Nasal Tumors Flashcards
What are positive prognostic factors for nasal LSA in cats? (5)
epitheliotropism, RT > 32 Gy, localized (stage 1), eating well, FeLV negative
What are negative prognostic factors for nasal LSA in cats? (4)
age, anemia, anorexia, cribriform involvement
Is ETS a risk factor for canine nasal tumors?
Maybe. No per Bukowski 1997; Yes per Reif 1998 –> in this study, dolichocephalic breeds had increased odds ratio of 2.0 (vs. 0.5).
What % of canine nasal tumors have been shown to express VEGFR? EGFR? (Shiomitsu 2009)
90% - VEGFR
50% - EGFR (EGFR1 62.5% in recent 2017 paper)
What % of dogs with dRT for acanthomatous ameloblastoma developed a RT-induced sarcoma?
3%
What are negative prognostic factors for nasal tumors in dogs?
age (> 10yrs), epistaxis, shorter duration of c/s, advanced stage, metastatic dz, SCC/undifferentiated carcinoma, failure to achieve resolution of c/s
Describe a modified Adam’s stage 3 nasal tumor?
nasal mass with orbital involvement or nasopharyngeal/SQ/submucosal mass
What is MST for canine nasal tumors tx with dRT followed by exenteration? (Bowles 2014)
457 days, similar to RT alone.
What is MST for stage 1 vs. stage 4 modified-Adam’s canine nasal tumor?
stage 1 - 23.4 months
stage 4 - 6.7 months
Which factor most significantly affects survival in dogs with nasal carcinomas without treatment?
Epistaxis
88d vs. 224d
What is a laryngeal oncocytoma?
Rhabdomyoma
In cats with nasal LSA, what % develop LSA elsewhere?
13-16%
So systemic therapy may be warranted, but unclear on timing.
Which molecular imaging biomarker was most predictive of PD for nasal tumors treated with dRT (using IMRT)? (Bradshaw 2015)
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)
What is the prognosis for untreated nasal carcinomas?
3-4 months (Rassnick 2006, Morris 1994)
What was the MST for dogs with intranasal carcinomas treated with DOX/carbo (most recent study - Woodruff 2019)?
234d (7.8mo) compared to 7mo for Langova 2004
How does MRI differ from CT in size and staging of nasal tumors (Lux 2017)?
MRI estimated larger tumor volume in 5/6 dogs but there was still 5/6 agreement of tumor stage b/w CT and MRI
What was sensitivity of squash prep compared to hitopath for nasal tumor biopsies?
Sn 94%, Sp 81%
Most errors were LSA vs. lymphoid hyperplasia
What was the conclusion of study looking at RTK receptor expression in K9 nasal carcinoma? (Hocker 2017)
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%)
What is expression of COX-1 and COX-2 in normal nasal epithelium and nasal tumors? (Borzacchiello 2004)
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)
What variability was observed in RT planning amount 4 radiation oncologists? (Christensen 2016)
up to 50%
What % of cases exhibited late effects following single SRS dose for nasal tumors? (Kubicek 2016)
41%
What was the overall MST for nasal tumors with SBRT? MST for carcinoma, sarcoma, OSA? (Kubicek 2016)
Overall - 8.5mo
Carcinoma 10.4mo, sarcoma 10.7mo, OSA 3.1mo
Did firocoxib improve survival when combined with RT? Did it improve QOL? (Cancedda 2015)
No improvement in survival, did improve QOL per owner survey.
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)
First tx - 114d (3.8mo)
OST - 453d (1.2y)
What was the overall MST for intranasal sarcomas treated with RT? (Sones 2012)
444d (1.2y)
3 protocols used: daily, M/W/F, palliative
Survival time: OSA > FSA > CSA
What % of dogs had complete resolution of signs with palliative RT? What % had partial resolution? (Tan-Coleman 2012)
78% CR, 16.5% PR = 94.8% ORR
What was the median response to pRT for nasal tumors? (Tan-Coleman 2012)
178d (6mo) – note that this is what we quote
What was the median response to a second course of pRT for nasal tumors? (Tan-Coleman 2012)
4.3mo
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)
1st - 513d (1.4y)
2nd - 282d (0.8y)
Severe late effects in 2/9 dogs - blind
What treatment provided the best outcome for dogs with intranasal lymphoma? RT, chemo, or both? (George 2016)
Both - 455d
RT alone - 375d, chemo alone - 175d
Conclusion: best to include RT
What % of phosphorylated VEGFR, PDGFR-a, PDGFR-B, and c-KIT were seen in nasal carcinoma?
Phosphorylation of these receptors were not observed. Authors concluded that response to Palladia must be through other RTK. (Hocker 2017)
What is the overall MST with CT-guided imaging for dRT? 1yr survival? 2yr survival?
11-19.7mo
1yr - 37-60%
2yr - 14-48%
What is the Sn/Sp of CT for detecting LN metastasis from oral/nasal cancer?
Low Sn, fairly high Sp. No independent CT factors were predictive.
For mand/retro: Sn 12.5%/10.5%; Sp 91.1%/96.7%
What was MST of slow release cisplatin IM combined with RT for nasal tumors? How was this tolerated? (Lana 2004)
MST 474d (1.3y) Well-tolerated
How did RT + exenteration compare to RT alone? (Adams 2005)
RT + exenteration - 47.7 mo; had more late complications (rhinitis, osteomyelitis/necrosis)
RT alone - 19.7 mo
What was RR and MST of cisplatin alone for nasal tumors? (Hahn 1992)
RR 27%, MST 5 months
What is the met rate of nasal tumors?
30-50% but late in course of disease
What is modified Adams stage 1?
tumor confined to one nasal passage or sinus with no bone involvement
What is modified Adams stage 2?
any bone involvement (beyond turbinates) but no evidence of orbit or SQ mass
What was duration of survival for dogs treated with IMRT, 2.4 x 10Gy? (Lawrence 20120)
420d (1.2y)
Similar to historic controls and had profound decrease in acute SEs
What was the median PFS and 1 and 2 year PFS for 3x10 Gy (followed for 1 year)? (Gieger 2017)
PFS 354d
1 yr and 2 yr PFS were 49% and 39%
What was the MST and 1 and 2 yr survival for 3x10 Gy (followed for 1 year)? (Gieger 2017)
MST 586d
1 yr and 2 yr MST 69% and 22%
Are cat nasal planum SCC responsive to radiation?
Yes
Did cats tolerate an accelerated hypo fractionated RT protocol for nasal planum squam?
Yes, MST 916d (2.5y)
What CT features are more likely to be associated with malignant nasal tumor in cats?
abnormal MRPLN hilus and bone lysis
High expression of ____ in nasal tumors was associated with poor response to tx and shorter survival times? (Fu JVIM 2014)
survivin
What is the MST for a dog with nasal carcinoma without treatment?
95d (3. 2 months)
What is the MST for dogs with nasal tumors treated with surgery alone?
3-6 months
What is the median duration of control for dogs treated with dRT?
312d
T/F: IMRT results in a longer MST than 3DCRT in nasal tumors?
False
Lawrence paper
T/F: Duration of c/s <90d correlates with longer survival with pRT.
False