Nasal Tumors

Question 1

What are positive prognostic factors for nasal LSA in cats? (5)

Answer 1

epitheliotropism, RT > 32 Gy, localized (stage 1), eating well, FeLV negative

Question 2

What are negative prognostic factors for nasal LSA in cats? (4)

Answer 2

age, anemia, anorexia, cribriform involvement

Question 3

Is ETS a risk factor for canine nasal tumors?

Answer 3

Maybe. No per Bukowski 1997; Yes per Reif 1998 –> in this study, dolichocephalic breeds had increased odds ratio of 2.0 (vs. 0.5).

Question 4

What % of canine nasal tumors have been shown to express VEGFR? EGFR? (Shiomitsu 2009)

Answer 4

90% - VEGFR

50% - EGFR (EGFR1 62.5% in recent 2017 paper)

Question 5

What % of dogs with dRT for acanthomatous ameloblastoma developed a RT-induced sarcoma?

Answer 5

3%

Question 6

What are negative prognostic factors for nasal tumors in dogs?

Answer 6

age (> 10yrs), epistaxis, shorter duration of c/s, advanced stage, metastatic dz, SCC/undifferentiated carcinoma, failure to achieve resolution of c/s

Question 7

Describe a modified Adam’s stage 3 nasal tumor?

Answer 7

nasal mass with orbital involvement or nasopharyngeal/SQ/submucosal mass

Question 8

What is MST for canine nasal tumors tx with dRT followed by exenteration? (Bowles 2014)

Answer 8

457 days, similar to RT alone.

Question 9

What is MST for stage 1 vs. stage 4 modified-Adam’s canine nasal tumor?

Answer 9

stage 1 - 23.4 months

stage 4 - 6.7 months

Question 10

Which factor most significantly affects survival in dogs with nasal carcinomas without treatment?

Answer 10

Epistaxis

88d vs. 224d

Question 11

What is a laryngeal oncocytoma?

Answer 11

Rhabdomyoma

Question 12

In cats with nasal LSA, what % develop LSA elsewhere?

Answer 12

13-16%

So systemic therapy may be warranted, but unclear on timing.

Question 13

Which molecular imaging biomarker was most predictive of PD for nasal tumors treated with dRT (using IMRT)? (Bradshaw 2015)

Answer 13

FLT (biomarker for cell proliferation) – thymidine analogs so markers for DNA synthesis (thymidine kinase - TK-1 expressed during S phase and higher in most cancer cells)

Question 14

What is the prognosis for untreated nasal carcinomas?

Answer 14

3-4 months (Rassnick 2006, Morris 1994)

Question 15

What was the MST for dogs with intranasal carcinomas treated with DOX/carbo (most recent study - Woodruff 2019)?

Answer 15

234d (7.8mo) compared to 7mo for Langova 2004

Question 16

How does MRI differ from CT in size and staging of nasal tumors (Lux 2017)?

Answer 16

MRI estimated larger tumor volume in 5/6 dogs but there was still 5/6 agreement of tumor stage b/w CT and MRI

Question 17

What was sensitivity of squash prep compared to hitopath for nasal tumor biopsies?

Answer 17

Sn 94%, Sp 81%

Most errors were LSA vs. lymphoid hyperplasia

Question 18

What was the conclusion of study looking at RTK receptor expression in K9 nasal carcinoma? (Hocker 2017)

Answer 18

Phosphorylation of VEGFR2, PDGFR-alpha, PDGFR-beta, and c-KIT was NOT observed in any samples (carcinoma or normal). Conclude that Palladia effects occur through inhibition of unidentified RTK pathways.
(EGFR1 may be a target due to expression in 62.5%)

Question 19

What is expression of COX-1 and COX-2 in normal nasal epithelium and nasal tumors? (Borzacchiello 2004)

Answer 19

COX-1 in normal nasal mucosa, rare in tumors

COX-2 strongly expressed in majority of tumors (in another study, Kleiter 2004, 81% expressed COX-2)

Question 20

What variability was observed in RT planning amount 4 radiation oncologists? (Christensen 2016)

Answer 20

up to 50%

Question 21

What % of cases exhibited late effects following single SRS dose for nasal tumors? (Kubicek 2016)

Answer 21

41%

Question 22

What was the overall MST for nasal tumors with SBRT? MST for carcinoma, sarcoma, OSA? (Kubicek 2016)

Answer 22

Overall - 8.5mo

Carcinoma 10.4mo, sarcoma 10.7mo, OSA 3.1mo

Question 23

Did firocoxib improve survival when combined with RT? Did it improve QOL? (Cancedda 2015)

Answer 23

No improvement in survival, did improve QOL per owner survey.

Question 24

In a study evaluating re-irradiation of nasal carcinoma, what was the response time to the first tx? What was the overall MST? (Gieger 2013)

Answer 24

First tx - 114d (3.8mo)

OST - 453d (1.2y)

Question 25

What was the overall MST for intranasal sarcomas treated with RT? (Sones 2012)

Answer 25

444d (1.2y) 3 protocols used: daily, M/W/F, palliative Survival time: OSA > FSA > CSA

Question 26

What % of dogs had complete resolution of signs with palliative RT? What % had partial resolution? (Tan-Coleman 2012)

Answer 26

78% CR, 16.5% PR = 94.8% ORR

Question 27

What was the median response to pRT for nasal tumors? (Tan-Coleman 2012)

Answer 27

178d (6mo) -- note that this is what we quote

Question 28

What was the median response to a second course of pRT for nasal tumors? (Tan-Coleman 2012)

Answer 28

4.3mo

Question 29

In dogs that had re-irradiation with curative intent (52Gy first tx and 36Gy second tx), what was the median response to first tx and median response to second tx? (Bommarito 2011)

Answer 29

1st - 513d (1.4y) 2nd - 282d (0.8y) Severe late effects in 2/9 dogs - blind

Question 30

What treatment provided the best outcome for dogs with intranasal lymphoma? RT, chemo, or both? (George 2016)

Answer 30

Both - 455d RT alone - 375d, chemo alone - 175d Conclusion: best to include RT

Question 31

What % of phosphorylated VEGFR, PDGFR-a, PDGFR-B, and c-KIT were seen in nasal carcinoma?

Answer 31

Phosphorylation of these receptors were not observed. Authors concluded that response to Palladia must be through other RTK. (Hocker 2017)

Question 32

What is the overall MST with CT-guided imaging for dRT? 1yr survival? 2yr survival?

Answer 32

11-19.7mo 1yr - 37-60% 2yr - 14-48%

Question 33

What is the Sn/Sp of CT for detecting LN metastasis from oral/nasal cancer?

Answer 33

Low Sn, fairly high Sp. No independent CT factors were predictive. For mand/retro: Sn 12.5%/10.5%; Sp 91.1%/96.7%

Question 34

What was MST of slow release cisplatin IM combined with RT for nasal tumors? How was this tolerated? (Lana 2004)

Answer 34

``` MST 474d (1.3y) Well-tolerated ```

Question 35

How did RT + exenteration compare to RT alone? (Adams 2005)

Answer 35

RT + exenteration - 47.7 mo; had more late complications (rhinitis, osteomyelitis/necrosis) RT alone - 19.7 mo

Question 36

What was RR and MST of cisplatin alone for nasal tumors? (Hahn 1992)

Answer 36

RR 27%, MST 5 months

Question 37

What is the met rate of nasal tumors?

Answer 37

30-50% but late in course of disease

Question 38

What is modified Adams stage 1?

Answer 38

tumor confined to one nasal passage or sinus with no bone involvement

Question 39

What is modified Adams stage 2?

Answer 39

any bone involvement (beyond turbinates) but no evidence of orbit or SQ mass

Question 40

What was duration of survival for dogs treated with IMRT, 2.4 x 10Gy? (Lawrence 20120)

Answer 40

420d (1.2y) | Similar to historic controls and had profound decrease in acute SEs

Question 41

What was the median PFS and 1 and 2 year PFS for 3x10 Gy (followed for 1 year)? (Gieger 2017)

Answer 41

PFS 354d | 1 yr and 2 yr PFS were 49% and 39%

Question 42

What was the MST and 1 and 2 yr survival for 3x10 Gy (followed for 1 year)? (Gieger 2017)

Answer 42

MST 586d | 1 yr and 2 yr MST 69% and 22%

Question 43

Are cat nasal planum SCC responsive to radiation?

Answer 43

Yes

Question 44

Did cats tolerate an accelerated hypo fractionated RT protocol for nasal planum squam?

Answer 44

Yes, MST 916d (2.5y)

Question 45

What CT features are more likely to be associated with malignant nasal tumor in cats?

Answer 45

abnormal MRPLN hilus and bone lysis

Question 46

High expression of ____ in nasal tumors was associated with poor response to tx and shorter survival times? (Fu JVIM 2014)

Answer 46

survivin

Question 47

What is the MST for a dog with nasal carcinoma without treatment?

Answer 47

95d (3. 2 months)

Question 48

What is the MST for dogs with nasal tumors treated with surgery alone?

Answer 48

3-6 months

Question 49

What is the median duration of control for dogs treated with dRT?

Answer 49

312d

Question 50

T/F: IMRT results in a longer MST than 3DCRT in nasal tumors?

Answer 50

False | Lawrence paper

Question 51

T/F: Duration of c/s <90d correlates with longer survival with pRT.

Answer 51

False