. The overall MST was 375 days for the intermediate to high grade group. Cases treated with radiation ± chemotherapy had an MST of 455 days (n = 12) and those treated with chemotherapy alone (n = 6) had an MST of 157 days in the intermediate to high grade group. The MST was 823 days for the low-grade group. Results support the use of radiation therapy for treatment of canine intranasal lymphoma, however a randomized, controlled, clinical trial would be needed for more definitive recommendations. The role of adjunctive chemotherapy also may require further investigation.
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Affiliation(s)
- Rebecca George
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL, 36849
| | - Annette Smith
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL, 36849
| | - Stephanie Schleis
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL, 36849
| | - William Brawner
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL, 36849
| | - Gregory Almond
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL, 36849
| | - Michael Kent
- Department of Surgical and Radiological Sciences, UC Davis School of Veterinary Medicine, Davis, CA, 95616
| | - Jackie Wypij
- Department of Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana-Champaign, IL, 61802
| | - Juan Borrego
- Instituto Veterinario de Oncología Comparada (IVOC), Valencia, España, and University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI, 53706
| | - Antony Moore
- Veterinary Oncology Consultants, Wauchope, New South Wales, Australia, 2446
| | - Michele Keyerleber
- Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536 and Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, 14853
| | - Sarah Kraiza
- Florida Veterinary Referral Center, Estero, FL, 33928
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Holtermann N, Kiupel M, Kessler M, Teske E, Betz D, Hirschberger J. Masitinib monotherapy in canine epitheliotropic lymphoma. Vet Comp Oncol 2015; 14 Suppl 1:127-35. [DOI: 10.1111/vco.12157] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 04/19/2015] [Accepted: 05/04/2015] [Indexed: 12/18/2022]
Affiliation(s)
- N. Holtermann
- Medizinische Kleintierklinik; Ludwig Maximilians University Munich; Munich Germany
| | - M. Kiupel
- Department of Pathology and Diagnostic Investigations, College of Veterinary Medicine, Michigan State University; Diagnostic Center for Population and Animal Health; Lansing MI USA
| | - M. Kessler
- Tierklinik Hofheim; Im Langgewann 9; 65719 Hofheim/Taunus Germany
| | - E. Teske
- Department of Clinical Sciences of Companion Animals, Veterinary Faculty; Utrecht University; Utrecht The Netherlands
| | - D. Betz
- Klinik für Kleintiere; Tierärztliche Hochschule Hannover; Hannover Germany
| | - J. Hirschberger
- Medizinische Kleintierklinik; Ludwig Maximilians University Munich; Munich Germany
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