Respiratory

Question 1

Which IHC marker can be used to differentiate intranasal olfactory neuroblastoma from other tumors?
(Church, VCO, 2019)

Answer 1

TuJ-1 (class III beta-tubulin neuronal cytoskeletal-specific antigen)
Debulking surgery and RT can lead to prolonged survival.

Question 2

What was the MST of dogs recieving SRBT to nasal tumors?
How did the acute and late toxity rate comapre with IMRT?
(Mayer, JAVMA, 2019)

Answer 2

The MST was 388 days (ca. 1 year)

The acute effects were milder, while the late effects were comparable with IMRT.

Question 3

What was the MST of dogs with stage III/IV nasal adenocarcinoma treated with Palladia as a sole treatment?
(Merino-Gutierrez, JSAP, 2021)

Answer 3

The MST was ca. 4,5 months (139 days).
No difference was seen between stage III and stage IV.
Dogs with epistaxis achieved longer survival times.

Question 4

After IMRT/IGRT for a sinonasal tumors which pattern of local failure most likely?
What are the possible explanations for that?
(Poirier, VCO, 2021)

Answer 4

75% of failure occured in-field (20% were marginal, 6% out of field)
Resistant tumor subpopulation or low tumor dose
(the integration integrated boost technique maybe the waranted)

Question 5

What are hamartomas?

Answer 5

Disorderd grwoth of original tissue that may be linked to a congenital, viral or inflammatory cause. They are mostly benign and associated with the skin, oral mucosa, CNS, vertebral column, abdominal, ocular and cardiac tissue.
IHC is needed (cytokeratin +) for the correct diagnosis.

Question 6

What is coblation?

Prudic, JAVMA, 2020

Answer 6

It is an ablative procedure. It uses the energy of a bipolar radiofrequency that passes through a conductive medium such as NaCl solution. The ions get disassociated and forms a high-energy plasma field, which destroys intracellular bonds. It aslo causes rapid coagulation of blood vessels with suspected longterm venous depletion.
It is less termogenic than standard ablative procedures.

Question 7

Can contrast-enhanced CT be recommended for the assessment mandibular and retropharyngeal LNs in dogs with oral and nasal cancer?
What was the sensitivity and specificity of this method?
(Skinner, VCO, 2018)

Answer 7

It cannot be used for the assessment of cervical LNs.

The sensitivity was 12% and 10% (mand and retro), specificity 91% and 96%, accuracy 67% and 76%.

Question 8

What is the “boost” technique in IMRT?
Where the complications acceptable?
(Soukup, VCO, 2018)

Answer 8

A higher total dose is applied to the GTV, while the CTV getting the regular high dose.
The early side effects were acceptable, but the occurance of late side effects need to be investiaged.

Question 9

Does image guided-IMRT improve MST in dogs with modified Adams stage IV?
Is there a difference between stage IVa and IVb?
(Stevens, VRU, 2020)

Answer 9

Yes, the MST was 10 months compared to 7 months (3D non-corformal RT planning).
There was no difference between lysis of the cribriform plate and lysis with intracranial extension.

Question 10

What was the MST in dogs treated with chemotherapy for sinonasal tumors?
Which histopathological tumor types did better?
(Woodruff, VCO, 2021)

Answer 10

The MST was 234 days (similar to Langova et al 2004 with 220 days)
Sarcomas had the longest survival (448 days) and anaplastic, SCC and undifferentiated carcinomas had the shortest MST (59 days).

Question 11

If there is near-complete resolution in the GTV in sino-nasal tumors should be RT plans addapted during RT?
How much did tumor volume change during IM-RT?
(Yoshikawa, VRU, 2019)

Answer 11

Yes, it can increase the magnitude of late effects.
The change is most likely do to reduction in adjecent fluid volume or tumor volume.
There was a large volume reduction between 2.7 and 29.9 %.

Question 12

What was the MST and 1- and 2-year survival of cats with nasal lymphoma in a recent study?
How many cats had progressive disease?
How many were systemic progressions and when did it occur?
(Meier, VCO, 2019)

Answer 12

The MST was approx. 2,5 years (922 days), 1-year survival 61% and 2-year 41%.
49% cats develped progressive disease: 29% local and approx. 1/3 had systemic disease mostly in the following 6 months after therapy.

Question 13

What was the MST of cats treated with palliative RT for nasal carcinoma?
What factors affected survival negatively?
(Giuliano, JSAP, 2020)

Answer 13

The MST was approx. 1 year (342 days)

Adams stage IV ( MST 152 days) and facial deformity (MST 67 days) affected survival neagtively.

Question 14

Cat CT aid diagnosis in cats with nasal mass lesions? Is biopsy obsolete?
What are the major differences between non-lymphomatous tumors, lymphoma and inflammatrory processes?
(Bouyoussu, JFMS, 2021)

Answer 14

CT can aid the diagnosis, but cannot replace biopsy, which is needed for the definitive diagnosis.
non-lymphomatous tumors: unilateral, extension within the frontal sinus, calcification
lymphoma: mixed and expansile growth pattern, lymphadenomegaly
inflammatory: highly variable, but abscence of bony changes

Question 15

Is there any association between feline skull conformation (e.g. brachicephalic breeds) and occurence of nasal disease or neoplasia?
Which are the most common nasal tumors in cats?
(Ferguson, JFMS, 2020)

Answer 15

No.

Lymphoma, adenocarcinoma, undifferentiated carcinoma.

Question 16

In a study evaluating definitive RT protocol in feline nasal carcinomas, what was the MST, when did progression occur and were there any negative prognostic factors?
Stiborova, VCO, 2020

Answer 16

MST was 15 months (not much difference between more palliative protocols, Guilano!).
Response rate was 74%, but progression occured approx. 9 months after therapy.

No negative prognostic factors were identified (also no diff. between Adams IV and rest, head deformation).
Epistaxis had a positive effect on survival (maybe these patients were identified sooner).
1-year 57%, 2-year 27% survival.

Question 17

Which locations of melanocytic tumors in cats are considered to have a more aggriessive behaviour?
Does pigmentation seems to be a predisposing factors?
(Reck, JSAP, 2020)

Answer 17

Oral, lip, nasal mucosa, nasal planum

Yes, pigmentation seems to play a role.

Question 18

Is malignant transformation possible in melanocytic tumors of the nasal planum in cats?
(Reck, JSAP, 2020)

Answer 18

Yes, in a case series, 4 cats had lesions that were considered to begnin and persisted for a considerable amount of time. But then showed rapid growth and rapid recurrence after therapy.
MST approx. 9 months

Question 19

What were the response rate, MST and prognostic factors in cats recieving HDR brachytherapy for nasal SCC?
(Lino, JFMS, 2019)

Answer 19

The response rate was 96% (74% CR)
MST > 2 years (834 days), DFI 10 months
Male sex, extension of the tumor to the upper lip, tumor size, previous treatment and tumor response were associated with survival.

Question 20

Is there a difference in the DFI, response and OS in cats treated with plesiotherpy for nasal SCC?
Which prognostic factors affected survival?
(Berlato, JFMS, 2019)

Answer 20

CR was 74 % (overall response 96% (PR 22%)), OS was 3 years, and there were no significant differences between 1 and 5 fractions.
DFI for all cats was approx 2 years, but was longer for cats treated with 5 fractions (1966 vs 248 days).
Early stage disease (Tis (pre-invasive), T1 (<2 cm, superficial, exophytic), T2 (2-5cm or with min. invasion), abscence of concurrent problems and CR affected survival.

T3 >5cm, or invasion in subcutis
T4 invasion in the fascia, muscle, bone, cartilage

Question 21

What is the difference between plesiotherapy and brachytherapy?

Answer 21

In plesiotherapy a ionizing radiation source is in contact with the exterior surface of the body.
In brachytherapy the sealed source is placed inside the body (interstitially or intracavitary).

Question 22

What is photodynamic therapy?

Answer 22

Photodynamic therapy uses a photosensitizer, light and endogenous oxygen to kill cancer cells through the formation of reactive oxygen.
It is non-invasive, and applied only once.

Question 23

What was the MST, DFI and response rate of cats with SCC treated with photodynamic therapy?
In which situations would it be not recommended?
What should owners consider after PDT?
(Flickinger, JFMS, 2018)

Answer 23

The MST was >3y (40 months), DFI median not reached (mean 35months)
Response rate 84% (CR 61%, PR 22%).
Large (>1,5 cm) and/or invasive (penetrating the basal membrane) should not be treated with PDT. Progression in <6 months.
In the following 2 weeks owners should protect the cats from increased exposure ti sunlight.

Question 24

A new stage classification has been proposed by Lee, VCO, 2020 based on the updated human TNM classification for primary pulmonary carcinomas.
Were the stages prognostic of survival? What were the MSTs?
What additional factors were independently prognostic?
What about the use of chemotherapy?

Answer 24

The stages were prognostic.
Stage 1: <3 years, Stage 2: < 2 years, Stage 3: 5 months, Stage 4: 1,5 months
T1: < 3cm, solitary
T2: 3-5 cm, solitary, invasion to pleura,main bronchi
T3: 5-7cm, multiple (same lobe), invasion to pericardium, chest wall, phrenic nerve
T4: >7cm (multiple nodules in ipsilateral lobes), invasion mediastinum, diaphragma…
N0, N1 (tracheobronchial), N2 (distant LN)
M0, M1 (malignant effusion, contralateral mets, distant mets)

Stage1: T1, N0, M0
Stage 2: T2-3, N0, M0; T1-2, N1, M0
Stage3: T4, N0, M0; T3-T4, N1; T1-4, N2, M0
Stage 4: M1

Tumor size, incomplete margins, tumor grade, LN metastasis

Adjuvant chemo did not have an impact.

Question 25

What was the response rate for dogs with pulmonary carcinoma undergoing hypofractionated RT?
What toxocities occured?
(Kawabe, VRU, 2019)

Answer 25

There were 6 PR and 3 SD (maximum reduction after ca. 2 months)
Mostly low grade skin toxicites.
RT can be used preoperatively for reduce the size of large tumors.

Question 26

Does the administration of metronomic chemotherapy (including thalidomide) has a positive effect on time to progression and survival time in dogs with advanced stage pulmonary carcinomas?
What was the TTP and MST?
(Polton, VCO, 2018)

Answer 26

yes, TTP 6 months and MST 4,5 months

the dogs reciving surgery or chemotherapy did worse

Question 27

Should be the administration of palliative treatment for cats with metastatic pulmonary carcinoma be considered?
(Treggiari, JSAP, 2021)

Answer 27

Although the MST was quite short (2 months), some cats achieved long survival. Mostly cats without clinical signs did better.

Question 28

Can the IHC staining with TTF-1 be used to diagnose feline lung digit syndrome?
(Fintonello, JFMS, 2017)

Answer 28

The alone usage of TTF-1 (low sensitivity) is not enough to diagnose feline lung-digit syndrome when the diagnosis is uncertain. In uncertain cases electron microscopy should be used due to presence of ciliated cells,
TTF-1 can be used to confirm cases.