Use of an Image-Guided Robotic Radiosurgery System for the Treatment of Canine Nonlymphomatous Nasal Tumors

Glasser, Seth A.; Charney, Sarah C.; Dervisis, Nikolaos; Witten, M.R.; Ettinger, Stephen J.; Berg, Jason M.; Joseph, Richard

doi:10.5326/jaaha-ms-6024

Cited by 29 publications

(49 citation statements)

References 22 publications

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“…Similar outcomes have been reached by groups using high conformality as applied in stereotactic techniques (stereotactic body radiation therapy [SBRT], stereotactic radiosurgery [SRT]) . The use of stereotactic, severely hypofractionated radiation regimes in general prescribe the dose to a GTV/PTV volume, which is smaller than the commonly used GTV/CTV/PTV setup of conventional RT . While it indeed can be argued that most cases treated with more finely fractionated protocols progress from the original GTV rather than from the microscopic disease in the CTV (and hence the volumes other than GTV are of lesser importance), future increased local control could again shift this paradigm.…”

Section: Discussionmentioning

confidence: 78%

“…However, previous efforts with implantable low‐dose releasing cisplatinum‐containing implantable sponges could not demonstrate tumour selectivity in terms of improved local control . Similar outcomes have been reached by groups using high conformality as applied in stereotactic techniques (stereotactic body radiation therapy [SBRT], stereotactic radiosurgery [SRT]) . The use of stereotactic, severely hypofractionated radiation regimes in general prescribe the dose to a GTV/PTV volume, which is smaller than the commonly used GTV/CTV/PTV setup of conventional RT .…”

Section: Discussionmentioning

confidence: 97%

“…Radiation therapy (RT) is regarded as a standard of care treatment for canine sinonasal tumours; however, in spite of aggressive local treatment a definitive cure is rarely obtained. Median survival times with definitive‐intent protocols applied in 10 to 18 fractions and total doses of 42 to 54 Gy are typically not exceeding 10.8 to 19.7 months . The majority of patients, for example, 65% to 75%, have to expect local failure and the progression‐free interval in regularly fractionated protocols is short, with only 29% of dogs free of progression at 1 year .…”

Section: Introductionmentioning

confidence: 99%

“…definitive-intent protocols applied in 10 to 18 fractions and total doses of 42 to 54 Gy are typically not exceeding 10.8 to 19.7 months. [1][2][3][4][5][6][7][8][9] The majority of patients, for example, 65% to 75%, have to expect local failure 2,3,6-10 and the progression-free interval in regularly fractionated protocols is short, with only 29% of dogs free of progression at 1 year. 7 In order to overcome the issue of poor local control, local treatment had been modified using postradiotherapy surgical exenteration, 1 to 3 fraction stereotactic protocols or increased "boosts" of RT.…”

mentioning

confidence: 99%

“…7 In order to overcome the issue of poor local control, local treatment had been modified using postradiotherapy surgical exenteration, 1 to 3 fraction stereotactic protocols or increased "boosts" of RT. Unfortunately, these modified treatments resulted only in either comparable 4,5,10 or only slightly better outcomes, 11 and in many cases also in unacceptable toxicity. 1,12 The idea that with newer radiation technology a higher, more efficient dose can safely be given is intriguing.…”

mentioning

confidence: 99%

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A prospective pilot study on early toxicity from a simultaneously integrated boost technique for canine sinonasal tumours using image‐guided intensity‐modulated radiation therapy

Soukup

Meier

Pot

et al. 2018

Vet Comparative Oncology

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In order to overcome the common local treatment failure of canine sinonasal tumours, integrated boost techniques were tried in the cobalt/orthovoltage era, but dismissed because of unacceptable early (acute) toxicity. Intriguingly, a recent calculation study of a simultaneously integrated boost (SIB) technique for sinonasal irradiation using intensity-modulated radiation therapy (IMRT) predicted theoretical feasibility. In this prospective pilot study we applied a commonly used protocol of 10 × 4.2 Gy to the planning target volume (PTV) with a 20%-SIB dose to the gross tumour volume (GTV). Our hypothesis expected this dose escalation to be clinically tolerable if applied with image-guided IMRT. We included 9 dogs diagnosed with sinonasal tumours without local/distant metastases. For treatment planning, organs at risk were contoured according to strict anatomical guidelines. Planning volume extensions (GTV/CTV/PTV) were standardized to minimize interplanner variability. Treatments were applied with rigid patient positioning and verified daily with image guidance. After radiation therapy, we set focus on early ophthalmologic complications as well as mucosal and cutaneous toxicity. Early toxicity was evaluated at week 1, 2, 3, 8 and 12 after radiotherapy. Only mild ophthalmologic complications were found. Three patients (33%) had self-limiting moderate to severe early toxicity (grade 3 mucositis) which was managed medically. No patient developed ulcerations/haemorrhage/necrosis of skin/mucosa. The SIB protocol applied with image-guided IMRT to treat canine sinonasal tumours led to clinically acceptable side effects. The suspected increased tumour control probability and the risk of late toxicity with the used dose escalation of 20% has to be further investigated.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 97%