Treatment of equine sarcoids: A systematic review.
Abstract: The sarcoid is the most common equine cutaneous neoplasm. Evidence-based treatment of this condition is often lacking, and selection of treatment modality based on clinical experience or anecdotal evidence. Objective: To assess the quality of the currently available best evidence regarding the treatment of the equine sarcoid. Methods: Systematic review. Methods: In compliance with PRISMA guidelines, literature searches were performed in PUBMED, Web of Science, CAB Abstracts, EMBASE (Ovid) and Scopus in April 2021. Included papers were required to describe an interventional study examining sarcoid treatment strategy, of level 4 evidence or greater. The case definition required confirmation of at least some included lesions on histopathology, and a minimum of 6 months of follow-up was required on treated cases. Studies were assessed by two independent reviewers (KO, CD). Data extraction was performed manually, followed by risk of bias assessment. Methodological quality was assessed using the GRADE system. Results: In total, 10 studies were included in the review. Case definition was confirmed via histopathology in all included lesions in 60% of papers. Time to follow-up was variably reported. Overall risk of bias ranged from 'some concerns' to 'critical'. Reported sarcoid regression rate ranged from 28% to 100% on an individual sarcoid level, and 9%-100% on a whole horse level. Transient local inflammation was reported following most treatment strategies, with further adverse events reported infrequently. Conclusions: Review methodology excluded a large proportion of available literature regarding the equine sarcoid. Significant heterogeneity between included studies prevented quantitative synthesis and most included papers were at significant risk of bias, indirectness, and imprecision. Conclusions: There is insufficient evidence currently available to recommend one sarcoid treatment over another. There is an urgent need for sufficiently powered, randomised, placebo-controlled trials in order to allow more definitive comparison of the efficacy of different treatment strategies.
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Publication Date: 2023-03-14 PubMed ID: 36917551DOI: 10.1111/evj.13935Google Scholar: Lookup
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Summary
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The research article is a systematic review of treatment options for equine sarcoids, a common horse skin tumor. The article identifies a lack of high-quality evidence for treatment selection and concludes there isn’t enough evidence to recommend one treatment over another.
Research Objective
- The main objective of this research was to assess the quality of current best evidence regarding equine sarcoid treatment. Given the prevalence of this kind of tumor in horses, understanding the optimal methods of treatment is crucial to improving equine health. The researchers hope to contribute to the body of knowledge surrounding this condition by critically evaluating existing research in the field.
Research Methodology
- A systematic review of literature was carried out following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. These guidelines provide a framework for conducting and reporting systematic reviews and meta-analyses in scientific research.
- Multiple academic databases (PUBMED, Web of Science, CAB Abstracts, EMBASE (Ovid), and Scopus) were combed through for pertinent studies in April 2021.
- To qualify for inclusion, the papers needed to detail an intervention study on sarcoid treatment with evidence level 4 or higher. This means that the studies included had to have a robust methodology to allow meaningful analysis of the treatment strategy proposed.
- The authors also required the studies to provide a minimum of 6 months of follow-up on treated cases and a confirmed case definition through histopathology, a microscopic examination of tissue.
- Two independent reviewers assessed all the studies. The process involved manual data extraction followed by a risk of bias assessment. The researchers used the GRADE system, an approach to rating the certainty of evidence.
Research Findings
- A total of 10 studies were included in this review. Histopathology confirmed 60% of the lesions.
- Time to follow-up varied across studies. Sarcoid regression rates, which indicate the effectiveness of the treatment, ranged between 28%-100% on a sarcoid level, and 9%-100% on a horse level.
- Most treatment strategies resulted in some local inflammation, with other adverse events infrequently noted.
- The studies’ overall bias risk ranged from ‘some concerns’ to ‘critical’.
Conclusions
- The methodology of the review excluded a substantial portion of literature about equine sarcoid.
- There was a significant heterogeneity (variability) in the included studies, which hindered quantitative synthesis.
- The authors concluded that there is insufficient evidence currently available to endorse a specific sarcoid treatment over others.
- What’s urgently needed are sufficiently powered, randomised, placebo-controlled trials to steer future comparison of distinct therapy strategies.
Cite This Article
APA
Offer KS, Dixon CE, Sutton DGM.
(2023).
Treatment of equine sarcoids: A systematic review.
Equine Vet J.
https://doi.org/10.1111/evj.13935 Publication
Researcher Affiliations
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
- Tufts Equine Center at the Hospital for Large Animals, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA.
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
References
This article includes 47 references
- Schaffer PA, Wobeser B, Martin LER, Dennis MM, Duncan CG. Cutaneous neoplastic lesions of equids in the Central United States and Canada: 3351 biopsy specimens from 3272 equids (2000-2010).. J Am Vet Med Assoc 2013;242:99-104.
- Taylor S, Haldorson G. A review of equine sarcoid.. Equine Vet Educ 2013;25:210-6.
- Ireland JL, Wylie CE, Collins SN, Verheyen KLP, Newton JR. Preventive health care and owner-reported disease prevalence of horses and ponies in Great Britain.. Res Vet Sci 2013;95:418-24.
- Bogaert L, Martens A, Van Poucke M, Ducatelle R, De Cock H, Dewulf J. High prevalence of bovine papillomaviral DNA in the normal skin of equine sarcoid-affected and healthy horses.. Vet Microbiol 2008;129:58-68.
- Knottenbelt DC, Kelly DF. The diagnosis and treatment of periorbital sarcoid in the horse: 445 cases from 1974 to 1999.. Vet Ophthalmol 2000;3:169-91.
- Martens A, De Moor A, Vlaminck L, Pille F, Steenhaut M. Evaluation of excision, cryosurgery and local BCG vaccination for the treatment of equine sarcoids.. Vet Rec 2001;149:665-9.
- McConaghy FF, Davis RE, Reppas GP, Rawlinson J, McClintock SA, Hutchins DR. Management of equine sarcoids: 1975-93.. N Z Vet J 1994;42:180-4.
- Compston PC, Turner T, Wylie CE, Payne RJ. Laser surgery as a treatment for histologically confirmed sarcoids in the horse.. Equine Vet J 2016;48:451-6.
- McCauley CT, Hawkins JF, Adams SB, Fessler JF. Use of a carbon dioxide laser for surgical management of cutaneous masses in horses: 32 cases (1993-2000).. J Am Vet Med Assoc 2002;220:1192-7.
- Carstanjen B, Jordan P, Lepage OM. Carbon dioxide laser as a surgical instrument for sarcoid therapy - a retrospective study on 60 cases.. Can Vet J 1997;38:773-6.
- Hawkins JF, McCauley CT. Use of a carbon dioxide laser for surgical management of cutaneous masses in horses: 65 cases (1993-2004).. Proc SPIE Int Soc Optics Photon 2005;686:620-3.
- Lane JG. The treatment of equine Sarcoids by cryosurgery.. Equine Vet J 1977;9:127-33.
- Knottenbelt DC, Watson AH, Hotchkiss JW, Chopra S, Higgins AJ. A pilot study on the use of ultra-deformable liposomes containing bleomycin in the treatment of equine sarcoid.. Equine Vet Educ 2020;32:258-63.
- Stewart AA, Rush B, Davis E. The efficacy of intratumoural 5-fluorouracil for the treatment of equine sarcoids.. Aust Vet J 2006;84:101-6.
- Theon AP, Galuppo LD, Snyder JR, Wilson WD. Intratumoral administration of cisplatin for treatment of sarcoids in 378 horses.. Proc Am Assoc Equine Pract 2006;52:337-9.
- Nogueira SAF, Torres SMF, Malone ED, Diaz SF, Jessen C, Gilbert S. Efficacy of imiquimod 5% cream in the treatment of equine sarcoids: a pilot study.. Vet Dermatol 2006;17:259-65.
- Stadler S, Kainzbauer C, Haralambus R, Brehm W, Hainisch E, Brandt S. Successful treatment of equine sarcoids by topical aciclovir application.. Vet Rec 2011;168:187-7.
- Klein WR, Bras GE, Misdorp W, Steerenberg PA, de Jong WH, Tiesjema RH. Equine sarcoid: BCG immunotherapy compared to cryosurgery in a prospective randomised clinical trial.. Cancer Immunol Immunother 1986;21:133-40.
- Byam-Cook KL, Henson FMD, Slater JD. Treatment of periocular and non-ocular sarcoids in 18 horses by interstitial brachytherapy with iridium-192.. Vet Rec 2006;159:337-41.
- Hollis AR. Strontium plesiotherapy for the treatment of sarcoids in the horse.. Equine Vet Educ 2020;32:7-11.
- Hollis AR, Berlato D. Initial experience with high dose rate brachytherapy of periorbital sarcoids in the horse.. Equine Vet Educ 2018;30:444-9.
- Théon AP, Pascoe JR. Iridium-192 interstitial brachytherapy for equine periocular tumours: treatment results and prognostic factors in 115 horses.. Equine Vet J 1995;27:117-21.
- Walker M, Adams W, Hoskinson J, Held JP, Blackford J, Geiser D. Iridium-192 brachytherapy for equine sarcoid, one and two year remission rates.. Vet Radiol 1991;32:206-8.
- Cemazar M, Tamzali Y, Sersa G, Tozon N, Mir LM, Miklavcic D. Electrochemotherapy in veterinary oncology.. J Vet Intern Med 2008;22:826-31.
- Tamzali Y, Borde L, Rols MP, Golzio M, Lyazrhi F, Teissie J. Successful treatment of equine sarcoids with cisplatin electrochemotherapy: a retrospective study of 48 cases.. Equine Vet J 2012;44:214-20.
- Knottenbelt DC. The equine sarcoid why are there so many treatment options?. Vet Clin N Am Equine Pract 2019;35:243-62.
- OCEBM Levels of Evidence Working Group. The Oxford levels of evidence 2.. Oxford Centre for Evidence-Based Medicine Accessed 22 November 2022.
- Team TE. EndNote.. EndNote X9 ed. Philadelphia, PA: Clarivate; 2013.
- Ryan R, Synnot A, Prictor M, Hill S. Data extraction template for included studies.. Cochrane Consumers and Communication Group London: The Cochrane Collaboration; 2016. p. 1-25.
- Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M. ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions.. BMJ 2016;355:355.
- Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I. RoB 2: a revised tool for assessing risk of bias in randomised trials.. BMJ 2019;366:l4898.
- McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and shiny web app for visualizing risk-of-bias assessments.. Res Synth Methods 2020;12:55-61.
- Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline.. BMJ 2020;368:l6890.
- Christen-Clottu O, Klocke P, Burger D, Straub R, Gerber V. Treatment of clinically diagnosed equine sarcoid with a mistletoe extract (Viscum album austriacus).. J Vet Intern Med 2010;24:1483-9.
- Theon AP, Pascoe JR, Galuppo LD, Fisher PE, Griffey SM, Madigan JE. Comparison of perioperative versus postoperative intratumoural administration of cisplatin for treatment of cutaneous sarcoids and squamous cell carcinomas in horses.. J Am Vet Med Assoc 1999;215:1655-65.
- Spoormakers TJP, Klein WR, Jacobs JJL, Van Den Ingh TSGAM, Koten JW, Den Otter W. Comparison of the efficacy of local treatment of equine sarcoids with IL-2 or cisplatin/IL-2.. Cancer Immun Immunother 2003;52:179-84.
- Pettersson CM, Brostrom H, Humblot P, Bergvall KE. Topical treatment of equine sarcoids with imiquimod 5% cream or Sanguinaria canadensis and zinc chloride - an open prospective study.. Vet Dermatol 2020;31:471-e126.
- Hollis AR. Radiotherapy for the treatment of periocular tumours in the horse.. Equine Vet Educ 2019;31:647-52.
- Baust JG, Gage AA. The molecular basis of cryosurgery.. BJU Int 2005;95:1187-91.
- Hewes CA, Sullins KE. Use of cisplatin-containing biodegradable beads for treatment of cutaneous neoplasia in Equidae: 59 cases (2000-2004).. J Am Vet Med Assoc 2006;229:1617-22.
- Heller R, Jaroszeski M, Leo-Messina J, Perrot R, Van Voorhis N, Reintgen D. Treatment of B16 mouse melanoma with the combination of electropermeabilization and chemotherapy.. Bioelectrochem Bioenerg 1995;36:83-7.
- Spugnini EP, Baldi A. Electrochemotherapy in veterinary oncology state-of-the-art and perspectives.. Vet Clin North Am Small Anim 2019;49:967-79.
- Marty M, Sersa G, Garbay JR, Gehl J, Collins CG, Snoj M. Electrochemotherapy - an easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE (European standard operating procedures of electrochemotherapy) study.. EJC Suppl 2006;4:3-13.
- Berruex F, Gerber V, Wohlfender FD, Burger D, Koch C. Clinical course of sarcoids in 61 Franches-Montagnes horses over a 5-7 year period.. Vet Q 2016;36:189-96.
- GRADE. Handbook for grading quality of evidence and strength of recommendations.. In: Schünemann H, Brozek J, Guyatt G, Oxman A, editors. Going from evidence to recommendations. London: The GRADE Working Group; 2013. p. 1-3.
- Vandenbroucke JP. Observational research and evidence-based medicine: what should we teach young physicians?. J Clin Epidemiol 1998;51:467-72.
- Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid.. Evidence-Based Med 2016;21:125-7.
Citations
This article has been cited 6 times.- Semik-Gurgul E, Gurgul A, Szmatoła T. Transcriptome and methylome sequencing reveals altered long non-coding RNA genes expression and their aberrant DNA methylation in equine sarcoids. Funct Integr Genomics 2023 Aug 8;23(3):268.
- Monteiro MM, de Castro ELA, Pereira AJM, Thiesen R, Thiesen RMC, Salvarani FM. BCG Immunotherapy in Equine Sarcoid Treatment: Mechanisms, Clinical Efficacy, and Challenges in Veterinary Oncology. Viruses 2025 Sep 29;17(10).
- Vasconcelos AB, França DA, Prado ACD, Yamauchi DH, Silva ACAD, Barros IO, Valença SRFA, Lucheis SB, Bosco SMG. Molecular Detection of Pythium insidiosum in Cutaneous Lesions of Horses from Northeastern Brazil. Animals (Basel) 2025 Sep 30;15(19).
- Labens R, Saba C, Williams J, Hollis A, Ensink J, Jose-Cunilleras E, Jordana-Garcia M, Bergvall K, Ruppin M, Condon F, Spelta C, Elce Y, De Ridder T, Morton J, McGee C, Reddell P. Intratumoural tigilanol tiglate in the multicentre treatment of equine sarcoids and cutaneous melanomas. Equine Vet J 2026 Jan;58(1):89-104.
- Sobhy NM, Refaai W, Kumar R, Bottros Youssef CR, Goyal SM. Molecular Characterization of Bovine Deltapapillomavirus in Equine Sarcoids in Egypt. Vet Med Int 2025;2025:9773642.
- Beermann A, Clottu O, Reif M, Biegel U, Unger L, Koch C. A randomized placebo-controlled double-blinded study comparing oral and subcutaneous administration of mistletoe extract for the treatment of equine sarcoid disease. J Vet Intern Med 2024 May-Jun;38(3):1815-1824.
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