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      Comparative evaluation of a novel, moderately hypofractionated radiation protocol in 56 dogs with symptomatic intracranial neoplasia

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          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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          Most cited references28

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          Response criteria for phase II studies of supratentorial malignant glioma.

          We suggest "new" response criteria for phase II studies of supratentorial malignant glioma and favor rigorous criteria similar to those in medical oncology, with important modifications. Four response categories are proposed: complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Response in this scheme is based on major changes in tumor size on the enhanced computed tomographic (CT) or magnetic resonance imaging (MRI) scan. Scan changes are interpreted in light of steroid use and neurologic findings. We advocate careful patient selection, emphasize pitfalls in the assessment of response, and suggest guidelines to minimize misinterpretations of response.
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            Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy.

            To investigate radiation necrosis in patients treated for glioma in terms of incidence, outcomes, predictive and prognostic factors. Records were reviewed for 426 patients followed up until death or for at least 3 years. Logistic regression analysis was performed to identify predictive and prognostic factors. Multivariate survival analysis was conducted using Cox proportional hazards regression. Separate analyses were performed for the subset of 352 patients who received a biologically effective dose (BED) > or =85.5 Gy2 (> or =45 Gy/25 fractions) who were at highest risk for radionecrosis. Twenty-one patients developed radionecrosis (4.9%). Actuarial incidence plateaued at 13.3% after 3 years. In the high-risk subset, radiation parameters confirmed as risk factors included total dose (p < 0.001), BED (p < 0.005), neuret (p < 0.001), fraction size (p = 0.028), and the product of total dose and fraction size (p = 0.001). No patient receiving a BED <96 Gy2 developed radionecrosis. Subsequent chemotherapy significantly increased the risk of cerebral necrosis (p = 0.001) even when adjusted for BED (odds ratio [OR], 5.8; 95% confidence interval [CI], 1.6-20.3) or length of follow-up (OR, 5.4; 95% CI, 1.5-19.3). Concurrent use of valproate appeared to delay the onset of necrosis (p = 0.013). The development of radionecrosis did not affect survival (p = 0.09). Cerebral necrosis is unlikely at doses below 50 Gy in 25 fractions. The risk increases significantly with increasing radiation dose, fraction size, and the subsequent administration of chemotherapy.
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              International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe

              In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors’ experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.
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                Author and article information

                Contributors
                crohrer@vetclinics.uzh.ch
                Journal
                J Vet Intern Med
                J. Vet. Intern. Med
                10.1111/(ISSN)1939-1676
                JVIM
                Journal of Veterinary Internal Medicine
                John Wiley & Sons, Inc. (Hoboken, USA )
                0891-6640
                1939-1676
                11 October 2018
                Nov-Dec 2018
                : 32
                : 6 ( doiID: 10.1111/jvim.2018.32.issue-6 )
                : 2013-2020
                Affiliations
                [ 1 ] Division of Radiation Oncology, Vetsuisse Faculty University of Zurich Zurich Switzerland
                [ 2 ] QMHA Diagnostic Imaging, The Royal Veterinary College Hertfordshire United Kingdom
                [ 3 ] Radiation Oncology Hirslanden Clinic Zurich Switzerland
                [ 4 ] Section of Small Animal Surgery/Neurology, Vetsuisse Faculty University of Zurich Zurich Switzerland
                [ 5 ] Department of Biostatistics, Epidemiology Biostatistics and Prevention Institute, Faculty of Medicine University of Zurich Zurich Switzerland
                Author notes
                [*] [* ] Correspondence

                Carla Rohrer Bley, Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich Winterthurerstrasse 260 CH‐8057 Zurich, Switzerland.

                Email: crohrer@ 123456vetclinics.uzh.ch

                Author information
                https://orcid.org/0000-0003-0793-9005
                https://orcid.org/0000-0002-5733-2722
                Article
                JVIM15324
                10.1111/jvim.15324
                6272041
                30308086
                6e93f36b-77f9-43e8-bba8-2a23c619bd34
                © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 21 March 2018
                : 15 August 2018
                : 15 August 2018
                Page count
                Figures: 3, Tables: 0, Pages: 8, Words: 6893
                Categories
                Standard Article
                SMALL ANIMAL
                Standard Articles
                Neurology
                Custom metadata
                2.0
                jvim15324
                November/December 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.3 mode:remove_FC converted:01.12.2018

                Veterinary medicine
                brain tumor,dog,fractionation,neurologic signs,radiation therapy,risk
                Veterinary medicine
                brain tumor, dog, fractionation, neurologic signs, radiation therapy, risk

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