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Best MP, Straw RC, Gumpel E, Fry DR. Long-term remission and survival in dogs with high-grade, B cell lymphoma treated with chemotherapy with or without sequential low-dose rate half-body irradiation. J Vet Intern Med 2023; 37:2368-2374. [PMID: 37700548 PMCID: PMC10658474 DOI: 10.1111/jvim.16840] [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: 12/13/2022] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Standard of care for dogs with high-grade lymphoma, multiagent chemotherapy, achieves good initial responses but long-term remissions are infrequent; previous studies using half-body irradiation suggest improved long-term outcomes. HYPOTHESIS The addition of low-dose rate half-body irradiation would improve outcomes in dogs with B-cell lymphoma. ANIMALS Client-owned dogs with stage III or higher, substage a, B-cell lymphoma that achieved complete remission after 4 doses of multiagent chemotherapy. METHODS A case-controlled design comparing 2-year remission and survival rates between dogs treated with CHOP-based chemotherapy and those treated with chemotherapy and sequential low-dose rate half-body irradiation. RESULTS Thirty-eight dogs were enrolled with 18 included in final analysis, 9 prospectively-enrolled dogs and 9 case-matched historical controls. The irradiation cohort's 2-year disease-free rate was 56% whereas median duration exceeded the 730-day study period compared with 0% and 261 days in the chemotherapy only group. Remission duration significantly differed between cohorts (P < .01), hazard ratio 0.218 (95% CI: 0.06-0.77). The irradiation cohort's 2-year survival rate was 78% with median overall survival duration exceeding the 730 day study period compared with 11% and 286 days in the chemotherapy only group. Overall survival time significantly differed between cohorts (P < .02), hazard ratio 0.173 (95% CI: 0.03-0.839). CONCLUSIONS AND CLINICAL IMPORTANCE The improved long-term outcome achieved by dogs administered sequential low-dose rate half-body irradiation in this study is similar to previous observational studies. Where long-term remission is sought in dogs with B-cell lymphoma low-dose rate half-body irradiation could be considered in addition to standard chemotherapy.
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Affiliation(s)
| | - Rod C. Straw
- Brisbane Veterinary Specialist CentreBrisbaneQueenslandAustralia
- The Australian Animal Cancer FoundationAlbany CreekQueenslandAustralia
| | - Elias Gumpel
- Small Animal Specialist HospitalNorth RydeNew South WalesAustralia
| | - Darren R. Fry
- Brisbane Veterinary Specialist CentreBrisbaneQueenslandAustralia
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Mellor PJ, Polton GA, Brearley M, Haugland S, Smith KC, Scase TJ, McNeil PE, Holloway A, Archer J, Powell RM, Villiers EJ, Herrtage ME, Argyle DJ, Day MJ. Solitary plasmacytoma of bone in two successfully treated cats. J Feline Med Surg 2016; 9:72-7. [DOI: 10.1016/j.jfms.2006.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2006] [Indexed: 11/29/2022]
Abstract
This is the first report of feline solitary plasmacytoma of bone. We describe the clinical, clinico-pathological, radiographic and pathological findings of two successfully treated cats with long-term follow-up. The first case presented with spinal pain and neurological deficits. Radiographs demonstrated sclerosis of lumbar vertebra L6 and a myelogram confirmed interference to flow of contrast in the L4–7 region. A biopsy of L6 revealed neoplastic plasma cell infiltration. There was no evidence of paraproteinaemia on serum protein electrophoresis. The cat underwent hypofractionated megavoltage radiotherapy. Clinical signs resolved completely and 4 years after diagnosis the cat remains well and has no electrophoretically detectable paraproteinaemia. The second case presented with neurological deficits of the tail and spinal radiographs revealed extensive osteolysis of the sacrum. A biopsy of sacral bone demonstrated neoplastic plasma cell infiltration. The animal was normoglobulinaemic. The cat improved clinically with induction chemotherapy (melphalan and methylprednisolone). The same chemotherapeutics were continued at maintenance doses for 4.3 years, at which time there was recurrence of neurological deficits and a palpable sacral mass. Cytological examination of a fine needle aspirate confirmed recurrence of plasma cell neoplasia. A low concentration monoclonal paraproteinaemia was detected. Vincristine was administered resulting in resolution of neurological deficits and a palpably smaller sacral mass. Eighteen months into vincristine therapy, there was recurrence of clinical signs and the cat was euthanased, more than 6 years after the initial diagnosis.
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Affiliation(s)
- Paul J. Mellor
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Gerry A. Polton
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin, Hertfordshire, UK
| | - Malcolm Brearley
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin, Hertfordshire, UK
| | - Sean Haugland
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Ken C. Smith
- Animal Health Trust, Lanwades Park, Kentford, UK
| | - Tim J. Scase
- Animal Health Trust, Lanwades Park, Kentford, UK
| | | | - Andrew Holloway
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Joy Archer
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Roger M. Powell
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Mike E. Herrtage
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - David J. Argyle
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Michael J. Day
- School of Clinical Veterinary Science, University of Bristol, Langford, UK
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Husbands BD, McNiel EA, Modiano JF. Initial evaluation of safety of wide-field irradiation in the treatment of hematopoietic neoplasia in the cat. Vet Radiol Ultrasound 2010; 51:688-96. [PMID: 21158248 DOI: 10.1111/j.1740-8261.2010.01728.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Localized radiation therapy is well tolerated in cats with confined tumors; however, the use of wide-field radiation therapy to treat disseminated neoplasia has not been evaluated systematically in this species. Wide-field external beam radiation therapy, which we define as irradiation of cranial or caudal halves of the body either individually or sequentially, was undertaken as an experimental option to treat cats with either chemotherapy-refractory or naive hematopoietic neoplasia considered to have a poor prognosis. Fifteen cats with hematopoietic malignancies received wide-field external beam radiation therapy between 2003 and 2006. Cats received 8 Gy delivered in 4 Gy fractions with 60Co photons. Treatment-related toxicity was scored according to criteria established by the Veterinary Cooperative Oncology Group. Animals without preexisting abnormalities on hemograms exhibited no or mild (Grade 1 or 2) hematopoietic toxicity. Although most cats (14 of 15) had preexisting gastrointestinal (GI) signs, these signs were stable (29%) or improved (42%) following irradiation. Worsening GI signs following irradiation occurred transiently in two cats and in association with progressive disease in two others. No pulmonary, renal, hepatic, or dermatologic toxicities were detected. In summary, wide-field external beam radiation therapy can be administered safely to, and may provide therapeutic benefit for, cats with disseminated hematopoietic neoplasia.
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Affiliation(s)
- Brian D Husbands
- Veterinary Medical Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA.
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Lurie D, Gordon I, Théon A, Rodriguez C, Suter S, Kent M. Sequential Low-Dose Rate Half-Body Irradiation and Chemotherapy for the Treatment of Canine Multicentric Lymphoma. J Vet Intern Med 2009; 23:1064-70. [DOI: 10.1111/j.1939-1676.2009.0353.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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5
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Lurie DM, Kent MS, Fry MM, Théon AP. A toxicity study of low-dose rate half-body irradiation and chemotherapy in dogs with lymphoma. Vet Comp Oncol 2008; 6:257-67. [DOI: 10.1111/j.1476-5829.2008.00164.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Kesner AL, Lau VK, Speiser M, Hsueh WA, Agazaryan N, DeMarco JJ, Czernin J, Silverman DH. Time-course of effects of external beam radiation on [18F]FDG uptake in healthy tissue and bone marrow. J Appl Clin Med Phys 2008; 9:147-156. [PMID: 18716585 PMCID: PMC5722291 DOI: 10.1120/jacmp.v9i3.2747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 02/13/2008] [Accepted: 02/15/2008] [Indexed: 11/23/2022] Open
Abstract
The utility of PET for monitoring responses to radiation therapy have been complicated by metabolically active processes in surrounding normal tissues. We examined the time‐course of [18F]FDG uptake in normal tissues using small animal‐dedicated PET during the 2 month period following external beam radiation. Four mice received 12 Gy of external beam radiation, in a single fraction to the left half of the body. Small animal [18F]FDG‐PET scans were acquired for each mouse at 0 (pre‐radiation), 1, 2, 3, 4, 5, 8, 12, 19, 24, and 38 days following irradiation. [18F]FDG activity in various tissues was compared between irradiated and non‐irradiated body halves before, and at each time point after irradiation. Radiation had a significant impact on [18F]FDG uptake in previously healthy tissues, and time‐course of effects differed in different types of tissues. For example, liver tissue demonstrated increased uptake, particularly over days 3–12, with the mean left to right uptake ratio increasing 52% over mean baseline values (p<0.0001). In contrast, femoral bone marrow uptake demonstrated decreased uptake, particularly over days 2–8, with the mean left to right uptake ratio decreasing 26% below mean baseline values (p=0.0005). Significant effects were also seen in lung and brain tissue. Radiation had diverse effects on [18F]FDG uptake in previously healthy tissues. These kinds of data may help lay groundwork for a systematically acquired database of the time‐course of effects of radiation on healthy tissues, useful for animal models of cancer therapy imminently, as well as interspecies extrapolations pertinent to clinical application eventually. PACs Number: 87.50.‐a
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Affiliation(s)
- Adam L Kesner
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Victoria K Lau
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Michael Speiser
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Wei-Ann Hsueh
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - John J DeMarco
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Daniel Hs Silverman
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, USA
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Axiak SM, Carreras JK, Hahn KA, Endicott MM, Parshley DE, King GK. Hematologic Changes Associated with Half-Body Irradiation in Dogs with Lymphoma. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb00757.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Gustafson NR, Lana SE, Mayer MN, LaRue SM. A preliminary assessment of whole-body radiotherapy interposed within a chemotherapy protocol for canine lymphoma. Vet Comp Oncol 2004; 2:125-31. [DOI: 10.1111/j.1476-5810.2004.00046.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Radiation is becoming widely available to treat tumours in veterinary patients. Orthovoltage machines capable of delivering low energy external beam radiation are less versatile than linear accelerators and cobalt-60 machines that deliver megavoltage radiation. In addition, electron beam capabilities that are available with some linear accelerators allow more targeted treatment in smaller patients. Acute effects of radiation are to be expected, but in nearly all cases such side effects resolve without limiting protocols. In contrast, late effects of radiation are dose limiting and are more likely with higher doses per treatment fraction. Protocols that use smaller doses per fraction have a lower risk of late effects thereby allowing higher total doses to be delivered which leads to higher tumour control rates. It is possible to provide long-term tumour control in cats and dogs using radiation therapy, particularly for mast cell tumours, soft tissue sarcomas, oral tumours and brain tumours in dogs and soft tissue sarcomas and skin tumours in cats. Individualization of treatments for tumours based on tumour staging and proliferative fraction should be considered, rather than making blanket assumptions about the behaviour of histologically determined tumour types.
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Affiliation(s)
- Antony S Moore
- Department of Clinical Sciences, Section of Oncology and Harrington Oncology Program, Tufts University School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA.
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Abstract
Chemotherapy is the mainstay of therapy for the treatment of lymphoma in dogs and cats. Radiation therapy can be utilized in the management of patients with solitary lymphoma and to induce a rapid local response in selected patients with multicentric lymphoma. A combination of surgery and radiation therapy can offer an excellent prognosis for cats with thymoma. Radiation therapy can also play a role in the management of dogs with thymoma.
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12
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Abstract
Palliative radiation therapy can be useful in controlling the pain associated with tumors for which definitive therapy is not an option. The patient's quality of life is improved while side effects, hospitalization, and cost of treatment are minimized. Palliative radiation therapy should be considered as part of the oncologist's armamentarium; however, further investigations are warranted to develop appropriate protocols based on patient response.
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Affiliation(s)
- S Siegel
- Angell Memorial Animal Hospital, Boston, Massachusetts, USA
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13
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Page RL, Thrall DE. Clinical indications and applications of radiotherapy and hyperthermia in veterinary oncology. Vet Clin North Am Small Anim Pract 1990; 20:1075-92. [PMID: 2196731 DOI: 10.1016/s0195-5616(90)50085-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The response of dogs and cats with neoplasia to radiation therapy has improved significantly during the past 10 years. This has largely been due to more aggressive radiation therapy treatment schedules, more accurate planning, and refinement of clinical indications. Sufficient numbers of dogs and cats irradiated with curative intent have not been accumulated to yet define the full impact of more aggressive therapy. However, many tumors will likely remain resistant to irradiation because of concomitant normal tissue injury that must be minimized. Systematic investigation of combination therapy (surgery, radiation, chemotherapy, and hyperthermia) should succeed in reducing local tissue side effects and increased local tumor control. A comprehensive approach to tumor management begins with decisions thoughtful of optimal treatment for suspected malignant tumors even at the time of initial examination and client counseling. An incisional biopsy provides essential information to determine the therapeutic course and should be considered prior to initial excision. More aggressive treatment, of even small tumors, early in the clinical course will lead to prolonged tumor control. Radiation therapy should be considered fundamental in the comprehensive treatment plan of many solid tumors.
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Affiliation(s)
- R L Page
- North Carolina State University College of Veterinary Medicine, Raleigh
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Abstract
Canine LSA is a fatal disease if untreated, but fortunately it is also a disease that is very responsive to therapeutic intervention. It is likely that most cases seen and treated by practitioners will be managed with the currently effective drugs and with new protocols as they are developed. Other approaches, including immunotherapy and BMT, are likely to remain more in the arena of the academic institution but should be available in the referral setting for appropriate cases. Great strides have been made in the less than 30 years that canine LSA has been widely treated; it is reasonable that similar progress is to be expected in the years to come.
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Affiliation(s)
- R C Rosenthal
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison
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Laing EJ, Fitzpatrick PJ, Binnington AG, Norris AM, Mosseri A, Rider WD, Valli VE, Baur A. Half-body radiotherapy in the treatment of canine lymphoma. J Vet Intern Med 1989; 3:102-8. [PMID: 2654376 DOI: 10.1111/j.1939-1676.1989.tb03087.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In a Phase I-II study, half-body radiotherapy was used to treat 14 dogs with multicentric lymphoma. Using this technique, a radiation dose of 7 Gray (Gy) was delivered to one half of the body in a single exposure. The other half of the body was treated approximately 28 days later. Of 14 treated dogs, 11 (79%) had a measurable decrease in tumor size. Five dogs achieved a complete or partial remission with a mean duration of 102 and 54 days, respectively. In predicting response to therapy, poor prognostic factors included large tumor burdens, advanced disease stage, and chemotherapy-resistant tumors. Side effects of treatment were divided chronologically into acute (radiation sickness, tumor lysis), subacute (bone marrow suppression), and chronic (radiation pneumonitis, lymphoma-cell leukemia) syndromes. Complications were more severe in tumor-bearing dogs when compared with healthy control animals. Dogs with small tumor burdens and minimal internal disease had fewer complications compared with those with more advanced disease.
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Affiliation(s)
- E J Laing
- Department of Clinical Studies, Ontario Veterinary College, Guelph, Canada
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