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Stokes R, Wustefeld-Janssens BG, Hinson W, Wiener DJ, Hollenbeck D, Bertran J, Mickelson M, Chen CL, Selmic L, Aly A, Hayes G. Surgical and oncologic outcomes in dogs with malignant peripheral nerve sheath tumours arising from the brachial or lumbosacral plexus. Vet Comp Oncol 2023; 21:739-747. [PMID: 37727977 DOI: 10.1111/vco.12938] [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] [Received: 04/07/2023] [Revised: 08/12/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Malignant peripheral nerve sheath tumours (MPNST) of a plexus nerve or nerve root cause significant morbidity and present a treatment challenge. The surgical approach can be complex and information is lacking on outcomes. The objective of this study was to describe surgical complication rates and oncologic outcomes for canine MPNST of the brachial or lumbosacral plexus. Dogs treated for a naïve MPNST with amputation/hemipelvectomy with or without a laminectomy were retrospectively analysed. Oncologic outcomes were disease free interval (DFI), overall survival (OS), and 1- and 2-year survival rates. Thirty dogs were included. The surgery performed was amputation alone in 17 cases (57%), and amputation/hemipelvectomy with laminectomy in 13 cases (43%). Four dogs (13%) had an intraoperative complication, while 11 dogs (37%) had postoperative complications. Histologic margins were reported as R0 in 12 dogs (40%), R1 in 12 dogs (40%), and R2 in five dogs (17%). No association was found between histologic grade and margin nor extent of surgical approach and margin. Thirteen dogs (46%) had recurrence. The median DFI was 511 days (95% CI: 140-882 days). The median disease specific OST was 570 days (95% CI: 467-673 days) with 1- and 2-year survival rates of 82% and 22% respectively. No variables were significantly associated with recurrence, DFI, or disease specific OST. These data show surgical treatment of plexus MPNST was associated with a high intra- and postoperative complication rate but relatively good disease outcomes. This information can guide clinicians in surgical risk management and owner communication regarding realistic outcomes and complications.
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Affiliation(s)
- Rebecca Stokes
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Brandan G Wustefeld-Janssens
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Whitney Hinson
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Dominique J Wiener
- Department of Veterinary Pathobiology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Danielle Hollenbeck
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Judith Bertran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Megan Mickelson
- Veterinary Health Center, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Carolyn L Chen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ali Aly
- Departmet of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Galina Hayes
- Departmet of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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2
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Yoshikawa H, Lafferty MH, Griffin LR, LaRue SM. A retrospective study of sinonasal tumors in 182 dogs treated with stereotactic radiotherapy (3 × 10 Gy) (2010-2015). J Vet Intern Med 2023; 37:2356-2367. [PMID: 37688322 PMCID: PMC10658520 DOI: 10.1111/jvim.16838] [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] [Received: 07/27/2022] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Stereotactic radiotherapy (SRT) is an emerging treatment for sinonasal tumors in dogs. Reported results regarding tumor control and incidence of acute and late radiation morbidities are inconsistent. OBJECTIVES To determine treatment efficacy and prognostic indicators of SRT in dogs with sinonasal tumors and to quantify acute and late radiation morbidities. ANIMALS One hundred and eighty-two client-owned dogs with sinonasal tumors diagnosed cytologically, histologically, or radiographically that underwent SRT. METHODS Single-arm retrospective study by reviewing medical records of dogs treated with SRT (10 Gy × 3) between 2010 and 2015. Kaplan-Meier analysis was used to determine overall survival (OST; from the first day of SRT to death by any cause) and disease-specific survival times (DSST; OST but censoring tumor/treatment-unrelated death). Tumors were staged using modified Adams criteria. RESULTS Median OST and DSST of dogs treated with 1 course of SRT was 441 (95% CI: 389-493 days) and 482 (428-536 days) days, respectively with skin/oral cavity acute morbidities observed in 3% of dogs. DSST in dogs with stage 4 disease showed no statistical difference compared to other stages (P = .64). Oro-nasal (n = 2) or naso-cutaneous (n = 11) fistula development occurred in 7.1% of dogs with median time of 425 days (range: 83-1733 days). Possible chronic rhinitis after SRT was recorded in 54 of 88 dogs (61%) where information was available. CONCLUSIONS AND CLINICAL IMPORTANCE Results are comparable to other reports of treatment of SRT. Acute morbidities were minimal. Modified Adams stage scheme appeared to be inappropriate for prognostication for dogs with sinonasal tumors treated with SRT.
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Affiliation(s)
- Hiroto Yoshikawa
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Mary H. Lafferty
- Flint Animal Cancer CenterColorado State UniversityFort CollinsColoradoUSA
| | - Lynn R. Griffin
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Susan M. LaRue
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
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3
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Espinosa J, Ortega M, Pumarola M, Fraga E, Martín L. Metastatic Multifocal Malignant Peripheral Nerve Sheath Tumour in the Cervicothoracic Spinal Cord of a Dog Initially Mimicking Meningomyelitis. Vet Sci 2023; 10:vetsci10020170. [PMID: 36851474 PMCID: PMC9965354 DOI: 10.3390/vetsci10020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
A nine year old cross-breed dog was presented with a two week history of ambulatory tetraparesis and proprioceptive ataxia affecting all four limbs. Meningomyelitis of Unknown Origin (MUO) was presumptively diagnosed based on the magnetic resonance imaging (MRI) findings and cerebrospinal fluid (CSF) analysis. The dog received a tapering dose of glucocorticoids and cyclosporine, showing significant improvement and the stabilization of the clinical signs for seven months. After this period, the dog showed an acute clinical deterioration and a follow-up MRI revealed new multiple lesions affecting different spinal nerve roots along the cervicothoracic spinal cord. Following euthanasia, a final diagnose of multiple malignant peripheral nerve sheath tumors (MPNSTs) was made based on the histopathological examination. MPNSTs can affect the cranial nerves, spinal nerves or the associated nerve roots at any location and can lead to secondary spinal cord compression. The aim of the present case report is to describe the clinical presentation and atypical MRI findings of a dog with histologically confirmed multiple MPNSTs. According to the reviewed literature, this is the first reported case of simultaneous MPNSTs in the cervicothoracic spinal cord of a dog.
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Affiliation(s)
- Javier Espinosa
- Neurology and Neurosurgery Service of Centro Clínico Veterinario Indautxu, Alameda de San Mamés 38, 48010 Bilbao, Spain
- Neurology and Neurosurgery Service, Pride Referrals, Derby DE248 HX, UK
| | - María Ortega
- Neurology and Neurosurgery Service of Centro Clínico Veterinario Indautxu, Alameda de San Mamés 38, 48010 Bilbao, Spain
| | - Martí Pumarola
- Mouse and Comparative Pathology Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Campus UAB, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Eduardo Fraga
- Fraga Diagnostic España, S.L., Mijas Costa, 29649 Malaga, Spain
| | - Laura Martín
- Neurology and Neurosurgery Service of Centro Clínico Veterinario Indautxu, Alameda de San Mamés 38, 48010 Bilbao, Spain
- Correspondence:
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Marsh O, Shimizu N, Mason SL, Uriarte A. Case Report: A Novel Lateral Approach to the C7, C8, and T1 Intervertebral Foramina for Resection of Malignant Peripheral Nerve Sheath Neoplasia, Followed by Adjunctive Radiotherapy, in Three Dogs. Front Vet Sci 2022; 9:869082. [PMID: 35720837 PMCID: PMC9204227 DOI: 10.3389/fvets.2022.869082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
This case report describes the diagnosis, management and outcome of three dogs with peripheral nerve sheath tumors (PNSTs) involving the brachial plexus, C7 (case 1), C8 (case 2), and C8 and T1 (case 3) spinal nerves and nerve roots with intrathoracic invasion. Surgical resection required thoracic limb amputation and removal of the first rib, facilitating a novel lateral approach to the spinal nerves and foramina in all cases. This was followed by hemilaminectomy and rhizotomy in cases 1 and 2. Adjunctive radiotherapy was then performed in all dogs. All three dogs regained a good quality of life in the short-term following surgery. Two were euthanased after 3 and 10 months, following detection of a pulmonary mass in one case and multiple thoracic and abdominal masses in the other. The third dog was alive and well at the time of writing (7 months post-surgery). This surgical approach facilitated good access and allowed gross neoplastic tissue to be resected. The ease of surgical access was dependent, to a degree, on the size of the patient. This surgical approach can be considered in cases of PNSTs involving the caudal cervical or cranial thoracic spinal nerves and nerve roots. Adjunctive radiotherapy should be considered as part of a multi-modal approach to these challenging tumors due to the difficulty of achieving clean margins, particularly proximally, even with optimal surgical access.
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Affiliation(s)
- Oliver Marsh
- Linnaeus Veterinary Limited, Neurology and Neurosurgery Service, Southfields Veterinary Specialists, Essex, United Kingdom
| | - Naomi Shimizu
- Linnaeus Veterinary Limited, Orthopaedic and Soft Tissue Surgery Service, Southfields Veterinary Specialists, Essex, United Kingdom
| | - Sarah L. Mason
- Linnaeus Veterinary Limited, Oncology Service, Southfields Veterinary Specialists, Essex, United Kingdom
| | - Ane Uriarte
- Linnaeus Veterinary Limited, Neurology and Neurosurgery Service, Southfields Veterinary Specialists, Essex, United Kingdom
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5
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Meier V, Czichon F, Walsh L, Rohrer Bley C. Can volumetric modulated arc radiation therapy reduce organ at risk dose in stage 4 sinonasal tumors in dogs treated with boost irradiation? PLoS One 2021; 16:e0259112. [PMID: 34714825 PMCID: PMC8555811 DOI: 10.1371/journal.pone.0259112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022] Open
Abstract
Intensity modulated radiation therapy (IMRT) introduced marked changes to cancer treatment in animals by reducing dose to organs at risk (OAR). As the next technological step, volumetric modulated arc therapy (VMAT) has advantages (increased degrees-of-freedom, faster delivery) compared to fixed-field IMRT. Our objective was to investigate a possible advantage of VMAT over IMRT in terms of lower OAR doses in advanced-disease sinonasal tumors in dogs treated with simultaneously-integrated boost radiotherapy. A retrospective, analytical, observational study design was applied using 10 pre-existing computed tomography datasets on dogs with stage 4 sinonasal tumors. Each dataset was planned with both, 5-field IMRT and 2 arc VMAT with 10x4.83 Gy to the gross tumor volume and 10x4.2 Gy to the planning target volume. Adequate target dose coverage and normal tissue complication probability of brain ≤5% was required. Dose constraints aspired to were D60 <15 Gy for eyes, D2 <35.4 Gy for corneae, and Dmean <20 Gy for lacrimal glands. OAR dose was statistically significantly higher in IMRT plans than in VMAT plans. Median eye D60% was 18.5 Gy (interquartile range (IQR) 17.5) versus 16.1 Gy (IQR 7.4) (p = 0.007), median lacrimal gland dose 21.8 Gy (IQR 20.5) versus 18.6 Gy (IQR 7.0) (p = 0.013), and median cornea D2% 45.5 Gy (IQR 6.8) versus 39.9 Gy (IQR 10.0) (p<0.005) for IMRT versus VMAT plans, respectively. Constraints were met in 21/40 eyes, 7/40 corneae, and 24/40 lacrimal glands. Median delivery time was significantly longer for IMRT plans than for VMAT plans (p<0.01). Based on these results, VMAT plans were found to be superior in sparing doses to eyes, lacrimal glands, corneae. However, not all ocular OAR constraints could be met while ensuring adequate dose coverage and restricting brain toxicity risk for both planning techniques.
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Affiliation(s)
- Valeria Meier
- Vetsuisse Faculty, Department for Small Animals, Division of Radiation Oncology, University of Zurich, Zurich, Switzerland
- Department of Physics, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Felicitas Czichon
- Vetsuisse Faculty, Department for Small Animals, Division of Radiation Oncology, University of Zurich, Zurich, Switzerland
| | - Linda Walsh
- Department of Physics, University of Zurich, Zurich, Switzerland
| | - Carla Rohrer Bley
- Vetsuisse Faculty, Department for Small Animals, Division of Radiation Oncology, University of Zurich, Zurich, Switzerland
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6
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Boland L, Setyo L, Sangster C, Brunel L, Foo T, Bennett P. Colonic malignant peripheral nerve sheath tumour in a cat. JFMS Open Rep 2019; 5:2055116919849979. [PMID: 31236282 PMCID: PMC6572897 DOI: 10.1177/2055116919849979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Case summary A 14-year-old male neutered domestic mediumhair cat presented with a 4 month
history of inappetence and weight loss. Pertinent abnormalities on
haematology and biochemistry included a mild microcytic regenerative anaemia
(packed cell volume [PCV] 24% [reference interval (RI) 30–45%], mean cell
volume 30.8 fl [RI 40–45 fl], absolute reticulocyte count 326.8 ×
1012) and increased alkaline phosphatase activity (76 IU/l;
RI <50 IU/l). Abdominal ultrasound and CT scan revealed masses in the
transverse colon (2.0 cm × 1.2 cm) and right medial liver lobe (5.0 cm
diameter). Thoracic radiographs were unremarkable. Right medial liver lobe
resection and colectomy were performed. Immunohistochemistry was positive
for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly
positive for c-kit and negative for muscle-specific actin and CD18,
consistent with a colonic malignant peripheral nerve sheath tumour (MPNST)
with a hepatic metastasis. Postoperative treatment with metronomic
cyclophosphamide was well tolerated. Eighteen months postoperatively the cat
re-presented after 3 days of progressive lethargy and inappetence.
Haematology revealed a marked non- or pre-regenerative anaemia (PCV 10%).
Coagulation times were prolonged (prothrombin time 39 s [RI 15–22 s] and
activated partial thromboplastin time >300 s [RI 65–119 s]). Abdominal
ultrasound identified multiple renal and hepatic nodules. Euthanasia was
performed and post-mortem examination confirmed metastasis of the MPNST. Relevance and novel information This report describes the treatment of a metastatic colonic peripheral nerve
sheath tumour in a cat. Feline visceral MPNSTs are rare and little is known
about prognosis or optimal treatment.
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Affiliation(s)
- Lara Boland
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laura Setyo
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Cheryl Sangster
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Timothy Foo
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Peter Bennett
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
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7
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Poli F, Calistri M, Mandara MT, Baroni M. Central nervous system metastasis of an intradural malignant peripheral nerve sheath tumor in a dog. Open Vet J 2019; 9:49-53. [PMID: 31086766 PMCID: PMC6500854 DOI: 10.4314/ovj.v9i1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/14/2019] [Indexed: 11/17/2022] Open
Abstract
An 8-yr-old French Bulldog was presented with a non-ambulatory tetraparesis. Magnetic resonance showed an intradurally located mass at the level of the right second cervical nerve root. The mass was surgically removed and the dog was ambulatory within 4 d. A 10-mo post-surgical imaging follow-up revealed a recurrence of the primary mass and another intradural/intramedullary mass at the level of the first thoracic vertebral body. Overall histological features were suggestive of malignant peripheral nerve sheath tumor (MPNST) for both masses. Immunohistochemistry was found weak but diffusely positive for S-100 and neurono-specific enolase for both masses. A diagnosis of primary MPNST for the cervical mass and of metastasis for the thoracic mass was made, possibly disseminated via the subarachnoidal space. To our knowledge, the central nervous system metastasis of MPNSTs has not previously been reported in dogs. The clinician should be aware that these tumors, albeit rarely, can metastasize to the central nervous system.
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Affiliation(s)
- Federica Poli
- Valdinievole Veterinary Clinic, Via Costantino Nigra, Monsummano Terme (PT), Italy
| | - Maurizio Calistri
- Valdinievole Veterinary Clinic, Via Costantino Nigra, Monsummano Terme (PT), Italy
| | - Maria Teresa Mandara
- University of Perugia, Department of Veterinary Medicine, Via San Costanzo, Perugia, Italy
| | - Massimo Baroni
- Valdinievole Veterinary Clinic, Via Costantino Nigra, Monsummano Terme (PT), Italy
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8
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Dunfield EM, Turek MM, Buhr KA, Christensen NI. A survey of stereotactic radiation therapy in veterinary medicine. Vet Radiol Ultrasound 2018; 59:786-795. [PMID: 30062728 DOI: 10.1111/vru.12671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/14/2018] [Accepted: 05/22/2018] [Indexed: 12/31/2022] Open
Abstract
Radiotherapy plays an important role in curative and palliative cancer treatment. As a novel radiation delivery technique, stereotactic radiotherapy utilizes three-dimensional-conformal treatment planning, high-precision beam delivery technology, and patient specific position verification to target tumors, often in one to five high-dose fractions. Currently, there is no consensus about best stereotactic radiotherapy practices in veterinary radiotherapy. The objective of this study was to document the breadth of perspectives, techniques, and applications of stereotactic radiotherapy in veterinary medicine. We conducted an online survey of American College of Veterinary Radiology members specializing in radiation oncology to assess how, when, and why stereotactic radiotherapy is being used. Both stereotactic radiotherapy users and nonusers completed the survey. The overall response and survey completion rates were 54% (67/123) and 87% (58/67), respectively. Overall, 55% of respondents reported providing stereotactic radiotherapy at their facility, with a median of 4.5 canine cases and one feline case per month. Delivery methods included C-arm linear accelerator with multi-leaf collimator, helical tomotherapy, and CyberKnife. Nonpituitary intracranial tumors, pituitary tumors, and sinonasal tumors were the most common cancers treated using stereotactic radiotherapy in both species. The most common fractionation scheme was three fractions of 10 Gy/fraction. The results of this survey suggest common availability of stereotactic radiotherapy in veterinary radiation facilities. These results provide valuable information regarding current stereotactic radiotherapy practices in veterinary medicine, and may provide an initial step toward standardizing methods and establishing consensus guidelines.
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Affiliation(s)
- Elizabeth M Dunfield
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706
| | - Michelle M Turek
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706
| | - Kevin A Buhr
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53706
| | - Neil I Christensen
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706
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9
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Dolera M, Malfassi L, Marcarini S, Mazza G, Carrara N, Pavesi S, Sala M, Finesso S, Urso G. High dose hypofractionated frameless volumetric modulated arc radiotherapy is a feasible method for treating canine trigeminal nerve sheath tumors. Vet Radiol Ultrasound 2018; 59:624-631. [PMID: 29885013 DOI: 10.1111/vru.12637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 12/31/2022] Open
Abstract
The aim of this prospective pilot study was to evaluate the feasibility and effectiveness of curative intent high dose hypofractionated frameless volumetric modulated arc radiotherapy for treatment of canine trigeminal peripheral nerve sheath tumors. Client-owned dogs with a presumptive imaging-based diagnosis of trigeminal peripheral nerve sheath tumor were recruited for the study during the period of February 2010 to December 2013. Seven dogs were enrolled and treated with high dose hypofractionated volumetric modulated arc radiotherapy delivered by a 6 MV linear accelerator equipped with a micro-multileaf beam collimator. The plans were computed using a Monte Carlo algorithm with a prescription dose of 37 Gy delivered in five fractions on alternate days. Overall survival was estimated using a Kaplan-Meier curve analysis. Magnetic resonance imaging (MRI) follow-up examinations revealed complete response in one dog, partial response in four dogs, and stable disease in two dogs. Median overall survival was 952 days with a 95% confidence interval of 543-1361 days. Volumetric modulated arc radiotherapy was demonstrated to be feasible and effective for trigeminal peripheral nerve sheath tumor treatment in this sample of dogs. The technique required few sedations and spared organs at risk. Even though larger studies are required, these preliminary results supported the use of high dose hypofractionated volumetric modulated arc radiotherapy as an alternative to other treatment modalities.
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Affiliation(s)
- Mario Dolera
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Luca Malfassi
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Silvia Marcarini
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Giovanni Mazza
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Nancy Carrara
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Simone Pavesi
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Massimo Sala
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Sara Finesso
- La Cittadina Fondazione Studi e Ricerche Veterinarie, Lodi, Italy
| | - Gaetano Urso
- Azienda Ospedaliera della Provincia di Lodi, Lodi, Italy
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10
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Dolera M, Malfassi L, Carrara N, Finesso S, Marcarini S, Mazza G, Pavesi S, Sala M, Urso G. Volumetric Modulated Arc (Radio) Therapy in Pets Treatment: The "La Cittadina Fondazione" Experience. Cancers (Basel) 2018; 10:E30. [PMID: 29364837 PMCID: PMC5836062 DOI: 10.3390/cancers10020030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/29/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022] Open
Abstract
Volumetric Modulated Arc Therapy (VMAT) is a modern technique, widely used in human radiotherapy, which allows a high dose to be delivered to tumor volumes and low doses to the surrounding organs at risk (OAR). Veterinary clinics takes advantage of this feature due to the small target volumes and distances between the target and the OAR. Sparing the OAR permits dose escalation, and hypofractionation regimens reduce the number of treatment sessions with a simpler manageability in the veterinary field. Multimodal volumes definition is mandatory for the small volumes involved and a positioning device precisely reproducible with a setup confirmation is needed before each session for avoiding missing the target. Additionally, the elaborate treatment plan must pursue hard constraints and objectives, and its feasibility must be evaluated with a per patient quality control. The aim of this work is to report results with regard to brain meningiomas and gliomas, trigeminal nerve tumors, brachial plexus tumors, adrenal tumors with vascular invasion and rabbit thymomas, in comparison with literature to determine if VMAT is a safe and viable alternative to surgery or chemotherapy alone, or as an adjuvant therapy in pets.
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Affiliation(s)
- Mario Dolera
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Luca Malfassi
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Nancy Carrara
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Sara Finesso
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Silvia Marcarini
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Giovanni Mazza
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Simone Pavesi
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Massimo Sala
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Gaetano Urso
- Azienda Socio Sanitaria Territoriale della provincia di Lodi, 26841 Casalpusterlengo, Italy.
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