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Table 2.3 Mesenchymal.
| Neoplasia | Researched Treatment Options and Outcomes |
|---|---|
| Soft Tissue Sarcoma (Schwannoma, Neurofibroma, Peripheral Nerve Sheath Tumor, etc.) | Surgery, wide margins, with curative intent (Postorino et al. 1988; Kuntz et al. 1997; Dernell et al. 1998b; Banks et al. 2003b, 2004; Baez et al. 2004; Prpich et al. 2014; Bray et al. 2014b), and surgery‐marginal resection with adjuvant radiation (Evans 1987; Graves et al. 1988; Forrest et al. 2000; McKnight et al. 2000; Demetriou et al. 2012; Kung et al. 2014) are the current standard of care treatments for canine STS. Systemic chemotherapy of possible benefit for highly anaplastic tumors but as yet unproved for grade III soft tissue carcinomas (Selting et al. 2005). Hypo‐fractionated RT for gross STS with or without metronomic chemotherapy also reported (Cancedda et al. 2015a). Marginal resection and localized cisplatin chemotherapy into wound bed (OPLA‐Pt/Atrigel) was reported (Banks and Straw 2003; Havlicek et al. 2009). Metronomic chemotherapy (continuous low‐dose chemotherapy) with cyclophosphamide and piroxicam significantly increased disease‐free interval for incompletely resected soft tissue sarcomas compared to control dogs (Elmslie et al. 2008). Re‐excision for treatment of soft tissue sarcomas is recommended after recent incomplete resection (Bacon et al. 2007). In one large study, STS removal was performed in general practice, 21% showed local recurrence, and 11% developed metastasis in a median follow‐up time of 785 days (Bray et al. 2014a). The time to recurrence was within 1 year for 50%, 2 years for 80%, and in 2 cases recurrence occurred >4 years after the original surgery. In this study, only 6% of STS were grade III, completeness of excision was unknown, and 60% were extremity in location (Bray et al. 2014a). Another study showed an 11% recurrence rate for marginally excised, low‐grade, extremity STS over a median time of 522 days (Stefanello et al. 2011), and despite the marginal excision, margins were histologically “clean” or “clean but close” in 66%. In several papers, trends suggest that STS located on the limbs may have better prognosis; with longer survival, lower metastasis, and better response to treatment (Brehm et al. 1995; Kuntz et al. 1997; Prpich et al. 2014). Other studies have not found tumor location to be prognostic for survival or local recurrence (Baez et al. 2004; Bacon et al. 2007; Chase et al. 2009). Recurrent STS is more difficult to control and is associated with reduced overall survival (Bostock and Dye 1980; Postorino et al. 1988; Kuntz et al. 1997; Banks et al. 2004; Ehrhart 2005b; Heller et al. 2005; Liptak and Forrest 2013; Bray et al. 2014a). The chance of a surgical cure is greatest with the first surgery (Postorino et al. 1988; Graves et al. 1988; Kuntz et al. 1997; MacEwan et al. 2001; Banks et al. 2003b). Both completeness of excision and histological grade predict response to surgery (Kuntz et al. 1997; McSporran 2009; Avallone et al. 2014). Other reported major prognostic factors reported are tumor size, depth of growth, and pathological profiles (Avallone et al. 2014). Another study reported tumor size (<5 cm) and clean surgical margins ensured a good prognosis independently of grade, with a study population of 47.5% grade I, 45.5% grade II, and 7% grade III STS (Stefanello et al. 2011). Twenty‐five dogs with incompletely excised STS (data for chondrosarcoma and haemangiosarcoma excluded as not part of STS grouping) received ECT at the time of suture removal. The dogs were treated with intravenous bleomycin and the tumor bed and margins were infiltrated with cisplatin followed by 8 electrical pulses delivered in bursts of 1300 V/cm (2 cm lateral and deep margins were treated). This was repeated 2 weeks later. Disease‐free follow‐up time for grade 1 STS was 1298 days (1 dog), for grade II STS was a median of 483 days (19 dogs), and for grade III/undifferentiated tumors was median 283 days (3 dogs) Liposarcomas were excluded as the grade was not reported (Spugnini et al. 2019). |
| Vaccine‐Associated Sarcomas in Cats | Surgery (Davidson et al. 1997; Hershey et al. 2000; McEntee and Page 2001; Lidbetter et al. 2002; Phelps et al. 2011); surgery and radiation therapy (Cronin et al. 1998; Cohen et al. 2001; Bregazzi et al. 2001; Kobayashi et al. 2002); chemotherapy (Barber et al. 2000; Bregazzi et al. 2001; Poirier et al. 2002; Saba et al. 2012); immunotherapy (Kent 1993; King et al. 1995; Quintin‐Colonna et al. 1996; Jourdier et al. 2003). Phelps et al. 2011 reported resection with 5 cm margins around palpable tumor, with an overall MST of 901 days, 14% local recurrence; 20% metastasis post‐op. MST with and without recurrence was 499 and 1461 days, respectively (Phelps et al. 2011). Cats treated with surgery (most with clean margins) achieved a MST of 43 months, cats treated with coarse fractionated radiotherapy (most with either macroscopic disease or dirty margins) reached a MST of 24 months. In cats undergoing coarse fractionated therapy, factors predictive of a better outcome included lack of visible mass (30 versus 7 months MST) adjuvant chemotherapy for gross disease and a smaller number of surgeries preceding radiation therapy (Eckstein et al. 2009). Rate of local recurrence of 42% with pre‐operative radiation and complete excision (Kobayashi et al. 2002). Tumors fixed in formalin that were <3.75 cm were less likely to recur, highlighting the importance of prompt diagnosis and surgery (Porcellato et al. 2017). Patients with a mitotic count of > 20/10 high power fields had a higher risk of recurrence and a lower MST (Porcellato et al. 2017). ECT for macroscopic disease using bleomycin achieved a median time to recurrence of 12 months, and for microscopic disease achieved a median time to recurrence of 19 months (Spugnini et al. 2007). |
| Intermuscular Lipoma | Careful surgical dissection (peeling out), excellent prognosis (Thomson et al. 1999; Case et al. 2012). |
| Infiltrative Lipoma | Aggressive surgical resection, adjuvant radiation if margins incomplete (McChesney et al. 1980; Kramek et al. 1985; Bergman et al. 1994; McEntee et al. 2000). |
| Liposarcoma | Wide surgical resection with clean margins yields good prognosis (Baez et al. 2004). Adjuvant radiation if incomplete resection (Rodenas et al. 2006). Prolonged survival for splenic liposarcoma if no metastasis (MST 767 days), histological grade prognostic (Gower et al. 2015). |
| Mesothelioma | Surgery, usually debulking, pericardiectomy for palliation (surgical or thoracoscopic), intracavitary and/or intravenous chemotherapy (Moore et al. 1991b; Kerstetter et al. 1997; Dunning et al. 1998; Closa et al. 1999; Jackson et al. 1999; Stepien et al. 2000; Charney et al. 2005; Sparkes et al. 2005; Seo et al. 2007; Spugnini et al. 2008). Early metastasis a concern even if complete resection is achieved (Liptak and Brebner 2006). |
| Lymphangiosarcoma (LAS) | Surgery, chemotherapy, radiation therapy (Itoh et al. 2004). Survival times reported for 9 dogs for which treatment was pursued; 90 days with prednisone in 1 dog; 182 days with chemotherapy in 1 dog; 240, 267, 487, 630, and 941 days for 5 dogs receiving surgery; and 574 days for 1 dog receiving surgery, radiation and chemotherapy, 1 dog alive with recurrence at 243 days following surgery and carboplatin chemotherapy. Clinical improvement existed in LAS dogs receiving multi‐modal therapies (Curran et al. 2014). One dog treated with surgery and adjuvant doxorubicin had a 6‐month recurrence‐free interval, then treated with metronomic chemotherapy using chlorambucil and meloxicam, which failed to adequately control the disease. Toceranib phosphate was introduced and resulted in almost complete regression of the mass, leaving just a skin plaque (Marcinowska et al. 2013). Disseminated lymphangiosarcoma treated with surgery and adjuvant mitoxantrone (Sicotte et al. 2012). |
| Synovial Cell Sarcoma | Surgery (high amputation is the treatment of choice because local recurrence is higher with marginal or wide resection) (Vail et al. 1994); chemotherapy may be of benefit if sarcoma is high grade and there is no metastasis, or if the node is positive (Tilmant et al. 1986; Vail et al. 1994; Craig et al. 2002). Adjuvant radiation for incomplete excision investigational. |
| Oral Fibrosarcoma |
Surgical resection with wide margins is the treatment of choice (Schwarz et al. 1991a, 1991b; White 1991; Lascelles et al. 2003; Lascelles et al. 2004; Frazier et al. 2012; Gardner et al. 2015a); if not resectable with clean margins, surgery and radiation therapy (Forrest et al. 2000;
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