export_javma dec 14 2014 24511 tuohy jl selmic le outcome following curativeintent surgery for oral melanoma in dogs 70 cases 19982011

Question 1

Outcome following curative-intent surgery for oral melanoma in dogs: 70 cases 1998-2011
Touchy JL, Selmic LE, Worley DR

JAVMA 12/14/14

Answer 1

past studies on different treatments–>too many uncontrolled variables

Question 2

Abbreviations
CI

HR

MTD

Answer 2

C onfidence I nterval= CI
H azard R atio= HR

M aximum T olerated D ose= MTD

of adjuvant therapies

Question 3

Abbreviation

PFI

Answer 3

P rogressive F ree I nterval-time from definitive surgery to local recurrence, develop mets or progression of mets

Question 4

Abbreviation

ST

Answer 4

S urvive T ime–time from definitive sx to death from dz or recheck

Question 5

**Most common oral maligna ncy in dogs

Answer 5

Melanoma

Question 6

**Oral Melanoma characteristics:

Answer 6

• locally invasive
• highly metastatic
• pigmented OR melanotic
• ulcerated OR necrotic

Question 7

**Oral Melanoma mets to:

Answer 7

• regional LN

* lungs

Question 8

**Adjuntive therapies post sx:

Answer 8

• chemo
• rad
• xenogeneic DNA vaccine

(equivocal data for all based on other studies)

Question 9

Time Frame?
Location?

dogs?

Answer 9

• 13 1/2 yrs of records (5/1/98-12/31/11)
• Colorado State-Vet School
• 70 patients

Question 10

Inclusion criteria:

Answer 10

• histo report
• curative-intent sx
• striving for sx margins (2-3cm bone or 1cm soft tissue or widest margin appropriate)
• follow up

Question 11

Exclusion criteria:

Answer 11

• marginal resection planned or NO sx
• no follow up
• no cutaneous portion of lesion (have more favorable prognosis)

Question 12

**WHO staging

Answer 12

• I=tumor 4cm and/or suspicious LN
  IV=tumor invades adjacent structures regardless of LN;
  any size tumor with suspicious LN(s); Met DZ

Question 13

Tumor classification for 70 dogs?

Answer 13

• I 36=51.4%
• II 16=22.9%
• III 13=18.6%
• IV 1=1.4%
• undetermined due to lack of tumor size info 4=5.7%

Question 14

Mean age at time of Dx?

Answer 14

10.4 yr

Question 15

Mean wt at Dx?

Answer 15

59.8 lbs

Question 16

Most common breeds (highest to lowest)

Answer 16

Lab> Golden> Cocker>GSD

Question 17

Complete Excision in…? PFI?

Answer 17

51=72.9% about 3/4

median PFI=528d

Question 18

Sx + adjunctive tx in…? PFI?

Answer 18

29=41.4%

median PFI=723d

Question 19

How many had progression of the dz…?

Answer 19

32=45.7%

Question 20

Tumor affecting which tissue?

Answer 20

• mand ging 20=28.6%
• max ging 17=24.3%
• lip 17=24.3%
• tongue 10=14.3%
• buccal or labial mucosa 4=5.7%
• tonsil 1=1.4%
• hard palate 1=1.4%

Question 21

Max + Mand tumor location?

Answer 21

• rostral to PM4 23=32.9%

* Caudal to PM4 14=20%

Question 22

Median size of tumor?

Answer 22

2.3cm

Question 23

Met Dz at time of Dx?

Answer 23

9=12.9%
8 in LN=11.4%

1 in lungs=1.4%

Question 24

How many tumors were completely excised?

Answer 24

51=72.9%

Question 25

Type of sx performed?

Answer 25

• mand 20=28.6%
• max 17=24.3%
• full thickness lip 17=24.3%
• glossectomy 10=14.3%
• soft tissue w/2+cm margin 5=7.1%
• hard palate 1=1.4%

Question 26

Reasons other data collected was stat significant:

Answer 26

• higher stage dz sent to teaching hospital
• RAD tx good for local tumor control–>less having sx
• larger tumor size at time of ref vs what’s been tx by primary DVM
• later stage dz is offered adjuvant tx instead of sx
• Surgeon more aggressive getting better margins

Question 27

Hazard ratio of adjuvant tx?

Answer 27

2.3=130% increase of progression

Question 28

Hazard ratio if met at time of of dx?

Answer 28

3.8=281% increase in death

Question 29

Conclusion:

Answer 29

• Wide sx resection with complete margin as sole tx is best
• (6 other studies didn’t come to this conclusion)
• other studies had many uncontrolled variables