title: Intraoperative extracorporeal irradiation for limb sparing in 13 dogs.
abstract: OBJECTIVE
  To evaluate extracorporeal intraoperative radiation therapy (IORT) as a treatment method for limb and joint sparing in dogs with appendicular sarcomas in sites other than the distal aspect of the radius.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Thirteen client-owned dogs.
  
  
  METHODS
  The bone tumor database and medical records (1998-2002) were reviewed for dogs with primary appendicular bone tumors treated with IORT limb-sparing surgery and adjuvant chemotherapy. The segment of bone containing the tumor was isolated from adjacent soft tissue and an osteotomy performed distant to the tumor. The bone segment was exteriorized, irradiated (70 Gy single fraction), and then stabilized with internal fixation. Adjuvant chemotherapy was administered. Lameness was graded and local and distant tumor control was determined. Associations between intra- and postoperative variables with complications and Kaplan-Meier survival analysis for median disease-free interval and survival time were calculated.
  
  
  RESULTS
  Limb function was good or excellent in 10 dogs (77%). Postoperative complications (9 dogs, 69%) included deep infection, fracture of the irradiated bone, and implant failure. Surgical failure was more likely if a single implant was used to stabilize the osteotomized bone and if deep infection developed postoperatively. In 3 dogs, tumors recurred locally within bone in the radiation field. The disease-free and overall success rates of extracorporeal IORT for limb and joint preservation were 46% and 54%, respectively.
  
  
  CONCLUSIONS
  Extracorporeal IORT provides a novel alternative to traditional techniques for preservation of joint and limb function in dogs with primary appendicular sarcomas. A minimum of 2 implants and intramedullary bone cement should be used to stabilize the osteotomized bone to minimize postoperative complications. Extracorporeal IORT should be used with caution in dogs with tumors of the distal tibia because of a high complication rate. Dogs with tumors in areas of good soft-tissue coverage, such as the humerus and femur, may be good candidates for limb and joint-sparing surgery using extracorporeal IORT.
  
  
  CONCLUSIONS
  Extracorporeal IORT is a surgical technique that can be used for limb and joint salvage in dogs with primary appendicular sarcomas in sites usually not amenable to traditional limb-sparing techniques.
authors.affiliation: Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA. jiliptak@uoguelph.ca
authors.forename: Julius M
authors.initials: JM
authors.lastname: Liptak
authors.forename: William S
authors.initials: WS
authors.lastname: Dernell
authors.forename: B Duncan X
authors.initials: BD
authors.lastname: Lascelles
authors.forename: Susan M
authors.initials: SM
authors.lastname: Larue
authors.forename: Vicki J
authors.initials: VJ
authors.lastname: Jameson
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Powers
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Huber
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Withrow
mesh_terms: D000818:Animals; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000662:veterinary*; D016025:Bone Transplantation / Q000379:methods / Q000662:veterinary*; D003120:Colorado; D003131:Combined Modality Therapy; D004283:Dog Diseases / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D004285:Dogs; D005121:Extremities; D005260:Female; D007432:Intraoperative Period; D008297:Male; D011183:Postoperative Complications; D011839:Radiation, Ionizing; D011996:Records / Q000662:veterinary; D012189:Retrospective Studies; D012509:Sarcoma / Q000532:radiotherapy / Q000601:surgery / Q000662:veterinary*; D016019:Survival Analysis