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Mendez Valenzuela CR, Shin K, Weng HY, Plantenga JM, Vanhaezebrouck IF. Radiotherapy for Canine Apocrine Gland Anal Sac Adenocarcinoma: Survival Outcomes and Side Effects of a Palliative Treatment Protocol of 20 Gy in Five Consecutive Fractions. Vet Sci 2024; 11:219. [PMID: 38787191 PMCID: PMC11125963 DOI: 10.3390/vetsci11050219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
This research aims to evaluate the outcomes of a radiotherapy protocol, consisting of five fractions of 4 Gy each, resulting in a total dose of 20 Gy for apocrine gland anal sac tumors and local lymph nodes in canines. This protocol was assessed as a palliative treatment for macroscopic tumors alone, or in combination with additional therapies under different scenarios. Medical records from fifty canine patients met the inclusion criteria and were divided into different treatment groups: radiotherapy alone (n = 22, 44%), radiotherapy with chemotherapy or targeted therapy with toceranib (n = 18, 36%), surgery with radiotherapy (n = 5, 10%), and surgery with radiotherapy and chemotherapy or targeted therapy with toceranib (n = 5, 10%). Patients who received radiotherapy alone had a median survival time of 384 days (95% CI 198-569) and 628 days (95% CI 579-676) for RT + additional therapies. The median time to progression for patients with radiotherapy alone was 337 days (95% CI 282-391 days), and 402 days (95% CI 286-517 days) for radiotherapy plus additional treatments. Acute side effects were mild, with the majority having diarrhea (61%), and only one patient developed grade III late effects VRTOG v2 classification; however, this happened 22 months after the first radiotherapy protocol after re-irradiation. The results demonstrate that radiotherapy alone under this protocol provided a comparable median time to progression vs. radiotherapy plus additional treatments while maintaining acceptable side effects. The combination of this protocol with other treatment modalities offers attractive results for local disease control and survival while maintaining acceptable toxicities. Overall, these findings contribute to the growing evidence supporting the role of radiotherapy in managing apocrine gland anal sac adenocarcinoma in dogs.
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Affiliation(s)
| | - Kelly Shin
- College of Science, Purdue University, West Lafayette, IN 47907, USA
| | - Hsin-Yi Weng
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Jeannie M. Plantenga
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Isabelle F. Vanhaezebrouck
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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Williams C, Parys M, Handel I, Serra JC, Lawrence J. Minimal late radiation toxicity and transient early toxicity following postoperative definitive intent conformal radiation therapy (20 × 2.5 Gy) for canine apocrine gland anal sac adenocarcinoma. Vet Radiol Ultrasound 2021; 63:224-233. [PMID: 34904326 DOI: 10.1111/vru.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/21/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Postoperative radiation therapy (RT) may be beneficial for dogs with anal sac apocrine gland adenocarcinoma (ASAC). Clinically significant late toxicities have been reported in up to 65% of dogs with perianal tumors following non-conformal definitive RT, particularly when fractions of 3 Gy or higher are prescribed. The primary objective of this prospective, descriptive study was to evaluate tolerability of a novel 3D conformal RT (3DCRT) protocol in a group of dogs. Dogs with ASAC were prospectively enrolled if clients elected RT following surgery. The planning target volume was prescribed 50 Gy in 2.5 Gy fractions using 6 MV photons and administered over 26 days. Early and late radiation toxicities were graded according to standardized criteria. Thirteen dogs were initially enrolled but 1 was excluded due to a high risk of anesthesia-related mortality. Seven dogs presented with early stage disease. Median follow up time was 771 days (91-2223). Transient grade 3 dermatitis and anusitis developed in all dogs, with resolution within 4 weeks. Two dogs developed transient grade 2 late colitis. Locoregional failure in the irradiated field was documented in one dog at 738 days. All-cause median survival time was 771 days (95% confidence interval: 510 → 2223 days). Findings indicated that this fractionation may be safely administered to the canine anus and pelvic canal using 3DCRT, although acute toxicity should be anticipated. Further prospective studies are needed in order to confirm long-term tolerability and efficacy.
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Affiliation(s)
- Claire Williams
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK.,Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - Magdalena Parys
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK
| | - Ian Handel
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK
| | - Juan Carlos Serra
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK
| | - Jessica Lawrence
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
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Morello EM, Cino M, Giacobino D, Nicoletti A, Iussich S, Buracco P, Martano M. Prognostic Value of Ki67 and Other Clinical and Histopathological Factors in Canine Apocrine Gland Anal Sac Adenocarcinoma. Animals (Basel) 2021; 11:ani11061649. [PMID: 34199347 PMCID: PMC8228493 DOI: 10.3390/ani11061649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Apocrine gland anal sac adenocarcinoma (AGASACA) is a locally aggressive tumor with a high metastatic rate to the regional ileo-sacral lymph nodes and later to distant sites. Clinical signs depend on the tumor and regional lymph nodes size or on the paraneoplastic hypercalcemia. Therefore, dogs are often referred for perineal swelling, tenesmus, constipation and/or polyuria, polydipsia. Surgical excision of both the neoplastic anal sac and the metastatic regional lymph nodes represents the standard of care. Adjuvant chemotherapy and/or radiotherapy are also indicated. Prognostic factors include tumor size, hypercalcemia, regional lymph nodes metastasis and tumor histologic features. The aim of the study was to retrospectively evaluate the prognostic significance of tumor Ki67 expression. The authors’ hypothesis was that higher Ki67 index correlated with decreased disease-free interval and overall survival time. Clinical data such as tumor size, regional lymph nodes metastasis and hypercalcemia at presentation and histological features such as tumor pattern, mitotic count, necrosis, inflammatory infiltration, vascular invasion, anisokaryosis, and anisocytosis were also investigated and correlated to the oncologic outcome in the dogs included in the study. Abstract Apocrine gland anal sac adenocarcinoma (AGASACA) is locally aggressive and highly metastatic to regional lymph nodes. The aim of this study was to evaluate the prognostic significance of Ki67 in surgically excised AGASACA. Prognostic impact of size, regional lymph nodes metastasis, hypercalcemia, histologic pattern, mitotic count, necrosis, inflammatory and lympho-vascular invasion, anisokaryosis and anisocytosis was also evaluated. Thirty-five dogs were included, twenty-four of which also had metastatic lymph nodes. When the entire population was evaluated, only metastatic disease spread to regional lymph nodes, and necrosis and inflammatory infiltration were correlated to prognosis. When only dogs with metastatic disease were evaluated, size, solid histologic pattern, presence of lymphatic and vascular invasion showed influence on prognosis. Ki67 index was not associated with survival time and disease free interval in any case. The results of this study showed that lymph nodes metastasis at diagnosis reduced disease free interval. Moreover, tumor size greater than 5.25 cm, presence of lymphatic and vascular invasion and a solid histologic pattern were associated with a shorter survival time in dogs with metastasis to regional lymph nodes. Ki67 expression was not significantly associated with prognosis, therefore it could not be considered as a prognostic factor in this tumor type, while the role of hypercalcemia remained unclear.
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Affiliation(s)
- Emanuela Maria Morello
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Marzia Cino
- Department of Medical-Veterinary Science, Univesrity of Parma, Strada del Taglio 10, 43126 Parma, Italy;
- Correspondence: ; Tel.: +39-0521034786
| | - Davide Giacobino
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Arturo Nicoletti
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Selina Iussich
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Paolo Buracco
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Marina Martano
- Department of Medical-Veterinary Science, Univesrity of Parma, Strada del Taglio 10, 43126 Parma, Italy;
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Meier V, Staudinger C, Radonic S, Besserer J, Schneider U, Walsh L, Rohrer Bley C. Reducing margins for abdominopelvic tumours in dogs: Impact on dose-coverage and normal tissue complication probability. Vet Comp Oncol 2021; 19:266-274. [PMID: 33372354 PMCID: PMC8247346 DOI: 10.1111/vco.12671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/08/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022]
Abstract
Image‐guided, intensity modulated radiation therapy (IG‐IMRT) reduces dose to pelvic organs at risk without losing dose coverage to the planning target volume (PTV) and might permit margin reductions potentially resulting in lower toxicity. Appropriate PTV margins have not been established for IG‐IMRT in abdominopelvic tumours in dogs, and herein we explore if our usual PTV 5 mm margin can be reduced further. Datasets from dogs that underwent IG‐IMRT for non‐genitourinary abdominopelvic neoplasia with 5 mm‐PTV expansion were included in this retrospective virtual study. The clinical target volumes and organs at risk (OAR) colon, rectum, spinal cord were adapted to each co‐registered cone‐beam computed tomography (CBCT) used for positioning. New treatment plans were generated and smaller PTV margins of 3 mm and 4 mm evaluated with respect to adequate dose coverage and normal tissue complication probability (NTCP) of OAR. Ten dogs with a total of 70 CBCTs were included. Doses to the OAR of each CBCT deviated mildly from the originally planned doses. In some plans, insufficient build‐up of the high dose‐area at the body surface was found due to inadequate or missing bolus placement. Overall, the margin reduction to 4 mm or 3 mm did not impair dose coverage and led to significantly lower NTCP in all OAR except for spinal cord delayed myelopathy. However, overall NTCP for spinal cord was very low (<4%). PTV‐margins depend on patient immobilization and treatment technique and accuracy. IG‐IMRT allows treatment with very small margins in the abdominopelvic region, ensuring appropriate target dose coverage, while minimizing NTCP.
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Affiliation(s)
- Valeria Meier
- Division of Radiation Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Physics, University of Zurich, Zurich, Switzerland
| | - Chris Staudinger
- Division of Radiation Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Stephan Radonic
- Division of Radiation Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Physics, University of Zurich, Zurich, Switzerland
| | - Jürgen Besserer
- Division of Radiation Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Physics, University of Zurich, Zurich, Switzerland.,Radiation Oncology, Hirslanden Clinic, Zurich, Switzerland
| | - Uwe Schneider
- Division of Radiation Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Physics, University of Zurich, Zurich, Switzerland.,Radiation Oncology, Hirslanden Clinic, Zurich, Switzerland
| | - Linda Walsh
- Department of Physics, University of Zurich, Zurich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Meier V, Besserer J, Roos M, Rohrer Bley C. A complication probability study for a definitive‐intent, moderately hypofractionated image‐guided intensity‐modulated radiotherapy protocol for anal sac adenocarcinoma in dogs. Vet Comp Oncol 2018; 17:21-31. [DOI: 10.1111/vco.12441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 08/08/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Valeria Meier
- Division of Radiation Oncology, Small Animal Department, Vetsuisse FacultyUniversity of Zurich Zurich Switzerland
| | | | - Malgorzata Roos
- Department of Biostatistics, Epidemiology Biostatistics and Prevention Institute, Faculty of MedicineUniversity of Zurich Zurich Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Small Animal Department, Vetsuisse FacultyUniversity of Zurich Zurich Switzerland
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McQuown B, Keyerleber MA, Rosen K, McEntee MC, Burgess KE. Treatment of advanced canine anal sac adenocarcinoma with hypofractionated radiation therapy: 77 cases (1999-2013). Vet Comp Oncol 2016; 15:840-851. [PMID: 26991552 DOI: 10.1111/vco.12226] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 02/14/2016] [Accepted: 02/14/2016] [Indexed: 12/01/2022]
Abstract
Currently no standard of care exists for advanced, inoperable or metastatic anal sac adenocarcinoma (ASAC). The objective of this retrospective study was to assess the role of hypofractionated radiation therapy (RT) in 77 dogs with measurable ASAC. A total of 38% of dogs experienced a partial response to RT. For dogs presenting with clinical signs related to the tumour, improvement or resolution of signs was noted in 63%. For dogs presenting with hypercalcemia of malignancy, resolution was noted in 31% with RT alone and an additional 46% with radiation, prednisone, and/or bisphosphonates. Median overall survival was 329 days (range: 252-448 days). Median progression free survival was 289 days (range: 224-469). There was no difference in survival based on radiation protocol, use of chemotherapy, previous surgery or advanced stage. Radiation toxicities were mild and infrequent. Hypofractionated RT is well tolerated and is applicable in the treatment of advanced primary, locoregional or metastatic ASAC.
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Affiliation(s)
- B McQuown
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - M A Keyerleber
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - K Rosen
- New England Veterinary Oncology Group (NEVOG), Waltham, MA, USA
| | - M C McEntee
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - K E Burgess
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
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