CT characteristics and proposed scoring scheme are predictive of pathologic fracture in dogs with appendicular osteosarcoma treated with stereotactic body radiation therapy.

Abstract

Stereotactic body radiation therapy (SBRT) is an established limb-sparing treatment for dogs with appendicular osteosarcoma (OSA) and pathologic fractures are a common sequela. The objectives of this retrospective, observational, and descriptive study were to develop and evaluate objective CT criteria for predicting pathologic fractures and assess impacts on survival time. Included dogs had confirmed or suspected appendicular OSA, available CT scans, available outcome data, and were treated with SBRT. For each study, the number of quartiles affected by lysis on the most severely affected transverse slice, longest measurable length of contiguous full cortical lysis, presence of subchondral bone lysis, and ratio of the length of the affected bone to normal bone were recorded. A scoring system was developed for assigning grades (summed score 1-4=grade 1, 5-7=grade 2, and 8 or greater=grade 3.) A total of 127 CT datasets were sampled (123 patients). The median summed score was 7. The grade was correlated with pathologic fracture development (23% of grade 1, 35% of grade 2, and 57% of grade 3 resulting in fracture, P=0.028). Subchondral bone lysis was correlated with fracture (odds ratio, 2.2, P=0.02). Percent affected bone≥40% was associated with decreased survival (P=0.002). Dogs with<40% of affected bone had a median survival of 256 days versus 178 days for dogs with≥40% affected bone. Findings from the current study can be used to assist in determining prognosis and planning radiation therapy for future dogs affected by appendicular OSA.