title: Frameless stereotactic volumetric modulated arc radiotherapy of brachial plexus tumours in dogs: 10 cases.
abstract: OBJECTIVE
  Treatment of canine peripheral nerve sheath tumours (PNSTs) is challenging and prognosis after surgical resection is considered poor. The aim of this study was to evaluate the feasibility and effectiveness of stereotactic radiotherapy (RT) of these tumours.
  
  
  METHODS
  10 dogs with clinical symptoms and MRI findings consistent with PNSTs of the brachial plexus, branches and nerve roots were treated with linear accelerator-based volumetric-modulated arc radiotherapy (VMAT) with a dose of 35 Gy/5 fractions. Clinical and MRI follow-up examinations were planned and radiotoxicity and survival times were investigated.
  
  
  RESULTS
  Tumours involved the plexus and proximal nerves in three dogs, the plexus, proximal nerves and nerve roots in five dogs and the nerve roots and proximal nerves in two dogs. Partial response and partial or complete reductions of neurological deficits were observed in all the treated dogs. Local recurrence was observed in 9/10 of treated dogs. No symptom directly referable to radiotoxicity was observed. Mean overall survival of 371 ± 30 days [95% confidence interval (CI) of (315-427)] and mean progression-free survival of 240 ± 30 days (95% CI of 188-291) from this work are comparable with surgical literature data regarding the plexus and proximal nerve localization, but are superior in comparison with nerve root localization.
  
  
  CONCLUSIONS
  VMAT can be a safe and viable alternative to surgery in cases of canine brachial plexus PNSTs involving the proximal nerves and nerve roots. Advances in knowledge: To our knowledge, this is the first prospective observational clinical study regarding VMAT stereotactic RT treatment for canine brachial plexus PNSTs and suggests that VMAT may achieve at least similar clinical outcome than surgery in a safer way.
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Dolera
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Malfassi
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bianchi
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Nancy
authors.initials: N
authors.lastname: Carrara
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Finesso
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Marcarini
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mazza
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Pavesi
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sala
authors.affiliation: 1 La Cittadina Fondazione Studi e Ricerche Veterinarie, Romanengo, Italy.|2 Radiotherapy Department Azienda Socio Sanitaria Territoriale di Lodi, Lodi, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Urso
mesh_terms: D000818:Animals; D001917:Brachial Plexus / Q000473:pathology / Q000601:surgery*; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D008297:Male; D018317:Nerve Sheath Neoplasms / Q000473:pathology / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome