Respiratory System Flashcards
What’s the outcome of nasal planum tumour in dogs treated with surgery?
Generally good, recurrence is possible especially with incomplete margins. Bigger cut (incisivectomy/ maxillectomy) +/- RT may improve outcome.
What’s the outcome of nasal planum SCC in cats treated with surgery?
Very good, 10% recurrence (62 cats).
- median DFI = 594 days (1.6y; single); 426 days (multiple SCC)
- MST = 673 days (1.8y); 530 days (~1.5y)
What’s the outcome of surgical curettage and diathermy for feline SCC of the nasal planum?
Generally not advised as most SCC are invasive, but one study only had 6% recurrence within 18m
What’s the outcome of RT for canine nasal planum SCC?
disappointing, all recur within 2-3 months
What’s the outcome of RT for feline nasal planum SCC?
Orthovoltage: PFS 60%
Megavoltage: DFI 361-916 days; MST 902 (~2.5y)
Accelerated RT with protons: PFS 64%, MST 946 (2.6y)
What’s the outcome of Sr90 for feline nasal planum SCC?
CR: 80%
Recurrence: 20%
New lesions: 33%
PFS @ 3y = 82%
MST = 3076 days (8.4y)
What’s the outcome of intralesional carboplatin for feline nasal planum SCC?
CR: 73%
local recurrence rate: 30%
PFS: 16 months
What’s the outcome of electrochemotherapy for feline nasal planum SCC?
CR: 75-86%
DFI: 7-36 months
What’s the outcome of photodynamic therapy for feline nasal planum SCC?
ORR: 96%, with 85% CR
at 38 months, 45% had no recurrence (but 50% of those in CR recurred by 5 months)
Describe the staging system for sinonasal tumours.
What’s the likelihood of metastatic LN on presentation for canine sinonasal tumours?
10-20%
What’s the likelihood of distant metastasis on presentation for canine sinonasal tumours?
2-10% pulmonary metastasis.
one study that did thoracic and AUS, had 4/25 dogs with significant alteration to treatment due to concurrent illness
What are 2 rare paraneoplastic syndromes presentation for canine sinonasal tumours that can be noted on bloodwork?
erythrocytosis
hypercalcemia
What’s the outcome of canine nasal carcinoma without treatment?
MST 95 days
MST 88 days vs 224 days (with or without epistaxis)
What’s the general outcome of canine sinonasal tumours treated with CFRT?
MST 8 - 19.7 months
- 1 year survival 43-68%
- 2 year survival 11-44%
What treatment modalities for canine sinonasal tumours had the longest reported MST?
4.2Gy x 10fx followed by surgical exenteration. MST = 47 months! Has increased incidence of last side effects –> rhinits, osteomyelitis, fistula
another one with 3Gy x 18fx had MST of 15m but no long term side effects
What was the outcome of using gemcitabine as a radiation sensitizer for canine sinonasal tumours?
there was significant neutropenia and severe local tissue complications… not worth it.
not clear if radiation sensitizer will improve outcome
What’s the general outcome for canine sinonasal tumours treated with SRT?
MST: 8.5-19.5 months
in a large study with 182 dogs (Hiroto 2023) MST = 441 days (~15m), 3% with skin/oral cavity AE, 61% possible chronic rhinitis post RT
How does tumour stage influence canine sinonasal tumours treated with SRT?
it doesn’t! Stage is not prognostic in SRT settings
What’s the outcome of canine sinonasal tumours treated with PRT?
- 66-100% dogs will have improvement of clinical signs
- median duration of clinical improvement 4-10 months
- MST: 5-17 months
What’s the outcome of chemotherapy with canine sinonasal tumours?
favorable, but the case numbers are small.
- Cisplatin: RR= 27%, MST = 5m
- Doxorubicin, carboplatin, and piroxicam: MST = 7m
all dogs had improvement in clinical signs and tolerated the chemo well, some achieved CR.
What’s the outcome of electrochemotherapy for canine sinonasal tumours?
RR: 90%
MST = 16.9 months
How does the stage of the tumour influence palliative RT for canine sinonasal tumours?
Stage I is correlated with longer survival time
What are the reported times of canine nasal OSA treated with RT/SRT?
RT: MST = 624 (21 months)
SRT: MST = 3 months…
so it’s unclear how nasal OSA responses to RT
What’s the most common feline sinonasal tumour?
Lymphoma
(followed by CA/ AdnocA/ SCC, then sarcoma etc)
What’s the most common type of lymphoma in feline sinonasal tumour?
- lymphoblastic
- B cell
- need IHC to confirm to differentiate from carcinoma
What’s the outcome of feline non-lymphoproliferative sinonasal tumour treated with RT?
CFRT: MST 12 months
coarse fractionation: ~13 months
What’s the outcome of feline sinonasal lymphoma treated with RT?
long term survival possible
- ORR: 70-90%
- RT + chemo MST = 174 - 955 days (0.5y to 2.5y)
- progression at non-nasal site 13-16%
- unsure of the best timing for chemo though
Which breed is predisposed to laryngo-tracheal tumours?
Arctic breeds
What’s the likelihood of detecting tracheal/ laryngeal masses in cats on x-rays?
88%
How common in extra-luminal invasion of the trachea by thyroid carcinoma in dogs?
one study round that in up to 24% of dogs with differentiated follicular cell thyroid carcinoma
MST = 2.5 months
What the outcome for cats with tracheal/ laryngeal tumours?
Generally poor –> historically euthanized shortly after diagnosis.
But, with a combination of Sx, RT, Chemo, longer ST is possible (MST 4-5 months), esp for LSA
Which breed of cats are over-represented for pulmonary tumours?
Persians
What’s the most common primary pulmonary tumour in the dog? in the cat?
Dog: brocheoalveolar in origin (85%)
Cat: adenocarcinoma (60-70%)
Which breed is predisposed to pulmonary histiocytic sarcoma?
miniature Schnauzers
How common is local metastasis in canine pulmonary tumours?
71%
How common is distant metastasis in canine pulmonary tumours?
23% beyond the tracheobronchial lymph nodes
Which tumour types are more likely to metastasize from the lungs (dogs)?
SCC (50%)
anaplastic carcinoma (90%)
What’s the metastatic rate of feline primary pulmonary tumours?
76%
How often can pulmonary tumours be diagnosed incidentally?
up to 30%
What would patients be lame with a primary pulmonary tumour?
- from hypertrophic osteopathy (4% of dogs) –> can have concurrent ocular signs!
- acrometastasis/ lung digit syndrome (cats) –> in one study, all cats (36) had presented for lameness, none were for respiratory signs!
How common is GI signs for cats with primary lung tumours?
19%
What’s the MST for cats with acrometastasis undergoing digital amputation?
MST = 67 days
How common in pleural effusion for cats with primary pulmonary tumour?
14-30%
How common is single vs multiple masses in canine primary pulmonary tumour?
solitary: 54-57%
multiple: 13-37%
Which lung lobe is canine histiocytic sarcoma most likely to be found?
Right middle (43-65%) and left cranial (38%)
Which lung lobe is canine adenocarcinoma most likely to be found?
left caudal (29%)
What’s the diagnostic yield of pre-op FNA for pulmonary tumours in dogs? in cats?
Dogs: 38-90%
Cat: 80-100%
What’s the diagnostic yield of pre-op CT-guided biopsy for pulmonary tumours? what’s the complication rate?
- 92% accuracy, 80% sensitivity for diagnosing tumour.
- 43% complication rate; 30% hemorrhage, 27% pneumothorax
What’s the periop mortality rate for pneumonectomy in dogs and cats?
Dogs: 6%
Cats: 14%
What’s the response rate for cisplatin in dogs with primary lung carcinoma?
in a study with cisplatin and vindesine, 2/2 dogs experienced >50% reduction in tumour size.
What’s the outcome of vinorelbine in dogs with primary lung carcinoma?
In microscopic setting, the ST were 113d, 169d and >730d
What’s the utility of aerosolized chemotherapy or cytokine for dogs with lung tumours?
- in metastatic setting: CR and PR are noted
- in gross disease setting: SD or PD are noted
What’s the outcome of TKI for lung tumours?
promising, SD > 10 weeks in a dog with primary lung carcinoma
What’s the outcome of SRT for canine primary lung carcinoma?
- MST = 343 days
- Lymphadenopathy was not a negative prognostic factor
- 1 dog had CR (17%), 42% PR and 42% SD
- progressive disease noted median 229 days
What’s the outcome for weekly hypofractionated RT for unresectable canine primary lung tumours?
- median time to max size reduction = 56 days
- 6/9 PR, 3/9 SD
- 7/9 later had surgery, 5 had systemic chemo
What’s the outcome of surgery for primary lung tumour in dogs?
overall MST = 361 days
What are some prognostic factors for canine primary lung tumours treated with surgery?
- clinical signs (MST 240 vs 545 days)
- Stage: T1 (solitary) vs T2 (multiple), MST 790 vs 196 days (2y vs 6m)
- T3 (adjacent tissue invasion) = 81 days
- Carcinoma grade: Grade 1 = 790d, Grade 2 = 251d, and Grade 3 = 5 days
What are some other prognostic factors for remission/ survival in dogs undergoing surgery for lung tumours?
Associated with remission:
- primary tumour involvement, LN, mets
Associated with survival:
- tumour size: 100cm3, adenocarcinoma > SCC (8 vs 19m, not statistically significant though), peripheral > entire lobe
What’s the influence of nodal involvement in canine primary lung tumour treated with surgery?
N0, MST = 285 - 452 days (15m); 1/3 still in remission >2y
N1, MST = 26 - 126 days
Which tumour type had the best ST for canine primary lung tumour?
papillary adenocarcinoma (T1N0M0) MST = 555 days (1.5y)
What’s the outcome of Sx + CCNU for canine primary histiocytic sarcoma of the lung?
MST = 568 days
5/16 had localized pulmonary lesions
What’s the prognosis of cats with primary lung tumour treated with surgery?
guarded to poor
MST = 115 days
What are prognostic factors had been reported for feline lung tumours?
Tumour grade:
- High grade MST = 75-105 days
- Low grade MST = 698 -730 days
Nodal status:
- N0 MST = 498 days
- N1 MST = 65 days
Clinical signs:
- No MST = 578 days
- Yes MST = 4 days
Pleural effusion:
- Yes MST < 3 days
- No MST = 31-467 days
What’s the frequency of concurrent nasal polyps and intranasal neoplasia in dogs?
16% of 321 cases!
out of 50 initially diagnosed with nasal poly, follow-up biopsy in 25 confirmed 15 = polyps, with 9 actually been malignant cancer
What’s the utility of liquid biopsy with cell-free DNA?
The test has a sensitivity of 71.3% and a specificity of 98.7% for detecting seven predefined cancer types (lymphoma, hemangiosarcoma, osteosarcoma, leukemia, histiocytic sarcoma, primary lung tumors, and urothelial carcinoma)
What’s the outcome of thoracoscopic lung lobectomy for canine lung mass resection?
- all dogs survived to discharge
- MST = 311 days
- significant risk factors to conversion: tumour > 5cm and pre-op lymphadenopathy
- 88% had clean margin
What’s the safety and accuracy of fluoroscopy-guided fine-needle aspiration for sampling deep-seated pulmonary lesions in dogs and cats?
All were diagnostic (total of 10) and only 1 dog had a minor post procedural complication.
What are the top 3 feline tracheal masses and their MST?
- LSA, MST = 241 days (chemo +/- RT)
- Adenocarcinoma, MST = 21 days
- SCC, MST = 21 days
What’s the outcome of canine frontal sinus carcinoma treated with toceranib?
Palladia + Metacam –> subjective PR 80%, MST = 183.5 days
What’s the evaluated CD204(+) macrophage (M2) and total macrophage infiltration in canine lung carcinoma?
High CD204(+) macrophage levels were significantly associated with lung metastasis in TCC (P = 0.030) and shorter overall survival in canine patients with PA (P = 0.012) and TCC (P = 0.0053).
What’s the outcome of feline primary laryngeal or tracheal lymphoma treated with chemotherapy?
25% had debulking Sx, all received chemotherapy (23 cats)
PR = 35%
CR = 65%
mPFS and MST = 909 days (2.5y)
What’s the likelihood of extrapulmonary metastasis in cats with pulmonary carcinoma?
- 56.4%
- mostly reginal LN (43.5%)
- skeletal muscles (23%)
- kidneys (15.3%)
- parietal pleura (10.2%)
What’s the prognosis of primary pulmonary adenocarcinoma in small dogs with surgery?
in 52 small dogs
median PFI = 754 days
MST = 716 days (~ 2y)
Tumour size (>7cm) = reduced ST
What’s the natural behaviour of primary intranasal MCT in the dog?
- 55% had metastasis, mostly to the mandibular LNs
- 43% of dogs with outcome data were euthanized within 1 year
What’s the tolerability and efficacy of a cyclical hypofractionated radiotherapy protocol (‘QUAD shot’) in cats with sinonasal carcinomas?
4 Gray (Gy) delivered in four fractions within 48 h, with a minimum of 6 h between two treatments, and repeated every 3-4 weeks for a total dose of 48 Gy in three cycles.
MST = 460 days (1.3y), 1y survival 80%
4/7 euthanized due to tumoure-related causes.
In a case series (5 cats) with nasal planum hemangiosarcoma, what’s the general outcome?
Not bad with surgery, 1y+
What are some CT features for feline nasal masses that could help with distinguishing between LSA, non-lymphomatous masses, and inflammatory masses?
- LSA = mixed growth pattern and regional lymphadenopathy
- non-lymphomatous masses = unilateral nasal changes and areas of intralesional calcification
- inflammatory masses = lots of overlap with the above 2, but none had bony changes
What’s the outcome of stage III and IV nasal carcinoma in dogs treated with toceranib?
MST = 139 days (4.5m)
interestingly, dogs with epistaxis experienced a longer median survival of 166 days compared to 83 days for those without epistaxis.
What’s the outcome of palliative treatment (steroid, NSAIDs) for metastatic pulmonary carcinoma in cats (n=34)?
MST = 64 days
presence of pulmonary signs = only prognostic factor influencing survival
What’s the outcome of cats with intranasal carcinoma treated with radiation therapy?
- definitive intent/ SRT: MST = 721 days (~2y)
- palliative intent = 284 days
- re-treatment @ recurrence is possible, with overall MST of 824 (2.25y) days (vs 434 days/ 1.2 years)
Where is recurrence most likely going to occur in dogs treated with radiation therapy?
within the RT field
What’s the outcome of SRT for solar induced facial SCC in cats (pilots study, 5 cats)?
- OST 118-991 days (all still alive at submission)
- all had alopecia and erythema
- mild late AE
What’s the outcome of cats with nasal carcinoma treated with palliative RT?
- 24/28 (92%) had clinical improvement
- MST = 342 days
- Adams modified Stage IV = 152 days
- facial deformity = 67 days
What’s the outcome of Adams modified stage IV canine sinonasal tumours treated with IMRT?
- median PFS = 177 days
- MST = 319 days
23 CA, 6 SA - intracranial involvement was not prognostic
What’s the outcome of toceranib post-op canine pulmonary adenocarcinoma?
median TTP = 145d (Sx) vs 191d (Sx + toceranib) –> significantly different
What’s the outcome of dogs with nasal carcinoma treated with SRT?
median PFS = 359 days
MST = 563 days (1.5y)
What’s the minimum dose to the lacrimal gland that can produce KCS in dogs receiving 42Gy in 10 fx?
minimum lacrimal gland mean dose for developing KCS was 23.75 Gy, with no eyes receiving a mean LG dose <20 Gy developing the condition, compared to 71% of eyes with doses >20 Gy
What was the outcome of cats with pleural carcinomatosis treated with intracavitary carboplatin?
All cats (8) died within 5-16 days of treatment due to recurrent effusion or poor health…
What’s the outcome of surgically removed canine primary pulmonary carcinoma based on modified human lung cancer stage?
The median survival times for stages I-IV were 952, 658, 158, and 52 days, respectively,
What’s the outcome of cats with sinonasal carcinoma treated with 4.2G x 10 Fx?
- MST = 452 days (1.2y)
- 11.1% CR, 63% PR, 11.1% SD
- median TTP = 269 days
- those with epistaxis had longer ST
What’s the outcome and metastatic behavior of canine sinonasal osteosarcoma?
- MST = 410 days (13m)
- 30% developed metastasis
- median time to met = 458 days (15m)
mostly treated with RT
What’s the outcome of feline sinonasal LSA (stage 1) treated with 7Gy x 5 weekly fx +/- chemotherapy?
- RT only, PFS = 104 days, MST = 263 days (9m)
- RT + chemo, PFS = 677 days, MST = 983 days (2.7y)
What’s the outcome of dogs with nonlymphomatous intranasal tumours treated with SRT (10Gy x 3)?
- median event-free survival = 237 days (8m)
- OST = 542 days (18m)
What’s the survival time of canine pulmonary carcinoma vs histiocytic sarcoma vs neuroendocrine tumours with lung lobectomy?
MST:
- histiocytic sarcoma = 300 days
- carcinoma = 399 days
- neuroendocrine tumours = 498 days
