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Flory A, Wilson-Robles H. Noninvasive Blood-Based Cancer Detection in Veterinary Medicine. Vet Clin North Am Small Anim Pract 2024; 54:541-558. [PMID: 38195361 DOI: 10.1016/j.cvsm.2023.12.008] [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] [Indexed: 01/11/2024]
Abstract
The past decade has seen incredible advances in blood-based cancer detection in people and in dogs - yet this represents only a glimpse of the benefits these tests can provide to patients. The clinical uses of this technology range from screening asymptomatic individuals for early detection to use as an aid in diagnosis when cancer is suspected, to cancer monitoring both during and after treatment. This article summarizes the benefits of early cancer detection and examines use cases and methods of blood-based cancer detection in dogs, including quantitative, qualitative, and alternative approaches.
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Affiliation(s)
- Andi Flory
- PetDx, 9310 Athena Circle, Suite 230, La Jolla, CA 92037, USA.
| | - Heather Wilson-Robles
- Volition Veterinary Diagnostics Development, LLC 1489 West Warm Springs Road Suite 110, Henderson, NV 89014, USA; Ethos Discovery, 10435 Sorrento Valley Road, San Diego, CA 92121, USA; The Oncology Service, United Veterinary Health, 6651 Backlick Road, Springfield, VA 22150, USA
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Mortier JR, Maddox TW, Blackwood L, La Fontaine MD, Busoni V. Dynamic contrast-enhanced computed tomography perfusion parameters of canine suspected brain tumors at baseline and during radiotherapy might be different depending on tumor location but not associated with survival. Front Vet Sci 2023; 10:1179762. [PMID: 37187932 PMCID: PMC10175699 DOI: 10.3389/fvets.2023.1179762] [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: 03/04/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Treatment of brain tumors in dogs can be associated with significant morbidity and reliable prognostic factors are lacking. Dynamic contrast-enhanced computed tomography (DCECT) can be used to assess tumor perfusion. The objectives of this study were to assess perfusion parameters and change in size of suspected brain tumors before and during radiotherapy (RT) depending on their location and find a potential correlation with survival. Methods Seventeen client-owned dogs with suspected brain tumors were prospectively recruited. All dogs had a baseline DCECT to assess mass size, blood volume (BV), blood flow (BF), and transit time (TT). Twelve dogs had a repeat DCECT after 12 Gy of megavoltage RT. Survival times were calculated. Results Intra-axial masses had lower BF (p = 0.005) and BV (p < 0.001) than extra-axial masses but not than pituitary masses. Pituitary masses had lower BF (p = 0.001) and BV (p = 0.004) than extra-axial masses. The volume of the mass was positively associated with TT (p = 0.001) but not with BF and BV. Intra-axial masses showed a more marked decrease in size than extra-axial and pituitary masses during RT (p = 0.022 for length, p = 0.05 for height). Extra-axial masses showed a greater decrease in BF (p = 0.011) and BV (p = 0.012) during RT than pituitary masses and intra-axial masses. Heavier dogs had a shorter survival time (p = 0.011). Perfusion parameters were not correlated with survival. Conclusion DCECT perfusion parameters and change in size of brain masses during RT might be different based on the location of the mass.
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Affiliation(s)
- Jeremy R. Mortier
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
- Diagnostic Imaging Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
- *Correspondence: Jeremy R. Mortier,
| | - Thomas W. Maddox
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Laura Blackwood
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | | | - Valeria Busoni
- Diagnostic Imaging Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
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Beckmann K, Kowalska M, Meier V. Solitary intraventricular tumors in dogs and cats treated with radiotherapy alone or combined with ventriculoperitoneal shunts: A retrospective descriptive case series. Vet Med (Auckl) 2022; 37:204-215. [PMID: 36382395 PMCID: PMC9889607 DOI: 10.1111/jvim.16583] [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: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intraventricular tumors are rare, optimal treatment is not defined. Symptomatic patients often exhibit life-threatening hydrocephalus. With several months time-to-effect after radiotherapy (RT), increased intracranial pressure is concerning. This increase in pressure can be overcome by ventriculoperitoneal shunting (VPS). OBJECTIVES Retrospective evaluation of outcome and complications in dogs and cats with intracranial tumors treated with either RT or VPS/RT. ANIMALS Twelve client-owned cats and dogs. METHODS Dogs and cats with symptomatic intraventricular tumors treated with definitive-intent RT or VPS/RT were included in a retrospective, descriptive case series. Complications, tumor volume evolution, time-to-progression, and survival time were determined. RESULTS Twelve animals were included: 1 cat and 5 dogs treated with single-modality RT and 4 cats and 2 dogs treated with VPS/RT. Neurological worsening seen in 4/6 animals during single-modality RT and 2/6 died during RT (suspected brain herniation). All dogs with VPS normalized clinically by the end of RT or earlier. Complications occurred in 4/6 animals, all but 1 were successfully managed surgically. Imaging follow-up in 8 animals surviving RT showed a marked decrease in tumor volume. Median survival time was 162 days (95% confidence interval [CI]: 16; infinity) for animals treated with RT and 1103 days (95%CI: 752; infinity) for animals treated with VPS/RT. Median time-to-progression was 71 days (95%CI: 7; infinity) and 895 days (95%CI: 704; infinity) for each group, respectively. Two dogs died because of intraventricular metastasis 427 and 461 days after single-modality RT. CONCLUSIONS AND CLINICAL IMPORTANCE Ventriculoperitoneal shunting led to rapid normalization of neurological signs and RT had a measurable effect on tumor volume. Combination of VPS/RT seems to be beneficial.
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Affiliation(s)
- Katrin Beckmann
- Department for Small Animals, Division of Surgery, Section of NeurologyVetsuisse Faculty, University of ZurichZurichSwitzerland
| | - Malwina Kowalska
- Section of Epidemiology, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland,Ophthalmology Section, Equine DepartmentVetsuisse Faculty, University of ZurichZurichSwitzerland
| | - Valeria Meier
- Department for Small Animals, Division of Radiation OncologyVetsuisse Faculty, University of ZurichZurichSwitzerland
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Antonakakis MG, Carletti BE, Anselmi C, McGrath S, Minguez JJ. Use of a telovelar approach for complete resection of a choroid plexus tumor in a dog. Vet Surg 2022; 51:1273-1279. [PMID: 35899829 PMCID: PMC9796332 DOI: 10.1111/vsu.13859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To describe a telovelar approach to the fourth ventricle for excision of a choroid plexus tumor within the ventricle. ANIMAL A 3-year-old entire male Chihuahua. STUDY DESIGN Case report METHODS: A 3-year-old dog with two-month history of progressive vestibular signs and subdued mentation was diagnosed with a fourth ventricle tumor. Gross total resection of the tumor was achieved through a telovelar approach to the fourth ventricle. RESULTS Complete removal of the tumor was confirmed on immediate postoperative MRI. The dog recovered from the surgical procedure without complications, displaying some neurological deficits as preoperatively. His neurological examination was normal 2 weeks after surgery and remained so until the time of writing this case report (28 months) without additional treatment. CONCLUSION The telovelar approach allowed complete excision of a choroid plexus tumor located in the fourth ventricle of the dog reported here.
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Affiliation(s)
- Markos G. Antonakakis
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesColorado State UniversityFort CollinsColoradoUSA,Deparment of Neurology and NeurosurgeryPride Veterinary Centre Derby, part of IVC Evidensia GroupDerbyUK
| | - Beatrice E. Carletti
- Deparment of Neurology and NeurosurgeryPride Veterinary Centre Derby, part of IVC Evidensia GroupDerbyUK
| | - Carlo Anselmi
- Diagnostic Imaging DepartmentPride Veterinary Centre Derby, part of IVC Evidensia GroupDerbyUK
| | - Stephanie McGrath
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Juan J. Minguez
- Deparment of Neurology and NeurosurgeryPride Veterinary Centre Derby, part of IVC Evidensia GroupDerbyUK
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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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MagalhÃes TR, BenoÎt JÉ, NÉČovÁ S, North S, Queiroga FL. Outcome After Radiation Therapy in Canine Intracranial Meningiomas or Gliomas. In Vivo 2021; 35:1117-1123. [PMID: 33622909 DOI: 10.21873/invivo.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 12/22/2022]
Abstract
AIM To characterize a group of dogs diagnosed with meningioma or glioma treated with radiation therapy and assess the clinical impact of diagnosis and radiation protocol on survival time. PATIENTS AND METHODS Canine patient records from a single veterinary referral hospital, between 2011 and 2015, were searched for intracranial tumour cases treated with radiation therapy, as a sole modality. Thirty-two dogs were included. RESULTS Median survival times were 524 days [95% confidence interval (CI)=287-677] in total, 512 days (95% CI=101-682) for the glioma group and 536 days (95% CI=249-677) for the meningioma group. No significant difference in survival was detected when using a definitive or a palliative protocol (p=0.130), nor other prognostic factors were found. CONCLUSION Our results highlight the efficacy of radiation therapy in the treatment of canine meningioma, as well as glioma, suggesting a change in the current perception of the response of glial tumours to radiation.
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Affiliation(s)
| | - JÉrÔme BenoÎt
- Southfields Veterinary Specialists (formerly VRCC Veterinary Referrals), Essex, U.K
| | - SlavomÍra NÉČovÁ
- Southfields Veterinary Specialists (formerly VRCC Veterinary Referrals), Essex, U.K
| | - Susan North
- Southfields Veterinary Specialists (formerly VRCC Veterinary Referrals), Essex, U.K
| | - Felisbina LuÍsa Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; .,Center for Research and Technology of Agro-Environment and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal.,Center for the Study of Animal Sciences, CECA-ICETA, University of Porto, Porto, Portugal
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Rohrer Bley C, Staudinger C, Bley T, Marconato L, Sabattini S, Beckmann K. Canine presumed glial brain tumours treated with radiotherapy: Is there an inferior outcome in tumours contacting the subventricular zone? Vet Comp Oncol 2021; 20:29-37. [PMID: 33900018 DOI: 10.1111/vco.12703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
Post-treatment outcome in canine glial tumours is described with a broad range of survival times between 2 and 28 months. After surgery or radiation therapy, the tumours may progress locally or spread within the central nervous system. It is unknown if tumour- or patient-specific factors influence prognosis. In humans, glioblastoma involving the subventricular zone has been found to recur distantly, with shortened time to progression and overall survival. We included 32 dogs irradiated for a presumptive primary glial brain tumour in this retrospective cohort study. Tumours were grouped relative to subventricular zone contact and overt ventricular invasion assessing pre-treatment magnetic resonance images. Median time to progression (TTP) for all cases was 534 days (95%CI, 310-758), with a significantly shorter TTP in dogs with lesions at the subventricular zone (median TTP, 260 vs. 687 days; p = .049). Tumours at the subventricular zone progressed more often (p = .001), and more likely as CNS-metastasis (52.9% vs. 13.3%, p = .028). Median overall survival (OS) was 489 days (95%CI, 147-831) and median tumour-specific survival 609 days (95%CI, 382-835). Involvement of the subventricular zone was significantly associated with a shorter tumour-specific survival (median, 306 vs. 719 days; p = .044). Glial tumours contacting the subventricular zone in dogs have a shorter tumour-specific survival and a higher rate of progression and CNS-metastasis. Despite local tumour control, metastasis must be considered and should prompt further treatment approaches.
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Affiliation(s)
- Carla Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Chris Staudinger
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Tim Bley
- Neurology Service, Small Animal Clinic Aarau West, Oberentfelden, Switzerland
| | - Laura Marconato
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Katrin Beckmann
- Neurology Service, Clinic of Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Carter GL, Ogilvie GK, Mohammadian LA, Bergman PJ, Lee RP, Proulx DR. CyberKnife stereotactic radiotherapy for treatment of primary intracranial tumors in dogs. J Vet Intern Med 2021; 35:1480-1486. [PMID: 33755255 PMCID: PMC8163137 DOI: 10.1111/jvim.16086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background Limited data exist about the use, efficacy, and prognostic factors influencing outcome when CyberKnife is used to treat dogs with intracranial neoplasia. Objectives To determine the prognosis and associated prognostic factors for dogs that were imaged, determined to have primary intracranial tumors, and treated with CyberKnife radiotherapy. Animals Fifty‐nine dogs treated with CyberKnife radiotherapy for primary intracranial tumors. Methods Retrospective medical record review of cases from January 2010 to June 2016. Data extracted from medical records included signalment, weight, seizure history, tumor location, tumor type (based on imaging), gross tumor volume, planned tumor volume, treatment dates, radiation dose, recurrence, date of death, and cause of death. Results The median progression‐free interval (PFI) was 347 days (range 47 to 1529 days), and the median survival time (MST) was 738 days (range 4 to 2079 days). Tumor location was significantly associated with PFI when comparing cerebrum (median PFI 357 days; range 47‐1529 days) versus cerebellum (median PFI 97 days; range 97‐168 days) versus brainstem (median PFI 266 days; range 30‐1484 days), P = .03. Additionally, the presumed tumor type was significantly associated with MST (P < .001). Conclusions and Clinical Importance Use of Cyberknife and SRT might improve MST, compared with RT, in dogs with intracranial neoplasia.
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Affiliation(s)
| | - Gregory K Ogilvie
- VCA California Veterinary Specialists, Carlsbad, California, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | | | | | - Rachel P Lee
- VCA California Veterinary Specialists, Carlsbad, California, USA
| | - David R Proulx
- VCA California Veterinary Specialists, Carlsbad, California, USA
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Definitive-intent uniform megavoltage fractioned radiotherapy protocol for presumed canine intracranial gliomas: retrospective analysis of survival and prognostic factors in 38 cases (2013-2019). BMC Vet Res 2020; 16:412. [PMID: 33129320 PMCID: PMC7603708 DOI: 10.1186/s12917-020-02614-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Radiotherapy (RT) is currently considered the treatment of choice for presumed canine intracranial gliomas. However, variable therapeutic responses are described, due to heterogeneous populations and different radiation methods or protocols. Only one study dedicated to intracranial suspected glioma highlighted prognostic criteria. Determination or confirmation of specific clinical and imaging prognostic factors may guide the therapeutic management of these tumours. The objectives were to provide data on long-term clinical outcome (including quality of life, QoL) and to determine specific prognostic factors associated with survival time. We report a single-institution retrospective study, including all dogs with suspected symptomatic primary solitary intracranial glioma, treated with a complete uniform fractionated megavoltage radiation protocol of 15x3Gy over 5 weeks, between January 2013 and February 2019. Thirty-eight client-owned dogs were included. Medical records were retrospectively evaluated for median overall survival time (MST), clinical and imaging responses. Prognostic factors on survival were researched in terms of signalment, clinical presentation, tumour imaging characteristics and response following RT. Finally, the RT’s impact on the dogs’ clinical signs and Qol were evaluated by the owners. Results The disease-specific MST was 698 days (95% CI: 598–1135). Survival at 1 and 2 years were respectively 74.2 ± 7.4% and 49.0 ± 9.8%. Initial clinical signs were related to survival, as well as tumour characteristics such as cystic-pattern, mass effect and Tumour/Brain volume ratio. No significant adverse effect or radiotoxicity was observed. Conclusions RT appears as a safe and effective treatment for canine intracranial gliomas, allowing long-term tumour control, improvement of life’s quality and management of associated clinical signs. The initial clinical signs and MRI characteristics (Tumour/Brain volume ratio, cyst-like lesion and mass effect) may help predict the prognosis.
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Van Asselt N, Christensen N, Meier V, Bley CR, Laliberte S, Poirier VJ, Desai N, Chen Y, Turek M. Definitive-intent intensity-modulated radiation therapy provides similar outcomes to those previously published for definitive-intent three-dimensional conformal radiation therapy in dogs with primary brain tumors: A multi-institutional retrospective study. Vet Radiol Ultrasound 2020; 61:481-489. [PMID: 32356907 PMCID: PMC7953428 DOI: 10.1111/vru.12868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy with or without surgery is a common choice for brain tumors in dogs. Although numerous studies have evaluated use of three-dimensional conformal radiotherapy, reports of definitive-intent, IMRT for canine intracranial tumors are lacking. Intensity-modulated radiation therapy has the benefit of decreasing dose to nearby organs at risk and may aid in reducing toxicity. However, increasing dose conformity with IMRT calls for accurate target delineation and daily patient positioning, in order to decrease the risk of a geographic miss. To determine survival outcome and toxicity, we performed a multi-institutional retrospective observational study evaluating dogs with brain tumors treated with IMRT. Fifty-two dogs treated with fractionated, definitive-intent IMRT at four academic radiotherapy facilities were included. All dogs presented with neurologic signs and were diagnosed via MRI. Presumed radiological diagnoses included 37 meningiomas, 12 gliomas, and one peripheral nerve sheath tumor. One dog had two presumed meningiomas and one dog had either a glioma or meningioma. All dogs were treated in the macroscopic disease setting and were prescribed a total dose of 45-50 Gy (2.25-2.5 Gy per fraction in 18-20 daily fractions). Median survival time for all patients, including seven cases treated with a second course of therapy was 18.1 months (95% confidence of interval 12.3-26.6 months). As previously described for brain tumors, increasing severity of neurologic signs at diagnosis was associated with a worse outcome. Intensity-modulated radiation therapy was well tolerated with few reported acute, acute delayed, or late side effects.
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Affiliation(s)
- Nathaniel Van Asselt
- University of Wisconsin-Madison School of Veterinary Medicine, Madison, Wisconsin, USA
| | - Neil Christensen
- University of Wisconsin-Madison School of Veterinary Medicine, Madison, Wisconsin, USA
| | - Valeria Meier
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Switzerland
- Department of Physics, University of Zurich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Sarah Laliberte
- University of Guelph Ontario Veterinary College, Guelph, Ontario, Canada
| | - Valerie J. Poirier
- University of Guelph Ontario Veterinary College, Guelph, Ontario, Canada
| | - Noopur Desai
- The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Yi Chen
- University of Wisconsin-Madison Department of Biostatistics and Medical Informatics, Madison, Wisconsin, USA
| | - Michelle Turek
- University of Wisconsin-Madison School of Veterinary Medicine, Madison, Wisconsin, USA
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Meier V, Besserer J, Rohrer Bley C. Using biologically based objectives to optimize boost intensity-modulated radiation therapy planning for brainstem tumors in dogs. Vet Radiol Ultrasound 2020; 61:77-84. [PMID: 31600027 PMCID: PMC7004177 DOI: 10.1111/vru.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/22/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022] Open
Abstract
Irradiated brain tumors commonly progress at the primary site, generating interest in focal dose escalation. The aim of this retrospective observational study was to use biological optimization objectives for a modeling exercise with simultaneously-integrated boost IMRT (SIB-IMRT) to generate a dose-escalated protocol with acceptable late radiation toxicity risk estimate and improve tumor control for brainstem tumors in dogs safely. We re-planned 20 dog brainstem tumor datasets with SIB-IMRT, prescribing 20 × 2.81 Gy to the gross tumor volume (GTV) and 20 × 2.5 Gy to the planning target volume. During the optimization process, we used biologically equivalent generalized equivalent uniform doses (gEUD) as planning aids. These were derived from human data, calculated to adhere to normal tissue complication probability (NTCP) ≤5%, and converted to the herein used fractionation schedule. We extracted the absolute organ at risk dose-volume histograms to calculate NTCP of each individual plan. For planning optimization, gEUD(a = 4) = 39.8 Gy for brain and gEUD(a = 6.3) = 43.8 Gy for brainstem were applied. Mean brain NTCP was low with 0.43% (SD ±0.49%, range 0.01-2.04%); mean brainstem NTCP was higher with 7.18% (SD ±4.29%, range 2.87-20.72%). Nevertheless, NTCP of < 10% in brainstem was achievable in 80% (16/20) of dogs. Spearman's correlation between relative GTV and NTCP was high (ρ = 0.798, P < .001), emphasizing increased risk with relative size even with subvolume-boost. Including biologically based gEUD values into optimization allowed estimating NTCP during the planning process. In conclusion, gEUD-based SIB-IMRT planning resulted in dose-escalated treatment plans with acceptable risk estimate of NTCP < 10% in the majority of dogs with brainstem tumors. Risk was correlated with relative tumor size.
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Affiliation(s)
- Valeria Meier
- Division of Radiation Oncology, Small Animal Department, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
- Department of PhysicsUniversity of ZurichZurichSwitzerland
| | - Jürgen Besserer
- Division of Radiation Oncology, Small Animal Department, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
- Department of PhysicsUniversity of ZurichZurichSwitzerland
- Radiation OncologyHirslanden ClinicZurichSwitzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Small Animal Department, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
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Körner M, Roos M, Meier VS, Soukup A, Cancedda S, Parys MM, Turek M, Rohrer Bley C. Radiation therapy for intracranial tumours in cats with neurological signs. J Feline Med Surg 2019; 21:765-771. [PMID: 30339060 PMCID: PMC10814305 DOI: 10.1177/1098612x18801032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the outcome of cats with intracranial tumours presenting with neurological signs treated with radiation therapy. METHODS This study comprised a retrospective multicentre case series. Medical records of a total of 22 cats with intracranial space-occupying lesions, presenting with neurological signs and/or epileptic seizures and treated with external beam radiation therapy, were reviewed. In the treated cats, patient-, tumour- and treatment-related variables were investigated, including age, sex, tumour location, tumour volume, total radiation dose, equivalent dose in 2 Gy fractions (EQD2), corticosteroid dose, overall treatment time and institution for influence on local tumour control and survival. RESULTS Based on advanced imaging characteristics, the 22 treated cats presented with meningioma (n = 11), pituitary tumour (n = 8), choroid plexus tumour (n = 2) or glioma (n = 1). Allocated to the neuraxis, 11 lesions were extra-axial, three were intra-axial and eight were located in the pituitary region. At diagnosis, 21 cats exhibited altered neurological status. One cat presented with epileptic seizures and another cat had both seizures and altered neurological status. The mean total physical dose of radiation was 41.63 Gy (± 4.33), range 24-45 Gy. In all but one cat (95.5%), neurological signs improved after radiation therapy. The median progression-free survival was 510 days (95% confidence interval [CI]: 51-969). The proportion free of progression at 1 year was 55.7% (95% CI: 33-78). Fourteen cats died (only in five cases was death related to the intracranial tumour) and eight cats were still alive or lost to follow-up. The median overall survival time was 515 days (95% CI: 66-964). None of the tested variables influenced outcome. CONCLUSIONS AND RELEVANCE Radiation therapy seems to represent a viable treatment option in cats with intracranial tumours, relieving neurological signs and improving local tumour control. Radiation therapy may be considered for cats with tumours in complicated/inoperable localisations or for cases with a high peri- and postoperative risk.
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Affiliation(s)
- Maximilian Körner
- Divison of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Malgorzata Roos
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Valeria S Meier
- Divison of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Alena Soukup
- Divison of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Simona Cancedda
- Centro Oncologico Veterinario, Sasso Marconi, Bologna, Italy
| | - Magdalena M Parys
- Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, University of Edinburgh, Roslin, UK
| | - Michelle Turek
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Carla Rohrer Bley
- Divison of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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13
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Schwarz P, Meier V, Soukup A, Drees R, Besserer J, Beckmann K, Roos M, Rohrer Bley C. Comparative evaluation of a novel, moderately hypofractionated radiation protocol in 56 dogs with symptomatic intracranial neoplasia. J Vet Intern Med 2018; 32:2013-2020. [PMID: 30308086 PMCID: PMC6272041 DOI: 10.1111/jvim.15324] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Use of strongly hypofractionated radiation treatments in dogs with intracranial neoplasia did not improve outcomes and yielded increased rates of toxicosis. Objectives: To evaluate safety and efficacy of a new, moderately hypofractionated radiation protocol of 10 × 4 Gy compared to a standard protocol. Animals: Convenience sample of 56 client‐owned dogs with primary symptomatic brain tumors. Methods: Retrospective observational study. Twenty‐six dogs were assigned to the control standard protocol of 20 × 2.5 Gy (group A) and 30 dogs to the new protocol of 10 × 4 Gy (group B), assigned on owners' informed consent. Statistical analysis was conducted under the “as treated” regime, using Kaplan‐Meier and Cox‐regression analysis. Treatment was delivered with technically advanced image‐guided radiation therapy. The 2 treatment groups were compared in terms of outcome and signs of toxicosis. Results: Overall progression‐free interval (PFI) and overall survival (OS) time were favorable, with 663 (95%CI: 497;828) and 637 (95%CI: 403;870) days, respectively. We found no significant difference between the two groups: PFI for dogs in group A vs B was 608 (95%CI: 437;779) days and mean (median not reached) 863 (95%CI: 644;1083) days, respectively (P = .89), and OS for dogs in group A vs B 610 (95%CI: 404;816) and mean (median not reached) 796 (95%CI: 586;1007) days (P = .83). Conclusion and Clinical Importance: In conclusion, 10 × 4 Gy is a safe and efficient protocol for treatment of primary intracranial neoplasia and future dose escalation can be considered.
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Affiliation(s)
- Philip Schwarz
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Valeria Meier
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Alena Soukup
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Randi Drees
- QMHA Diagnostic Imaging, The Royal Veterinary College, Hertfordshire, United Kingdom
| | - Jürgen Besserer
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Radiation Oncology, Hirslanden Clinic, Zurich, Switzerland
| | - Katrin Beckmann
- Section of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Malgorzata Roos
- Department of Biostatistics, Epidemiology Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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14
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Berlato D, Zwingenberger AL, Ruiz-Drebing M, Pradel J, Clark N, Kent MS. Canine meningiomas treated with three-dimensional conformal radiation therapy require magnetic resonance imaging to avoid a geographic miss. Vet Radiol Ultrasound 2018; 59:777-785. [DOI: 10.1111/vru.12653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Davide Berlato
- Animal Health Trust; Centre for Small Animal Studies; Suffolk CB87UU UK
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California, Davis; Davis CA 95616
| | | | - Julie Pradel
- Animal Health Trust; Centre for Small Animal Studies; Suffolk CB87UU UK
| | - Nicola Clark
- Animal Health Trust; Centre for Small Animal Studies; Suffolk CB87UU UK
| | - Michael S Kent
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California, Davis; Davis CA 95616
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15
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Kelsey KL, Gieger TL, Nolan MW. Single fraction stereotactic radiation therapy (stereotactic radiosurgery) is a feasible method for treating intracranial meningiomas in dogs. Vet Radiol Ultrasound 2018; 59:632-638. [PMID: 29873144 DOI: 10.1111/vru.12636] [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: 05/22/2017] [Revised: 12/19/2017] [Accepted: 03/08/2018] [Indexed: 02/06/2023] Open
Abstract
The aim of this retrospective, pilot study was to evaluate stereotactic radiosurgery as a method for treating intracranial meningiomas in dogs. Included dogs had an imaging diagnosis of presumed intracranial meningioma, were treated using a standardized stereotactic radiosurgery protocol, and had a follow-up time of >6 months after stereotactic radiosurgery. A single fraction of 16 Gy stereotactic radiosurgery was delivered to the tumor, with an internal simultaneously integrated boost to a total dose of 20-24 Gy to the central portion of the tumor. Thirty-two dogs were sampled. One dog was euthanized in the periprocedural period, and 10 of the remaining 31 dogs (31%) experienced an acute adverse event (defined as declining neurologic function due to tumor progression or treatment-associated complication within the first 6 months after stereotactic radiosurgery), three of which were fatal. Too few subjects (n = 6) had cross-sectional imaging after stereotactic radiosurgery to determine an objective response rate; however, 17/30 (57%) dogs assessed for response had a perceived clinical benefit from treatment. The overall median survival time was 519 days (95% confidence interval: 330-708 days); 64% and 24% of dogs were alive at 1 and 2 years after stereotactic radiosurgery, respectively. Dogs with infratentorial tumor location and high gradient indices had shorter survival. There were no factors identified which were predictive of acute adverse event. Survival times reported herein are similar to what has previously been reported for other stereotactic and traditional fractionated radiotherapy protocols. Findings therefore supported the use of stereotactic radiosurgery as an alternative method for treating dogs with presumed intracranial meningiomas.
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Affiliation(s)
- Krista L Kelsey
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607
| | - Tracy L Gieger
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607.,Comparative Medicine Institute, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607
| | - Michael W Nolan
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607.,Comparative Medicine Institute, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607
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