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Gieger TL, Magestro L, Walz J, Yoshikawa H, Nolan MW. Outcomes of Stereotactic Radiation Therapy Versus Fractionated Radiation Therapy in 44 Dogs With Pituitary Masses: A Multi-Institutional Retrospective Study (2016-2022). Vet Comp Oncol 2024. [PMID: 38890790 DOI: 10.1111/vco.12991] [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: 09/18/2023] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024]
Abstract
Although canine pituitary masses (PM) are increasingly treated with stereotactic radiotherapy (SRT), historical literature supports superior outcomes with conventional full-course fractionated radiation therapy (FRT). A multi-institutional retrospective study was performed, including dogs with PM treated from 2016 to 2022 with SRT (total dose 30 or 35 Gy in 5 daily fractions) or FRT (total dose 50-54 Gy in 19-20 daily fractions). The influence of potential prognostic/predictive factors was assessed, including pituitary: brain height, pituitary: brain volume, sex, age and endocrine status (functional [F] vs. nonfunctional [NF] PM). Forty-four dogs with PM were included (26 F, 14 NF, 4 unknown). All patients completed protocols as scheduled (SRT = 27, FRT = 17) and two dogs had suspected Grade 1 acute neurotoxicity. During the first 6 months after RT, 5/27 (19%) dogs treated with SRT (4 F, 1 NF) and 3/17 (18%) dogs treated with FRT (all F) died or were euthanised because of progressive neurologic signs. The overall median survival time was 608 days (95% CI, 375-840 days). Young age at the time of treatment was significant for survival (p = 0.0288); the overall median survival time was 753 days for dogs <9 years of age (95% CI, 614-892 days) and 445 days for dogs ≥9 years of age (95% CI, 183-707 days). Survival time was not associated with treatment type or any other factor assessed herein. A prospective study using standardised protocols would further validate the results of the present study and potentially elucidate the predictors of early death.
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Affiliation(s)
- Tracy L Gieger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Leanne Magestro
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Jillian Walz
- Angell Memorial Animal Medical Center, Boston, Massachusetts, USA
| | - Hiroto Yoshikawa
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Michael W Nolan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Rapastella S, Morabito S, Sharman M, Benoit J, Schiavo L, Morris J, Dobson JM, Scudder CJ. Effect of pituitary-dependent hypercortisolism on the survival of dogs treated with radiotherapy for pituitary macroadenomas. J Vet Intern Med 2023; 37:1331-1340. [PMID: 37218395 PMCID: PMC10365051 DOI: 10.1111/jvim.16724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Radiotherapy (RT) is an effective treatment for dogs presented with neurologic signs caused by pituitary tumors. However, its impact on the outcome of concurrent pituitary-dependent hypercortisolism (PDH) is controversial. OBJECTIVES Determine whether dogs with PDH have longer survival after pituitary RT compared with dogs with nonhormonally active pituitary masses and to evaluate whether clinical, imaging, and RT variables affect survival. ANIMALS Ninety-four dogs divided into 2 groups: PDH and non-PDH, based on the presence of hypercortisolism. Forty-seven dogs were allocated to the PDH group and 47 to the non-PDH group. METHODS Retrospective cohort study in which clinical records of dogs undergoing RT for pituitary macroadenomas between 2008 and 2018 at 5 referral centers were retrospectively evaluated. RESULTS Survival was not statistically different between PDH and non-PDH groups (median survival time [MST], 590 days; 95% confidence interval [CI], 0-830 days and 738 days; 95% CI, 373-1103 days, respectively; P = .4). A definitive RT protocol was statistically associated with longer survival compared with a palliative protocol (MST 605 vs 262 days, P = .05). The only factor statistically associated with survival from multivariate Cox proportional hazard analysis was total radiation dose (Gy) delivered (P < .01). CONCLUSIONS AND CLINICAL IMPORTANCE No statistical difference in survival was identified between the PDH and non-PDH groups, and longer survival was associated with higher Gy delivered.
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Affiliation(s)
- Sofia Rapastella
- Anderson Moores Veterinary Specialists, part of Linnaeus Veterinary Limited, The GranaryWinchesterUK
| | | | - Mellora Sharman
- VetCT ‐ Teleconsulting Hospital, St John's Innovation Centre Cowley Rd CambridgeCambridgeUK
| | | | - Luca Schiavo
- University of Cambridge Ringgold standard institution ‐ Veterinary OncologyCambridgeUK
| | - Joanna Morris
- University of Glasgow School of Veterinary Medicine Ringgold standard institution ‐ Small Animal HospitalGlasgowUK
| | - Jane Margaret Dobson
- Department of Veterinary MedicineUniversity of Cambridge, Queen's Veterinary School HospitalCambridgeUK
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Van Stee LL, Van Rijn SJ, Galac S, Meij BP. Challenges of transsphenoidal pituitary surgery in severe brachycephalic dogs. Front Vet Sci 2023; 10:1154617. [PMID: 37408830 PMCID: PMC10318542 DOI: 10.3389/fvets.2023.1154617] [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: 01/30/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Transsphenoidal hypophysectomy is the standard surgical technique for the excision of pituitary neoplasms. Anatomy may be more obscured in brachycephalic skull types due to the crowding of soft tissue and osseous structures. We describe the unique challenges to approach the sphenoid bone and localize the correct burr hole site in severe brachycephalic dogs. Materials and methods A single institution retrospective case series of brachycephalic dogs with pituitary-dependent hypercortisolism (PDH). Preoperative computed tomography enabled 3D-, and cross-sectional reconstruction to plan and dry-practice the position of the ideal burr hole in relation to the sella turcica, pterygoid hamular processes, and hard palate. Rostral burring of the caudal hard palate obscuring the direct sphenoid approach necessitated adaptations to the original transsphenoidal hypophysectomy procedure. Postoperative outcomes and complications with respect to those seen in mesocephalic dogs are described. Results Ten brachycephalic dogs including French Bulldogs (n = 9) and a single Dogue de Bordeaux were included. All dogs were diagnosed with PDH and had preoperative advanced imaging performed on the skull. All but one dog had an enlarged pituitary gland, with a median pituitary/brain value of 0.5 (range 0.21-0.9). A total of 11 transsphenoidal hypophysectomy procedures were performed in these 10 dogs. Rostral extension of the soft palate incision into the hard palate was performed to access the burr hole site on the sphenoid bone. Major complications included aspiration pneumonia (n = 1), severe gastroesophageal reflux (n = 1), and central nervous signs (=1). All dogs survived until discharge, with a median time to follow-up of 618 days (range 79-1,669 days). Seven dogs experienced long-term remission of PDH. Conclusion Brachycephalic dogs undergoing transsphenoid al hypophysectomy benefit from meticulous presurgical planning and extension of the approach into the caudal hard palate. Advanced surgical skills can render a good outcome in a technically challenging environment.
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Affiliation(s)
- Lucinda L. Van Stee
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Sarah J. Van Rijn
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Sara Galac
- Small Animal Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Björn P. Meij
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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Effects of Staged Nursing Care on Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection and Postoperative Complications. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2171529. [PMID: 35966740 PMCID: PMC9374548 DOI: 10.1155/2022/2171529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 12/30/2022]
Abstract
Objective The purpose of this study was to determine whether staged nursing had an impact on the outcome of neuroendoscopic transsphenoidal pituitary tumor resection and postoperative complications. Methods As research participants, we chose 88 individuals with pituitary adenomas who were treated at our institution between February 2020 and November 2021; all patients received endoscopic transsphenoidal pituitary adenoma excision. The patients were randomly divided into two groups: the routine group (n = 44) and the stage group (n = 44). Patients in the routine group received care according to the routine nursing mode, and patients in the stage group received care according to the stage nursing mode. The staged nursing interventions included preoperative, intraoperative, and postoperative nursing. Postoperative recovery-related indicators such as the self-rating anxiety scale (SAS) and a self-rating depression scale (SDS), contentment, comfort, and postoperative complications were compared between the two groups. Results The postoperative recovery-related indexes of patients in the stage group were significantly lower than those in the routine group (P < 0.05); the SAS and SDS scores in the stage group after treatment were significantly lower than those in the routine group (P < 0.05); patients in the stage group were significantly more satisfied with their treatment after treatment than those in the routine group (P < 0.05); patients in the stage group were significantly more comfortable after treatment than those in the routine group (P < 0.05); a significantly lower incidence of postoperative complications was observed in the stage group compared to the routine group (P < 0.05). Conclusion Patients with neuroendoscopic transsphenoidal pituitary tumor excision benefit greatly from staged nursing. The nursing approach may successfully assure the procedure's smooth completion, boost patients' postoperative recovery, and reduce patients' worry, despair, and other unpleasant feelings. The nursing approach may successfully increase clinical satisfaction and comfort of patients by minimizing the likelihood of postoperative problems, and it is well-suited for practical use.
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Staudinger C, Meier V, Beckmann K, Körner M, Rohrer Bley C. Treatment of intracranial neoplasia in dogs using higher doses: A randomized controlled trial comparing a boosted to a conventional radiation protocol. Vet Med (Auckl) 2022; 36:1353-1364. [PMID: 35775129 PMCID: PMC9308416 DOI: 10.1111/jvim.16472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Local progression of intracranial tumors can be the consequence of insufficient radiation dose delivered. Dose increases in the brain must be made carefully so as not to risk debilitating adverse effects such as radiation necrosis. HYPOTHESIS A new protocol with 10 × 4 Gy + 11% physical dose increase limited to the macroscopic tumor volume results in a clinically better outcome compared to a 10 × 4 Gy protocol. ANIMALS Fifty-seven client-owned dogs with primary intracranial neoplasia. METHODS Randomized controlled trial. Twenty-eight dogs were assigned to the control protocol (10 × 4 Gy) and 29 to the simultaneous integrated boost (SIB) protocol with 4.45 Gy dose increase. Treatment groups were compared for outcome and signs of toxicity. RESULTS Mild, transient acute or early-delayed adverse radiation effects were observed in 5 dogs. Severe late adverse effects were not seen. Between the protocols, no significant differences were found for outcome (intention-to-treat analysis): overall time to progression (TTP) was 708 days (95% confidence interval (95% CI) [545,872]), in the control group it was 828 days (95% CI [401,1256]), and in the SIB group 627 days (95% CI [282,973]; P = .07). Median overall survival (OS) was 684 days (95% CI [516,853]), in the control group it was 724 days (95% CI [623,826]), and in the SIB group 557 days (95% CI [95,1020]; P = .47). None of the tested variables was prognostic in terms of outcome. CONCLUSION AND CLINICAL IMPORTANCE The dose escalation used with an 11% physical dose increase did not result in better outcome.
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Affiliation(s)
- Chris Staudinger
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Valeria Meier
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Physics, University of Zurich, Zurich, Switzerland
| | - Katrin Beckmann
- Division of Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Maximilian Körner
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Rodriguez P, Guzman DSM, Robertson J, La Porte AD, Hawkins MG, Paul-Murphy JR, Hansen KS. Stereotactic Radiation Treatment of a Pituitary Mass in a Rabbit (Oryctolagus cuniculus). J Exot Pet Med 2022. [DOI: 10.1053/j.jepm.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Morsink NC, Klaassen NJM, Meij BP, Kirpensteijn J, Grinwis GCM, Schaafsma IA, Hesselink JW, Nijsen JFW, van Nimwegen SA. Case Report: Radioactive Holmium-166 Microspheres for the Intratumoral Treatment of a Canine Pituitary Tumor. Front Vet Sci 2021; 8:748247. [PMID: 34805338 PMCID: PMC8600255 DOI: 10.3389/fvets.2021.748247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In this case study, a client-owned dog with a large pituitary tumor was experimentally treated by intratumoral injection of radioactive holmium-166 microspheres (166HoMS), named 166Ho microbrachytherapy. To our knowledge, this is the first intracranial intratumoral treatment through needle injection of radioactive microspheres. Materials and Methods: A 10-year-old Jack Russell Terrier was referred to the Clinic for Companion Animal Health (Faculty of Veterinary Medicine, Utrecht University, The Netherlands) with behavioral changes, restlessness, stiff gait, and compulsive circling. MRI and CT showed a pituitary tumor with basisphenoid bone invasion and marked mass effect. The tumor measured 8.8 cm3 with a pituitary height-to-brain area (P/B) ratio of 1.86 cm-1 [pituitary height (cm) ×10/brain area (cm2)]. To reduce tumor volume and neurological signs, 166HoMS were administered in the tumor center by transsphenoidal CT-guided needle injections. Results: Two manual CT-guided injections were performed containing 0.6 ml of 166HoMS suspension in total. A total of 1097 MBq was delivered, resulting in a calculated average tumor dose of 1866 Gy. At 138 days after treatment, the tumor volume measured 5.3 cm3 with a P/B ratio of 1.41 cm-1, revealing a total tumor volume reduction of 40%. Debulking surgery was performed five months after 166HoMS treatment due to recurrent neurological signs. The patient was euthanized two weeks later at request of the owners. Histopathological analysis indicated a pituitary adenoma at time of treatment, with more malignant characteristics during debulking surgery. Conclusion: The 40% tumor volume reduction without evident severe periprocedural side effects demonstrated the feasibility of intracranial intratumoral 166HoMS treatment in this single dog.
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Affiliation(s)
- Nino Chiron Morsink
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Nienke Johanna Maria Klaassen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Björn Petrus Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jolle Kirpensteijn
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Irene Afra Schaafsma
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jan Willem Hesselink
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Johannes Frank Wilhelmus Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Quirem Medical, Deventer, Netherlands
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Sanders K, Galac S, Meij BP. Pituitary tumour types in dogs and cats. Vet J 2021; 270:105623. [PMID: 33641809 DOI: 10.1016/j.tvjl.2021.105623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/25/2022]
Abstract
Pituitary tumours are common in dogs and are being increasingly recognized in cats. Pituitary tumours are usually classified as adenomas and should only be classified as carcinomas when there is evidence of metastatic spread of the tumour, which is rare. Despite the benign nature of most pituitary tumours, they can still compress or invade neighbouring tissues. Pituitary tumours can be functional (hormonally active) or non-functional (hormonally silent). The aim of this review was to provide an overview of the different pituitary tumour types in dogs and cats that have been reported in the literature. In dogs, the most common pituitary tumour type is the corticotroph adenoma, which can cause pituitary-dependent hypercortisolism. In cats, the most common pituitary tumour is the somatotroph adenoma, which can cause hypersomatotropism, and the second-most common is the corticotroph adenoma. A lactotroph adenoma has been described in one dog, while gonadotroph, thyrotroph and null cell adenomas have not been described in dogs or cats. Hormonally silent adenomas are likely underdiagnosed because they do not result in an endocrine syndrome. Tools used to classify pituitary tumours in humans, particularly immunohistochemistry for lineage-specific transcription factors, are likely to be useful to classify canine and feline pituitary tumours of unknown origin. Future studies are required to better understand the full range of pituitary adenoma pathology in dogs and cats and to determine whether certain adenoma subtypes behave more aggressively than others. Currently, the mechanisms that underlie pituitary tumorigenesis in dogs and cats are still largely unknown. A better understanding of the molecular background of these tumours could help to identify improved pituitary-targeted therapeutics.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
| | - S Galac
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - B P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
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Rivenburg R, Owen TJ, Martin LG, Chen AV. Pituitary Surgery: Changing the Paradigm in Veterinary Medicine in the United States. J Am Anim Hosp Assoc 2021; 57:73-80. [PMID: 33450023 DOI: 10.5326/jaaha-ms-7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 11/11/2022]
Abstract
Medical management is currently the most common treatment for pituitary-dependent hyperadrenocorticism and hypersomatotropism/acromegaly in veterinary medicine. Medical management does not provide a cure for either disease process, and rarely is pituitary imaging a part of initial diagnostics. Early pituitary imaging in animals with clinically functional pituitary tumors provides a baseline assessment, allows monitoring of tumor changes, and permits radiation and surgical planning. Surgery is the only treatment for pituitary tumors that has curative intent and allows for a definitive diagnosis. Surgical removal of pituitary tumors via transsphenoidal hypophysectomy is an effective treatment for clinical pituitary tumors in patients exhibiting endocrine abnormalities associated with pituitary-dependent hyperadrenocorticism and hypersomatotropism. Surgery, however, is rarely pursued until patients have failed medical management, and often not until they are showing neurologic signs, making surgical success challenging. It is well documented that dogs surgically treated when the pituitary mass is small have a lower mortality, a lower recurrence rate, and a longer survival than those with larger pituitary masses. Providing owners with the option of early pituitary imaging in addition to medical, surgical, and radiation treatment options should be the standard of care for animals diagnosed with pituitary-dependent hyperadrenocorticism or hypersomatotropism.
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10
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Gieger TL, Nolan MW. Treatment outcomes and target delineation utilizing CT and MRI in 13 dogs treated with a uniform stereotactic radiation therapy protocol (16 Gy single fraction) for pituitary masses: (2014-2017). Vet Comp Oncol 2020; 19:17-24. [PMID: 32548944 DOI: 10.1111/vco.12627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 12/31/2022]
Abstract
Canine pituitary tumours are increasingly treated with stereotactic radiotherapy (SRT). Here, we report clinical outcomes in dogs treated with single-fraction SRT; we also explore technical aspects of SRT treatment planning. A single-institution retrospective study was performed, including any dog with a pituitary mass (PM) that was treated using a standardized single-fraction (16 Gy) SRT protocol between 2014 and 2017. Via medical records review, 13 cases were identified. Nine dogs neurologically improved after SRT. Four dogs experienced MRI-documented tumour volume reduction. Nine dogs experienced neurologic decline in 1.5 to 18 months after SRT and were euthanized. The median overall survival time was 357 days, with 15% alive 18 months after SRT. To better understand whether SRT target delineation is predictably altered by use of magnetic resonance imaging (MRI) in addition to computed tomography (CT), two radiation oncologists (RO) retrospectively re-evaluated all imaging studies used for SRT planning in these 13 cases. Gross tumour volume (GTV) was contoured on co-registered CT and MRIs for each case. In seven cases, CT alone was deemed inadequate for GTV contouring by at least one RO. T1 post-contrast MRI was considered the ideal image for GTV contouring in 11 cases. Contouring on MRI yielded larger GTV than CT for 11 cases. Inter-observer variability existed in each case and was greater for MRI. In summary, use of co-registered CT and MRI images is generally considered advantageous for PM delineation when using SRT. Notably, survival times reported herein are shorter than what has previously been reported for PM treated with finely fractionated full-course RT protocols.
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Affiliation(s)
- Tracy L Gieger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Michael W Nolan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA.,Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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11
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Del Magno S, Fracassi F, Grinwis GCM, Mandrioli L, Gandini G, Rossi F, Sirri R, Pisoni L, Tryfonidou MA, Meij BP. Sequential Treatment of a Large Pituitary Corticotroph Neoplasm and Associated Neurological Signs in a Dog. J Am Anim Hosp Assoc 2019; 55:e55202. [PMID: 30776261 DOI: 10.5326/jaaha-ms-6831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
No standardized treatment guidelines are reported in veterinary medicine for dogs with large pituitary corticotroph neoplasms causing neurological signs, and such dogs usually have a short overall survival. When these dogs undergo pituitary surgery and the tumor regrows there are few reports of subsequent treatments. A 7 yr old male Maltese diagnosed with pituitary-dependent hypercortisolism developed seizures in conjunction with a large pituitary corticotroph adenoma and underwent transsphenoidal hypophysectomy. After 3 yr of clinical remission, hypercortisolism recurred, and trilostane therapy was initiated. One year later, the dog developed new neurological signs and computed tomography revealed regrowth of a large pituitary mass that was then treated with radiation therapy. The dog lived disease-free for 3 more yr. At postmortem examination, a more aggressive pituitary neoplasm than the one examined at the time of surgery was found, which is suggestive of malignant transformation into a carcinoma despite the absence of convincing metastasis.
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Affiliation(s)
- Sara Del Magno
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Federico Fracassi
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Guy C M Grinwis
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Luciana Mandrioli
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Gualtiero Gandini
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Federica Rossi
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Rubina Sirri
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Luciano Pisoni
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Marianna A Tryfonidou
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Björn P Meij
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
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Hansen KS, Zwingenberger AL, Théon AP, Kent MS. Long-term survival with stereotactic radiotherapy for imaging-diagnosed pituitary tumors in dogs. Vet Radiol Ultrasound 2018; 60:219-232. [PMID: 30575174 DOI: 10.1111/vru.12708] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 12/16/2022] Open
Abstract
Published studies on the use of stereotactic radiotherapy for dogs with pituitary tumors are limited. This retrospective observational study describes results of stereotactic radiotherapy for 45 dogs with imaging-diagnosed pituitary tumors. All dogs were treated at a single hospital during the period of December 2009-2015. The stereotactic radiotherapy was delivered in one 15 Gray (Gy) fraction or in three 8 Gy fractions. At the time of analysis, 41 dogs were deceased. Four were alive and censored from all survival analyses; one dog received 8 Gy every other day and was removed from protocol analyses. The median overall survival from first treatment was 311 days (95% confidence interval 226-410 days [range 1-2134 days]). Thirty-two dogs received 15 Gy (median overall survival 311 days; 95% confidence interval [range 221-427 days]), and 12 received 24 Gy on three consecutive days (median overall survival 245 days, 95% confidence interval [range 2-626 days]). Twenty-nine dogs had hyperadrenocorticism (median overall survival 245 days), while 16 had nonfunctional masses (median overall survival 626 days). Clinical improvement was reported in 37/45 cases. Presumptive signs of acute adverse effects within 4 months of stereotactic radiotherapy were noted in 10/45, and most had improvement spontaneously or with steroids. Late effects versus tumor progression were not discernable, but posttreatment blindness (2), hypernatremia (2), and progressive neurological signs (31) were reported. There was no statistical difference in median overall survival for different protocols. Patients with nonfunctional masses had longer median overall survival than those with hyperadrenocorticism (P = 0.0003). Survival outcomes with stereotactic radiotherapy were shorter than those previously reported with definitive radiation, especially for dogs with hyperadrenocorticism.
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Affiliation(s)
- Katherine S Hansen
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, 95616
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, 95616
| | - Alain P Théon
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, 95616
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, 95616
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Sanders K, Kooistra HS, Galac S. Treating canine Cushing's syndrome: Current options and future prospects. Vet J 2018; 241:42-51. [PMID: 30340659 DOI: 10.1016/j.tvjl.2018.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022]
Abstract
Naturally occurring hypercortisolism, also known as Cushing's syndrome, is a common endocrine disorder in dogs that can be caused by an adenocorticotrophic hormone (ACTH)-producing pituitary adenoma (pituitary-dependent hypercortisolism, PDH; 80-85% of cases), or by an adrenocortical tumor (ACT; 15-20% of cases). To determine the optimal treatment strategy, differentiating between these two main causes is essential. Good treatment options are surgical removal of the causal tumor, i.e. hypophysectomy for PDH and adrenalectomy for an ACT, or radiotherapy in cases with PDH. Because these options are not without risks, not widely available and not suitable for every patient, pharmacotherapy is often used. In cases with PDH, the steroidogenesis inhibitor trilostane is most often used. In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. In addition, developments in both adrenal-targeting and pituitary-targeting drugs that have the potential to become future treatment options are discussed, as a more selective and preferably also tumor-targeted approach could have many advantages for both PDH and ACTs.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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