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Are the effect of steroids on edema the only reason dogs with brain tumors get better?
Vet Comp Oncology 2024
Valerie J. Poirier, Tracy Gieger, Fiona M. K. James, Monica Jensen, Samuel Hocker, Christopher J. Pinard, Stephanie Nykamp
Background
Peritumoral brain edema (PTBE) is a common feature in canine brain tumors, particularly meningiomas. It is primarily vasogenic, resulting from increased vascular permeability due to blood-brain barrier disruption. Steroids are widely used to manage PTBE, but their impact on reducing edema in veterinary patients requires further study. This study aimed to evaluate the effect of steroids on PTBE volume in dogs with extra-axial brain tumors, hypothesizing a reduction in edema with steroid treatment.
Methods
This retrospective observational study analyzed 44 dogs with presumed meningiomas undergoing radiation therapy. Each dog underwent two MRIs (diagnostic and RT planning) within a median of 22 days. The volume of PTBE was measured using MRI, and changes in PTBE were assessed relative to steroid administration. Statistical analyses included paired tests to compare edema volumes and models to evaluate steroid effects.
Results
Steroid use was associated with a significant reduction in PTBE (p = 0.009). Among steroid-treated dogs (34/44), 44% showed a >30% reduction in PTBE, while 18% had increased edema. In contrast, dogs not receiving steroids had a median PTBE increase of 25%. Clinical improvements were reported in many cases regardless of PTBE reduction. Two dogs deteriorated clinically despite steroid use, showing substantial PTBE increases.
Limitations
The study was limited by its retrospective design, small sample size, and variability in MRI protocols. Differences in steroid dosages and timing could have influenced results. Additionally, histological confirmation of tumor type was not obtained in most cases, and there was potential for imaging inconsistencies.
Conclusions
Steroid treatment was associated with a variable but generally significant reduction in PTBE in dogs with extra-axial brain tumors. However, clinical improvement was not consistently linked to changes in PTBE, suggesting other mechanisms may influence symptom relief. Further prospective studies are needed to optimize steroid protocols and assess long-term outcomes.
Two different dogs (1) and (2) (both receiving steroids) with more than 30% decreased in VPTE volume between the two MRIs. (A)T2-FLAIR transverse image of diagnostic MRI. (B) T2-FLAIR transverse image of RT planning MRI. C. Post contrast RT planning CT transverseimage with VPTE-1 contour (magenta) and VPTE-2 contour (green). Abbreviations: T2-FLAIR, T2-weighted-fluid-attenuated inversion recoverysequence; VPTE-1, volume of peritumoral edema on diagnostic MRI (MRI-1); VPTE-2, volume of peritumoral edema on RT planning MRI (MRI-2).FIGURE 3 | Two different dogs 1 (not receiving steroids) and 2 (receiving steroids) with more than 30% increased in VPTE volume between the two MRIs.(A) T2-FLAIR transverse image of diagnostic MRI (MRI-1). (B) T2-FLAIR transverse image of RT planning MRI (MRI-2). (C) Post contrast RT planning CTtransverse image with VPTE-1 contour (magenta) and VPTE-2 contour (green). Abbreviations: T2-FLAIR, T2-weighted-fluid-attenuated inversion recoverysequence, VPTE-1, volume of peritumoral edema on diagnostic MRI (MRI-1), VPTE-2, volume of peritumoral edema on RT planning MRI (MRI-2).
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