Long-term outcomes with conventional fractionated and stereotactic radiotherapy for suspected heart-base tumours in dogs

Published radiotherapy results for suspected heart-based tumours in dogs are limited. In this retrospective longitudinal study (3/2014-2019), eight dogs with either clinical signs attributable to a heart-base mass (6), or asymptomatic with a progressively larger mass on echocardiogram (2), received conventional fractionated radiotherapy (CFRT) or stereotactic body radiotherapy (SBRT). Clinical findings in symptomatic cases included one or more of the following: retching/coughing (4), exercise intolerance (2), collapse (1), pericardial effusion (2), rare ventricular premature contractions (2), abdominal effusion (1), or respiratory distress due to chylothorax (1). CFRT cases received 50 Gray (Gy) in 20 fractions and SBRT cases received 30 Gy in 5 or 24 Gy in three fractions. Two dogs received chemotherapy post-radiation. At analysis, 7/8 dogs were deceased and one was alive 684 days post-treatment. The estimated median overall survival (MOS) from first treatment was 785 days (95% CI 114-868 days, [range 114-1492 days]). Five dogs received CFRT (MOS 817 days; (95% CI 155 days-not reached [range 155-1492 days])). Three dogs received SBRT with one alive at analysis (MOS 414 days, (95% CI, 114 days-not reached [range 114-414 days])). No statistically significant difference was found between survival for CFRT and SBRT. Of the symptomatic patients, 5/6 showed improvement. Mass size reduced in 4/5 cases receiving follow-up ultrasounds. Possible complications included asymptomatic radiation pneumonitis (4), atrial tachycardia/premature beats (4) and pericardial effusion with heart failure coincident with tumour progression (1). This study provides preliminary evidence that radiotherapy may impact clinically relevant or progressively enlarging heart-base masses.

Metastatic Cardiac Hemangiosarcoma in a 6 Year Old Wheaten Terrier Mix

A 6 year old Wheaten Terrier mix with a history of collapse and lethargy was referred for evaluation of pericardial effusion. The echocardiogram identified pericardial effusion and a right auricular mass. No sign of metastasis was noted at this time in thoracic radiographs and abdominal ultrasounds. The patient underwent the right auriculectomy via right lateral thoracotomy. Several metastatic masses were located in the visceral aspect of the pericardium at the time of surgery and were all excised. The right auricular mass and pericardial masses were diagnosed as hemangiosarcoma with a sign of metastasis. The patient recovered from surgery uneventfully and was discharged the sixth day after surgery. The patient received doxorubicin followed by cyclophosphamide, piroxicam and Coriolus versicolor extract postoperatively. Pulmonary metastases were noted 229 days and the dog was euthanized 318 days after surgery. No clinical signs were noted until 309 days postoperatively.

Hemothorax in Three Dogs with Intrathoracic Extracardiac Hemangiosarcoma

Intrathoracic extracardiac hemangiosarcoma (HSA) is rare in dogs. This report describes three dogs with acute onset dyspnea due to hemorrhagic pleural effusion resulting from intrathoracic extracardiac masses, which were confirmed as HSA by histopathology. The dogs were stabilized with thoracocentesis and intravascular fluid resuscitation. Computed tomography identified intrathoracic masses, which were not originating from the heart or pulmonary parenchyma. Surgical exploration was performed in all cases. Case 1 was euthanized intraoperatively as the tumor could not be dissected from the aorta. In cases 2 and 3, hemostasis and resection of the tumors was successful. Case 2 was euthanized 1 mo after surgery and case 3 was alive at the time of writing, 5 mo postoperatively. Intrathoracic extracardiac HSA should be considered as a differential for nontraumatic hemothorax and surgical treatment can be palliative.

Doxorubicin chemotherapy for presumptive cardiac hemangiosarcoma in dogs†

Sixty-four dogs were treated with single-agent doxorubicin (DOX) for presumptive cardiac hemangiosarcoma (cHSA). The objective response rate (CR + PR) was 41%, and the biologic response rate (CR + PR + SD), or clinical benefit, was 68%. The median progression-free survival (PFS) for treated dogs was 66 days. The median survival time (MST) for this group was 116 days and was significantly improved compared to a MST of 12 days for untreated control dogs (P = 0.0001). Biologic response was significantly associated with improved PFS (P < 0.0001) and OS (P < 0.0001). Univariate analysis identified larger tumour size as a variable negatively associated with PFS. The high rate of clinical benefit and improved MST suggest that DOX has activity in canine cHSA.

The history of veterinary cardiology

Throughout civilization, animals have played a pivotal role in the advancement of science and medicine. From as early as 400 BC when Hippocrates recognized that diseases had natural causes, the steadfast advances made by biologists, scientists, physicians and scholars were fueled by timely and important facts and information- much of it gained through animal observations that contributed importantly to understanding anatomy, physiology, and pathology. There have been many breakthroughs and historic developments. For example, William Harvey in the 16th and 17th centuries clarified the importance of the circulatory system, aided by observations in dogs and pigs, which helped to clarify and confirm his concepts. The nineteenth century witnessed advances in physical examination techniques including auscultation and percussion. These helped create the basis for enhanced proficiency in clinical cardiology. An explosion of technologic advances that followed in the 20th century have made possible sophisticated, accurate, and non-invasive diagnostics. This permitted rapid patient assessment, effective monitoring, the development of new cardiotonic drugs, clinical trials to assess efficacy, and multi-therapy strategies. The latter 20th century has marshaled a dizzying array of advances in medical genetics and molecular science, expanding the frontiers of etiologies and disease mechanisms in man, with important implications for animal health. Veterinary medicine has evolved during the last half century, from a trade designed to serve agrarian cultures, to a diverse profession supporting an array of career opportunities ranging from private, specialty practice, to highly organized, specialized medicine and subspecialty academic training programs in cardiology and allied disciplines.

Pericardial Free Patch Grafting as a Rescue Technique in Surgical Management of Right Atrial HSA

A 7 yr old, neutered female vizsla underwent an exploratory thoracotomy after diagnosis of recurrent hemorrhagic pericardial effusion and a right auricular mass. Staging tests were negative for metastasis. The patient underwent a right, fourth intercostal thoracotomy, subtotal pericardectomy, right auricular mass excision, and pericardial free patch graft. The patient experienced blood loss during surgery, which required a packed red blood cell transfusion. The patient experienced transient arrhythmias postoperatively, but was discharged from the hospital 48 hr later. Histopathologic diagnosis of the mass was hemangiosarcoma. The patient was treated with carboplatin single-agent chemotherapy and palliative radiation therapy. The patient died at home, presumably from metastatic disease 260 days postoperatively. Surgical mass removal or debulking along with pericardial free patch grafting may be considered as palliative treatment options for dogs diagnosed with right auricular masses. In this case report, other techniques failed to repair the defect in the heart and a free patch graft offered a good rescue procedure with a favorable outcome without the need for inflow and outflow occlusion when used in conjunction with adjunctive therapies.

Survival times in dogs with right atrial hemangiosarcoma treated by means of surgical resection with or without adjuvant chemotherapy: 23 cases (1986-2000)

OBJECTIVE

To determine survival times in dogs with right atrial hemangiosarcoma treated by means of pericardectomy and tumor resection, with or without adjuvant chemotherapy, and identify complications associated with treatment.

DESIGN

Retrospective study.

ANIMALS

23 dogs.

PROCEDURE

Dogs were included only if the diagnosis was confirmed histologically.

RESULTS

The most common initial complaints included acute collapse (8 [35%] dogs), anorexia or inappetence (8 [35%]), and lethargy (8 [35%]). The most common physical examination abnormalities included muffled heart sounds (12 [52%] dogs), tachycardia (7 [30%]), and weak pulses (7 [30%]). Postoperative complications developed in 12 (52%) dogs; however, most complications were minor. Twenty (87%) dogs were discharged from the hospital. Survival time was significantly longer in the 8 dogs that received adjuvant chemotherapy (mean, 164 days; median, 175 days) than in the 15 dogs that did not receive chemotherapy (mean, 46 days; median, 42 days). Dogs that received chemotherapy were significantly younger and had significantly lower WBC counts than did dogs that did not receive chemotherapy.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that in dogs with right atrial hemangiosarcoma, surgical resection of the tumor was associated with a low complication rate and complications that did arise typically were minor. In addition, use of adjuvant chemotherapy following resection was associated with significantly longer survival times, compared with resection alone.

Hemangiosarcoma in dogs and cats

Hemangiosarcoma (HSA, including angiosarcoma and malignant hemangioendothelioma) is a highly malignant tumor derived from the endothelial cell line and is characterized by early and aggressive metastasis. HAS is a common tumor type in dogs, but is rare in other species. Treatment options include surgery, chemotherapy, and possibly radiation, but survival times are invariably short (usually < 1 year), except for patients with superficial dermal HSAs. Further options to treat this tumor type are currently being investigated.

Use of pericardial patch graft reconstruction of the right atrium for treatment of hemangiosarcoma in a dog

Atrial mass resection is possible in a limited number of dogs with hemangiosarcoma in which only the right atrial appendage or atrial free wall is involved, A pericardial patch graft can be used to reconstruct the right atrium after resection of large atrial tumors. Tumor-free margins can be obtained by use of this technique.

Aortic body chemodectoma causing pulmonary oedema in a cat

A seven-year-old male domestic shorthaired cat was presented with persistent dyspnoea. Thoracic radiography and echocardiography revealed pulmonary oedema and a mass at the base of the heart. At necropsy the mass was found to be an aortic body chemodectoma that had metastasised to the sternal lymph node. This is a rare tumour in the cat, the third reported case where there was evidence of metastasis, and only the second reported case where there was evidence of lymphocytic infiltration of the primary tumour. Pulmonary oedema is an unusual presentation of this tumour in the cat.

Systemic, metastatic, eu- and heterotope tumours of the heart in necropsied dogs

10,090 dissections of dogs exhibited 2631 neoplastic processes of which 309 involved the heart in the form of eu- and heteropic tumours. The most common primary and/or secondary heart tumour type was hemangiosarcoma (n = 187), followed by paraganglioma (n = 46), carcinoma (n = 33), malignant lymphoma (n = 12), thyroid heart base tumour (n = 9), melanoma (n = 7), mast cell tumour (n = 3) and blastoma (n = 2). The tumour diagnoses were immunohistochemically proved by various antibodies to cytokeratins, vimentin, GFAP, NSE, von Willebrand factor, CD3, CD45RA, S100, thyroglobulin as well as histochemically with argyrophilic, Fontana-Masson and heterochromatic reactions. The odds ratio (OR) for breed and tumour prevalences were determined: German shepherds showed the highest OR for hemangiosarcomas and boxers for paragangliomas.

Critical appraisal meets clinical reality: evaluating evidence in the literature using canine hemangiosarcoma as an example

The many gaps in our understanding of cancer are a great frustration for veterinarians and their clients. Unfortunately, what has been done has not always addressed the questions clinicians need answered. How can clinicians deal more effectively with the literature? Can missing information be identified, coped with clinically, and addressed by researchers?

Surgical stapling devices in cardiovascular surgery

Stapling devices useful for cardiovascular applications include vascular clips, the ligation and division stapler, the thoracoabdominal stapling device with vascular load, and the pin-ring device of small vessel anastomosis. This article addresses the application, indication, advantages, and disadvantages of each of these devices.

Partial gastrectomy with an automatic stapling instrument for treatment of gastric necrosis secondary to gastric dilatation-volvulus

A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.