Prolonged survival after craniectomy with skull reconstruction and adjuvant definitive radiation therapy in three dogs with multilobular osteochondrosarcoma

Abstract

Multilobular osteochondrosarcoma is an uncommon canine tumor but presents a treatment challenge when arising on the skull. This retrospective case series study aimed to describe outcome of a multimodality treatment approach involving aggressive surgical resection and adjuvant definitive radiation therapy in a group of dogs with multilobular osteochondrosarcoma of the calvarium. Clinical, imaging, treatment, and outcome data were collected from retrospective review of medical records. Three dogs met inclusion criteria. The presenting clinical complaint was the presence of a mass effect of the skull in all three dogs and concurrent neurologic abnormalities in one dog. Advanced imaging revealed aggressive lytic and proliferative tumors arising from the calvarium in all three dogs. All dogs were treated surgically with a modified craniectomy, repaired with a titanium mesh—polymethyl methacrylate bone cement implant or a low prolife titanium mesh plate and followed by adjuvant definitive radiation therapy with 2.5 Gy per fraction for 22 daily fractions. There were no major immediate surgical complications and radiation was well tolerated overall. Neurologic improvement was seen in the patient that presented with neurologic disease. Survival times from surgery were 387, 422, and 730 days and from the time of radiation were 358, 397, and 677 days. Findings in this sample of three dogs supported the use of aggressive therapy with a combination of surgical craniectomy and cranioplasty utilizing a titanium mesh implant and high dose definitive radiation therapy for local control and prolonged survival times in dogs with multilobular osteochondrosarcoma of the skull.

Tumor ósseo multilobular em cão da raça yorkshire terrier: relato de caso

“…Com o emprego de exames de imagem como radiografia e ressonância magnética, foi constatada a localização do tumor ósseo sobre a região do arco zigomático esquerdo sem comprometimento de estruturas adjacentes ou presença de metástases tumorais, fatos já relatados em outras investigações (COOK et al, 2017;BUDGEON;WALLER, 2019). Os exames de imagem foram fundamentais para o estabelecimento diagnóstico, planejamento cirúrgico e pesquisa de metástases, levando a orientação do proprietário sobre a indicação do procedimento cirúrgico com ampla margem de segurança (DERNELL et al, 1998;HATHCOCK;NEWTON, 2000;HOLMES;KEYERLEBER;FAISSLER, 2019;LIPSITZ;LEVITSKI;BERRY, 2001;BUDGEON;WALLER, 2019;THOMPSON;POOL, 2002). A remoção cirúrgica costuma ser difícil devido à localização da neoplasia e a recorrência local ocorre em cerca de 50% dos casos (COOK et al, 2017;MAXIE et al, 2007), fato descrito, anteriormente, pelo tutor do animal.…”

Frontal sinus repair using polymethyl methacrylate after craniectomy for a resection of a fronto‐parietal osteoma in a dog

“…In recent times, the use of PMMA solely or combined with titanium mesh has been reported in veterinary medicine when cranioplasty is required to repair a skull bone defect. 11 However, the aim of the PMMA-cranioplasties in those cases is the reconstruction of the cranial vault to cover and protect the brain surface instead of separating the nasal and cranial cavities. One of the three dogs reported by Holmes et al was diagnosed with a recurrent sinus infection as well as implant infection which required a second surgery to replace the implant.…”

“…In recent times, the use of PMMA solely or combined with titanium mesh has been reported in veterinary medicine when cranioplasty is required to repair a skull bone defect 11 . However, the aim of the PMMA‐cranioplasties in those cases is the reconstruction of the cranial vault to cover and protect the brain surface instead of separating the nasal and cranial cavities.…”

“…The approach to lesions affecting the frontal lobes usually requires passage through the FS. This approach may result in postoperative complications in both human and veterinary medicine, such as intracranial infection, 11,12 cerebrospinal fluid leakage, 13 mucocele formation, 1–4 pneumoencephalus 6,7 or meningoencephalocele 8 . One case report describes a concomitant pneumoencephalus, herniation of the olfactory bulb and septic meningoencephalitis in a dog secondary to dorsal rhinotomy 14 .…”

Cranioplasty for Multilobular Osteochondrosarcoma Using 3-Dimensional Printing Technology in Dogs: A Report of Two Cases with a Long-Term Follow-Up

“…Although chemotherapy and radiotherapy may have benefits of local control of tumors or palliation of residual tumors (13,30,31), surgery remains the treatment of choice. Clean surgical margins are strongly associated with favorable prognosis (5,7,8,16).…”