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Onco Board Review 2 > Perianal > Flashcards

Perianal Flashcards

1
Q

What is the Polton 2007 staging system for AGASACA?

A 
Stage 1: <2.5cm
Stage 2: >2.5cm
Stage 3a: nodal metastasis, nodes <4.5cm
Stage 3b: nodal metastasis, nodes >4.5cm
Stage 4: distant metastasis
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2
Q

What is the PR of AGASACA to toceranib? SD?

A

PR - 25%
SD - 62.5%
(clinical benefit of 87.5%)

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3
Q

In dogs with locally metastatic AGASACA, what is one factor that statistically influences survival? (Potanas 2015)

A

sublumbar lymphadenopathy and LN extirpation

completeness of surgical excision did not influence survival in this study

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4
Q

Does carbo improve post-op survival in AGASACA? (Wouda 2013)

A

No

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5
Q

What was one statistically significant difference of carbo + sx vs. sx alone for AGASACA? (Woulda 2013)

A

Carbo group less likely to develop local recurrence (31%) vs. surgery alone (67%)

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6
Q

What four histopath features of canine AGASACA were associated with worse outcome? (Pradel 2018)

A
  1. solid growth pattern
  2. moderate/marked peripheral infiltration
  3. necrosis
  4. lymphovascular invasion
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7
Q

What was the RR and % clinical improvement with hypo fractionated RT for stage 3b AGASACA? (Meier 2018)

A

25% CR, 63% improvement

67% of hypercalcemic dogs also returned to normocalcemia

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8
Q

What was the PFS and MST with hypofractionated RT for stage 3b AGASACA? (Meier 2018)

A 
PFS 347d (11.6 months)
MST 447d (14.9 months)

(surgery was only 5-6 months for PFS and MST)

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9
Q

What was the MST for dogs with primary AGASACA < 3.2 cm and no metastatic dz? (Skorupski 2018)

A

1237d (3.4 yrs)

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10
Q

In the Skorupski 2018 study, what % of dogs developed recurrence and metastasis and when?

A

Recurrence - 20.5% at 354d

Metastasis - 26.5% at 589d

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11
Q

What is the median survival associated with a second surgical intervention for AGASACA? (Barnes 2017)

A

Median additional survival was 287d

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12
Q

What % of enlarged abdominal LN was AUS able to detect? (Palladino 2016)

A

30% (but AUS detected at least one enlarged node in all patients with mets, so reasonable screening method per this study)

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13
Q

What % of AGASACA stained positive for COX-2? (Knudsen 2013)

A

100%
Normal anal sac tissue also showed 100% staining of the ductal epithelial cells, in AGASACA it was the neoplastic cells that stained positive.

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14
Q

What is more sensitive to identify LN metastasis in AGASACA, MRI or AUS? (Anderson 2013)

A

MRI

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15
Q

What % of AGASACA expressed PDGFR-beta? What % expressed KIT? (Brown/LeBlanc 2012)

A
  1. 5% - PDGFR-beta (note that this differs from the Urie/London paper published in BMC Vet Res in 2012)
  2. 6% - KIT
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16
Q

What % of AGASACA expressed VEGFR2, KIT, PDGFR-alpha, and PDGFR-beta? (Urie/London 2012)

A

VEGFR2 - 79%
KIT - 30-33% primary and metastatic AGASACA
PDGFR-alpha - all tumor samples
PDGFR-beta - evident in storm but rarely in tumor

17
Q

What % phosphorylation of RET was detected in AGASACA? (Urie/London 2012)

A

54%

18
Q

What was MST and event-free survival for surgery + dRT (48 Gy) + mitoxantrone? (Turek 2003)

A 
MST 956d (31.8 months)
event-free survival 287d (~10 months)
19
Q

How is expression of e-cadherin significant in AGASACA? (Polton 2007)

A

Positive prognostic indicator.

Survival was significantly improved for cases with >75% e-cadherin expression compared to those with <75% expression

20
Q

While stage 3b cases did not respond as well to carbo, what was one benefit? (Polton 2007)

A

Partial response created downstaging and allowed for other therapies (surgery, RT)

21
Q

What is the treatment of choice for perianal adenomas?

A

Castration

22
Q

What breed is predisposed to AGASACA?

A

Cocker spaniel

23
Q

What is the metastatic rate of perianal ACA at diagnosis?

A

15%

24
Q

What % of AGASACA have metastasized at the time of diagnosis?

A

~50% (range reported is 46-96%)

25
Q

What % of AGASACA will be hypercalcemic?

A

27%

26
Q

Loss of what marker is negative prognostic factor for AGASACA?

A

E-cadherin

27
Q

T/F: Cyto can differentiate perianal adenoma from ACA.

A

False

28
Q

What is the median duration of response of AGASACA to Palladia? What is the perceived mechanism of response?

A

19-25 weeks

19.5% express PDGFR-beta

29
Q

Name 5 prognostic factors for AGASACA.

A
  1. large primary tumor (>2.5 cm)
  2. Presence of RLN (>4.5cm)/distant mets
  3. non pursuit of surgery
  4. Tx with chemo alone
  5. decreased E-cadherin expression
30
Q

What is the overall MST for AGASACA treated aggressively?

A

16-18 months (about 1.5 yrs)

31
Q

What % of dogs experienced PR to pRT for advanced AGASACA? (McQuown 2017)

A

38%

use of chemo was a positive prognostic factor

32
Q

What % of dogs had resolution of hyperCa from pRT for advanced AGASACA? (McQuown 2017)

A

31%

46% with RT, pred, and/or bisphosphonates

33
Q

Which is TRUE regarding outcome in dogs with AGASACA Stage 3b treated with surgery or palliative RT?

a. The PFI and MST for cases treated with surgery were significantly longer as compared to cases treated with pRT.
b. In all dogs with patients with life-threatening obstipation, resolution was seen by the end of pRT.
c. Hypercalcemia was identified as a negative prognostic sign in patients treated with surgery or pRT.
d. In dogs treated with pRT, MST was significantly influenced by the addition of chemotherapy.

A

b. in all patients with life-threatening obstipation, resolution was seen by the end of pRT

Meier RT stage 3b AGASACA VCO 2017

  • RT significantly longer PFI and MST
  • Surgery: PFI 159 days, MST 182 days
  • RT: PFI 347 days, MST 447 days
  • Sx and RT both led to fast relief of symptoms (21% were obstipated at presentation)

Onco Board Review 2 (20 decks)

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