ABSTRACT
Non-thermal irreversible electroporation (N-TIRE) has shown promise as an ablative therapy for a variety of soft-tissue neoplasms. Here we describe the therapeutic planning aspects and first clinical application of N-TIRE for the treatment of an inoperable, spontaneous malignant intracranial glioma in a canine patient. The N-TIRE ablation was performed safely, effectively reduced the tumor volume and associated intracranial hypertension, and provided sufficient improvement in neurological function of the patient to safely undergo adjunctive fractionated radiotherapy (RT) according to current standards of care. Complete remission was achieved based on serial magnetic resonance imaging examinations of the brain, although progressive radiation encephalopathy resulted in the death of the dog 149 days after N-TIRE therapy. The length of survival of this patient was comparable to dogs with intracranial tumors treated via standard excisional surgery and adjunctive fractionated external beam RT. Our results illustrate the potential benefits of N-TIRE for in vivo ablation of undesirable brain tissue, especially when traditional methods of cytoreductive surgery are not possible or ideal, and highlight the potential radiosensitizing effects of N-TIRE on the brain.
Subject(s)
Ablation Techniques/veterinary , Brain Neoplasms/veterinary , Dog Diseases/therapy , Electroporation/veterinary , Glioma/veterinary , Ablation Techniques/methods , Animals , Brain Diseases/etiology , Brain Diseases/mortality , Brain Diseases/veterinary , Brain Neoplasms/radiotherapy , Brain Neoplasms/therapy , Combined Modality Therapy/veterinary , Dog Diseases/radiotherapy , Dogs , Dose Fractionation, Radiation , Electroporation/methods , Glioma/radiotherapy , Glioma/therapy , Male , Prognosis , Radiotherapy Planning, Computer-Assisted/veterinary , Radiotherapy, Adjuvant/veterinaryABSTRACT
Six dogs with spontaneously occurring, previously untreated lymphoma were treated with half-body radiation therapy (RT) doses interposed in a CHOP-based 25-week chemotherapy regimen. Chemotherapy-related toxicities were as expected and were mildly increased in severity post-RT compared with pre-RT. Treatment was delayed by 1-2 weeks per delay in four dogs due to chemotherapy-related neutropenia. Radiation therapy was administered in two consecutive day fractions of 4 Gray to the cranial and caudal halves of the body 4 weeks apart. Radiation-related toxicities consisted of lethargy, alopecia, diarrhoea of less than 2-day duration and average decreases in neutrophil counts of 50%. Late effects from RT were not evident. Median remission and survival times for the six dogs were 455 and 560 days, respectively. The protocol was well tolerated and should be studied further to evaluate the potential therapeutic gain of the addition of RT to chemotherapy for the treatment of canine lymphoma.