Veterinary Oncology: The Lumps We Hate To Treat
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1 Veterinary Oncology: The Lumps We Hate To Treat Michelle Turek, DVM, DACVIM (Oncology), DACVR (Radiation Oncology) College of Veterinary Medicine University of Georgia Athens, GA
2 Veterinary Oncology Veterinary Oncologists American College of Veterinary Internal Medicine 313 Veterinary Radiation Oncologists American College of Veterinary Radiology 86 Vet Rad Onc Facilities US: 77 (20 academic, 57 private practice) Canada: 4 (2 academic, 2 private practice) Europe: 12 (UK, Italy, Switzerland, Germany, France)
3 CT based planning 1980s Megavoltage 1950s Stereotactic Radiosurgery Emerging therapy Image-Guided Radiotherapy State of the art Intensity Modulated Radiotherapy Current 3D Conformal Radiation Therapy 1990s
4 Veterinary Radiation Therapy Centers USA Courtesy Dr. Susan LaRue, CSU
5 Veterinary Radiation Therapy Centers - IMRT Courtesy Dr. Susan LaRue, CSU
6 Veterinary Radiation Therapy Centers - IGRT Courtesy Dr. Susan LaRue, CSU
7 Canine Cancer Statistics 62% of American households have a pet 78 million pet dogs in US 86 million pet cats in US 6 million dogs diagnosed with cancer each year Cancer affects 1 out of 3 dogs Half will die of cancer Breed predispositions
8 Comparative Oncology The Dog As A Model For Human Cancer
9 Common Companion Animal Cancers Non-hodgkin s lymphoma Osteosarcoma Lung cancer Breast (mammary) carcinoma Prostate carcinoma Brain tumors Melanoma Intra-nasal carcinoma Thyroid carcinoma Anal sac adenocarcinoma Mast cell tumor / Soft tissue sarcoma Feline oral squamous cell carcinoma Feline vaccine associated sarcoma
10 Common Companion Animal Cancers Non-hodgkin s lymphoma Osteosarcoma Breast (mammary) carcinoma Melanoma Intra-nasal carcinoma
11 Common Companion Animal Cancers Melanoma Intra-nasal carcinoma Anal sac adenocarcinoma Feline oral squamous cell carcinoma Feline vaccine associated sarcoma
12 Nasal Tumors 10% of all neoplasms evaluated by radiation facilities 5 th most common tumor tx Epistaxis or nasal discharge Facial deformity Breathing noise Sneezing
13 Stage 2 Stage 3 Stage 4
14 Nasal Tumors: Radiation Therapy RT is not curative but offers local control Goals for therapy are Tumor control (curativeintent) Palliation With no therapy, median ST for carcinomas is 4 months
15 Radiation Therapy Palliation: 6-8 Gy X 4 weekly fractions 4 Gy daily X 5 days % rate of clinical sign resolution Median duration days Curative-intent: 4.2 Gy X 10 days = 42 Gy Median survival time = months Stage 4: 6 months
16 Veterinary Radiation Oncology at UGA Siemens mevatron linac 6 MV X-ray (10 MV disabled) Various electron energies 58 leaf MLC Varian s Eclipse and Aria 3D RT Advanced imaging: CT and MRI
17 3D RT with MLC
18
19 KCS Conjunctivitis Corneal ulceration Cataracts Ocular Effects
20 Acute Side Effect Oral Mucositis
21 Radiotherapy is the art of sparing normal tissue Tumor Control Therapeutic Ratio Complications % COMPLICATIONS 0 Dose 0
22 Advanced IMRT w/ On-Board Imaging = Image Guided RT Varian Trilogy Cyberknife
23 Courtesy Dr. Susan LaRue, CSU
24 Dosimetric comparison 3D IGRT (Trilogy) Courtesy Dr. Susan LaRue, CSU
25 IGRT Dosimetry (Tomotherapy)
26 Patient Immobilization
27 Positioning Verification
28 Ocular Toxicity - IGRT Minor ocular toxicity despite severe periocular tumor extension 5 months Mild conjunctivitis Mild keratitis
29
30 Anal Sac Gland Adenocarcinoma
31 Highly metastatic to regional LN
32
33 2.7 Gy X 18 daily fractions = 48.6 Gy
34
35
36 Radiation skin effects Fraction 18 1 month post RT
37 Chemoradiation for ASAC Mitoxantrone or carboplatin Median survival time with chemoradiaton >1000 days Timing of chemotherapy vs. radiation is controversial
38 Melanoma Oral tumor in dogs Highly metastatic Lymph node and pulmonary metastasis Size matters for prognosis Death within 6-8 months due to metastasis Immunotherapy breakthrough
39 Hypofractionated protocols Oral melanoma is radioresistant Coarse-fractionated protocols are believed more effective than standard fractionation 8 Gy X 3 weekly 6 Gy X 6 weekly 9 Gy X 3 weekly 10 Gy X 3 weekly
40 Coarse Fraction Protocols: Overall response rate 80-90% Complete response rate 50-70% Pre-RT Month 4 Week 3
41 Biological therapy: Therapeutic tumor vaccine
42 Xenogeneic DNA Immunization Canine Differentiation Antigen Human Differentiation Antigen Immunity Bergman, PJ., Wolchok, J.D. Reproduced with permission.
43 VRTOG: Evaluation of ONCEPT and course fraction RT in canine oral melanoma
44
45 Manual Treatment Set Up
46 Base of tongue necrosis 6 months post coarse fraction RT
47 Radiation Skin Effects Fraction 4 10 mo post RT 4 mo post RT
48 Tumor response to radiation Fraction 1 Fraction 4 1 year post RT
49 Vaccine-associated sarcoma Highly invasive SQ tumors Related to vaccination Inflammation malignant transformation
50 Vaccine-associated sarcoma Treatment of choice : radiation and surgical resection
51 Vaccine-associated sarcoma
52 Prevention = Thoughtful vaccination Avoid interscapular region All other vax R shoulder Left = Leukemia Distal Right = Rabies Distal
53 Pre-operative radiotherapy RT SX sterilized cancer cell
54 Electron beam therapy
55 4 months post RT
56 Feline Anesthesia Challenge Daily propofol causes Heinz-body anemia
57
58 Pituitary Tumors Tumors we like to treat Most tumors are nonfunctional Dogs present with neurologic signs No radiation side effects Excellent progressive tumor response and clinical improvement
59 2.5 Gy X 20 daily fractions = 50 Gy
60 Feline Oral Squamous Cell Carcinoma
61 Feline Oral Squamous Cell Carcinoma Early detection is critical to a favorable outcome Courtesy Dr. Kai-Biu Shiu, WI
62 Strontium-90 Ophthalmic Applicator Sr-90 is a radioactive isotope that emits beta particles Sr 90 39Y + β - Shallow penetration Physical half life = 30 yrs
63 Sr-90 = Superficial irradiation
64 Indications for Sr-90 plesiotherapy SUPERFICIAL TUMORS: Feline cutaneous mast cell tumor Feline nasal planum squamous cell carcinoma Superficial ocular tumors
65
66 Challenges in Veterinary Radiation Oncology Advanced tumors Large incisions Anesthesia requirement Increases risk Slows throughput Rush to use of SRS/SRT Limited info about normal tissue tolerance Inconsistent reporting standards
67 Thank you for your interest! Questions?
1400 Telegraph Bloomfield Hills, MI 48302 248-334-6877-Phone number/248-334-6877-fax Number CANCER TREATMENT
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