tumor specific LC part 3 Flashcards
most common tumor of the nasal planum in cats
SCC
rare in dogs
cause of nasal planum scc
UV induced
may be malignant transformation from keratosis or carcinoma in situ
typically cats have white coat
breeds associated with scc
cats - white cats
dogs - goldens and labs 50-76% of cases
treatment of nasal planum scc
nasal planum resection
may need to remove incisive or maxillary bone sit sarcoma or mct
px is good but may recur or met
what is most important for recurrence of nasal plant tumors
complete resection
even with rt some dogs had recurrence within 9 weeks
nasal planecotmy in cats with scc recurrence, dfi, mst
less than 10% of cats had recurrence
DFI 426 - 594 d ~14-20 mo
mst 530 - 673 days ~18-22 mo
surgical curettage and diathermy has been used with rr of 6% for cosmesis
median time to recurrence in patients treated with primary RT or adjuvant RT
nasal squame????
2-3 months
orthovoltage rt in cats for scc pf
megvoltage rt in cats for scc pfi
protons rt in cats for scc
ortho - 1 year pf 60%
mega - pfi 361-916 d ~12-30 mo; mst 961(32 mo)
protons - mst 946d (11.5 mo) pf rate 64%
prognostic factors for cats with nasal planum scc treated with rt
ortho - stage and proliferative fraction
mega - larger size had 5.5 - 6 risk of dying
strontium penetration
depth of 3 mm
response in cats with nasal planum scc treated with strontium
cr - 88%
recurrence - 20%
new lesions in diff location - 33%
MPFI 1710 (~4.5 yr)
1 year df 89%
3 year df 82%
MST 3076 (8.5 yr)
intralesional chemo for feline nasal planum scc
carbo typically
cr 73%
local recurrence 30%
PFS 16 mth
electro chemo for feline nasal planum scc
CR 75%-86%
dfi 7-36 mths
cryosurgery for feline scc
must be smaller than 5 mm, superficial, non invasive
response rate 81%
local recurrence 17% - 73%
DFI 6mth - 26.7 mth
Photodynamic therapy
use of applied light after the administration of a photosensitizer.
The photosensitizer is activated by the light to form free radicals, which results in the induction of cell death. damages and restricts microvasculature inducing immune response
Due to the limited penetration of light into the tissue, the treatment depth is considered 5 mm or less
photodynamic therapy using 5-aminolevulinic acid (5-ALA) as a photosensitizer in cats with nasal planum scc
ORR 96% 49-85% CR
51% recurrence
rate of CR was dependent on stage
CR was noted in 100% of noninvasive tumors measuring <1.5 cm in diameter, 56% of invasive tumors measuring <1.5 cm in diam- eter, and 18% of invasive tumors measuring >1.5 cm in diameter
what is photodynamic therapy used for
nasal planum scc, K9 urinary tumros, equine sarcoids
what are the photosensitizers used in PDT
5-ALA and mTHPC
Nasal tumor SRT- what true
a. sarcomas do better than carcinomas
b. most common side effect oronasal fistula
c. IMRT leads to improved ST for stage I-VI Adams
a. all carcinoma vs all sarcoma - no difference in survival but grouping scc,carcin and undifferentiated carcinoma was worse
b. oronasal fistula can happen with srt - risk worse with surgery
c. stage 4 worse but overall mst improved compared to standard therapy 305 d vs
sinonasal tumor distribution
older >10 but report in dogs young as 9 mths
1% of tumors overall
medium to large breeds may be more affected
risk factors for sinonasal tumors
dolichocephalic breeds (long-nosed) or dogs living in urban envi- ronments, with resultant increased nasal filtering of pollutants, may be at higher risk for developing nasal cancer
tobacco smoke- conflicting reports
carcinomas make up what percent of sinonasal tumors
2/3 - adenocarcinoma, scc, undifferentiated carcinoma
sarcomas - fibrosarc, chondorsarc, osa, and undifferentiated make up most of the rest
rarely - mct, lsa, tvt
extremely rare - hsa, melanoma, neuroendocrine carcinoma, nerve sheath, neuroblastoma, histocytoma, MLO, rhabdo, leiomyo
met rate of nasal tumors
generally low but may be higher at death 40-50% - regional LN and lungs
less commonly bones, kidney, liver, skin, and Brain
mutations seen in sinonasal tumors
60% adenocarcinomas had mutated p53
COX-2 in epithelial tumors
50% EGFR in carcinomas
90% VEGR in carcinomas - tkis good tx
71% PDGFRα 40% PDGFRb - tkis good tx
average time to dx from start of cs in dogs with nasal tumors
2-3 mths
epistaxis, discharge, facial deformity, unwilling to open mouth, sneezing, dsypnea, starter, exophthalmos, ocular discharge
if caudal can cause neurologic sx -seizures, acute blindness, behavior change, paresis, circling, and obtundation
absence of this does not rule out cribriform plate involvement
differentials for nasal tumors non neoplastic
aspergillus fungal rhinitis
material rhinitis
idiopathic rhinitis
nasal parasite
bleeding disorders,
hypertension,
foreign body,
trauma,
developmental anomalies (e.g., cystic Rathke’s clefts
** if facial deformity almost always cancer
mri vs ct for nasal tumors
both good
mri cheaper
determining extent of tumor margins on MRI resulted in a higher tumor volume (18%) in 5/6 dogs and greater likelihood of detecting meningeal involvement. However, 5/6 dogs were classified as the same stage whether determined by CT or MRI
ct and mri findings suspicious for cancer
boney destruction
destruction of the sphenoid sinus
abnormal st in the retrobulbar space
nasopharyngeal invasion
hyperostosis of the lateral maxilla
a mass is not specific for neoplasia - inflammatory dz, polyps, fungal infections
PET CT markers for sinonasal tumors
18F-FDG as well as biomarkers of resistance to radiation, including 18F-FLT for proliferation and 61Cu-ATSM for hypoxia
PET/CT failed to reliably predict areas of residual tumor or recurrence that could be targeted with a boost dose of radiation to improve tumor control
Tumor volume measured by PET-CT and radiation-induced changes in tumor proliferation as shown by FLT uptake may be predictive of tumor behavior and clinical outcome
Adams staging for sinonasal tumors
and survival differences
stage 1 - mst 23.4 mth
stage 4 - mst 6.7 mths
met rate in sinonasal tumors
10-24% to local LN - mostly carcinomas
2-10% pulmonary mets
mst sinonasal tumors no treatment
95 days
epistaxis worse mst 88 vs 224 days
negative prognostic factors for sinonasal tumors
epistaxis, age >10, duration of signs, advanced stage, mets, histo carcinoma, scc, undifferentiated worse, expression of survivin, failure to relieve cs
prognostic factors in the treatment of canine sinonasal tumors remains controversial
treatment with rt on m-f schedule > mwf
extension past the cribriform did not change outcome but cribriform involvement did
mst of surgery sinonasal tumors
boney invasion occurs early and curative surgery is likely impossible
mst after sx 3-6 mths (similar to no tx)
mst of definitive fractionated rt for sinonasal tumors
8 - 20 mths
dose 42 - 54 gy in 10 - 18 fx
toxicity of fractionated rt to sinonasal tumors
acute - oral mucositis, keratoconjunctivitis and blepharitis, rhinitis, desquamation
late cataracts, kcs, atrophy of the cornea, uveitis, retinal hemorrhage/degeneration, brain necrosis, optic nerve degeneration, seizures, osteonecrosis, skin fibrosis
what is the life limiting problem for nasal tumors
locally aggressive - invade and recur
definitive rt following by sx of residual disease
mst 47 mth vs 19 mth for rt alone
another study with different protocol showed MST of 457
increased incidence of late effects, including rhinitis (bacterial and fungal), osteomyelitis, and fistula formation, but MST was the longest
gemcitabine as a radiosensitizer for sinonasal carcinoma
Gemcitabine was given intravenously at a dosage of 50 mg/m2 twice weekly before daily RT
significant hematologic toxicity (neutropenia) and local acute tissue com- plications
not a good option for tx
low-dose cisplatin (7.5 mg/m2 given intravenously every other day) administered in conjunction with definitive RT
well tolerated and did not appear to cause an increase in acute or late radiation effects
efficacy is unknown
Use of firocoxib, a COX-2 inhibitor, was evalu- ated in combination with RT
under powered
Quality of life was improved
no difference in outcomes
srt for nasal tumors
total 24 - 36 gy given over 1-3 tx
improved cs
mst 8.5- 19.5 mth - based on total dose
tumor stage was not prognostic in any of these SRT studies
severe late complications can include
oronasal fistula formation, seizures, ocular changes, skin necrosis, and osteonecrosis
reported in 3% to 40% of dogs
palliative rt outcome nasla tumors
improved cs in 66-100% of dogs with limited se
mst 146 - 512 days ~5-17mo
prognostic factors for nasal tumors treated with palliative rt
Tumor stage (stage 1) and duration of clinical signs (>90 days) have been correlated with longer survival in cases receiving this type of radiation
can dogs with nasal tumor get rt again
yes
small study dogs received 50 gy at first then 36gy after about 500 days , 2nd psi 282 d
mst after two rt protocols 927 days - 31 mth
second study reports a MST of 453 days 15mth in 37 dogs that were reirradiated after a coarsely fractionated radiation protocol
acute se limited
all had late SE and late se did lead to euth in some - sudden blindness
chemo alone for nasal tumors
cisplatin RR 27% - mst 5 mths
carbo/doxo/prioxicam RR 75%- mst 8 mths (if tcc worse 5 mth, if scc or undiff carc 2 month, if sarcoma better 15 mth)
palladia RR 71% - st 8 mths
can get TCC IN NASAL CAVITY!!!!
electrochemo for nasal tumors
RR 90%
MST 16.9
RT + adjunctive Palladia
RR
ST
RR - 80% vs RT alone (69%), toceranib alone (22%)
ST between groups not stat sig
10 mth palladia alone, 20 months palladia and rt, 12 mths rt alone
When all treatments fail to control epistaxis in nasal tumors
unilateral or bilat- eral carotid artery ligation can palliate symptoms in dogs for up to 3 months or longer without damage to the brain
mst nasal sarcoma treated with fractionated rt
MST was 444 days (15 months)
palliative 305 days - 10 mth
definitive MST 523 days - 17mth
prognosis of sinonasal osteosarcoma treated with RT is not clear
nasla lymphoma with rt +/- chemo
MST was 375 days for intermediate/large cell and 823 days 27 mths for the small cell group
no difference in MST for dogs treated with RT and chemotherapy versus chemotherapy alone
90% of dogs treated with RT improved clinically
Angiofibroma in nasal cavity
histologically benign but locally aggressive vascular nasopharyngeal tumor character- ized by a proliferation of irregular appearing blood vessels that are surrounded by a connective tissue stroma
no mets
Surgery tx
Where is SCC mostly located on the dog & cat?
Dog-nailbed; Cat-nasal planum, eyelids, pinnea
Which is more aggressive dog or cat nasal planum SCC?
Dog
What is the survival time with stage4 sinonasal tumors?
Cribiform lysis; 6.7months vs. 23.4 months
What is the survival time with epistaxis?
88 days (3 mo) vs. 224days (8 mo)
On MRI is turbinate lysis is diagnostic for neoplasia also is MRI better than CT?
no but cribriform lysis on mri was always neoplastic
MRI is no better than CT unless brain extension
Is sx helpful with sinonasal disease
No survival with sx+RT not better then MeV RT alone; RT then sx MST 47 months but high late effects
What is the survival with any RT protocol alone for sinonasal tumors?
8-19.7 months; IMRT spares eyes best with best control
What is the tx and survival for feline nasal adenoCA?
12months 1yr survival 44% with RT
What are risk factors for developing lung cancer?
Smoking, plutonium and other RT, anthracosis
What is the etiology and survival with feline multiple digit masses?
Usually met from SCC in lung; amp digits MST 67days
What are prognostic factors for lung cancer?
Size, stage, grade, mets, effusion, signs, disease post-op
Cat-only grade
What is the survival lung tumor with ln mets?
60-126 days (2-4 mo)
12-15 months if neg
What is the survival with stage for lung cancer?
T1 26months, T2 7months, T3 3months
What is the survival by grade of lung tumors?
Low grade 16 months, high grade 6 months
What is the MST for SCC lung cancer?
8 mth
What is the survival if surgery could not remove the entire lung tumor?
28 days vs. 330 if surgery complete
What is prognostic in cats with lung tumors and what is the survival?
Grade, low grade 25 months vs. high grade 2.5months
What are the criteria to perform a metestectomy?
Disease control >300 days; Less than 3 lesions on CXR, Long doubling time >40 days, no other mets
What causes ovine pulmonary adenocarcinoma?
Virus JSRV, originate in alveolar type2 & clara cells
What is the most common site for chondrosarcoma in the dog?
Nasal cavity-MST 210-580days (~7- 19 mo) various tx
Cat has incidental 3 cm primary pulmonary mass what to tell owner
px good despite histopath
frontal sinus carcinoma met rate
12%
frontal sinus tx with pallida and piroxicam
- subjective regression in skull deformity in 80%
MST 184 d ~6 mo
Use of a cyclical hypofractionated radiotherapy regime (‘QUAD shot’) for the treatment of feline sinonasal carcinomas
4Gy x 4 delivered within 48 hours
OST 460d, 15mth 1 yr 80%, 2 yr 0%, 4 euthanized d/t tumor related causes
No AE
CB in 6/7 cats
Diagnosis of feline mesenchymal nasal hamartoma by squash preparation cytology
pretence of osteoblast like and osteoclast like cells on cyto associated with mesenchymal nasal hamartoma on histo
primary pulmonary adenocarcinoma after surgical resection in small-breed dogs
PFI
MST
MPFI 754 d (25 mo)
MST 716 d (23 mo)
prognostic factors for primary pulmonary adenocarcinoma after surgical resection in small-breed dogs
Tumor size was associated with progression free interval in all cases
> 7 cm was negatively associated with OST
> 5 <7 cm and margins where associated with PFI on multivariate
UNIVARIATE ; clinical signs, lymph node metastasis, margin, and histologic grade were associated with PFI, and age, clinical signs, margin, and lymph node metastasis were associated with OST
primary lung tumors in dogs and cats and environmental radon activity
Primary pulmonary neoplasia (PPN) rate is higher in dogs and cats residing in counties with a high radon exposure risk (Environmental Protection Agency [EPA]zone 1) compared to zones 2 (moderate radon exposure risk) and 3 (low radon expo-sure risk).
histopathologic types of primary pulmonary neoplasia and outcomes MST
Pulmonary carcinoma most common 87.1% then sarcoma 7.6%
5.9% of sarcoma classified as HS with sig worse MST of 300 vs 399d for carcinoma
Dogs with neuroendocrine tumors (1.5%) best MST of 498d
No difference for carcinoma based on stage or adjuvant chemotherapy
modified human lung cancer stage classification in dogs with surgically excised primary pulmonary carcinomas
MST for stages
prognostic factors
incomplete excision (241d - 8 mth vs 758d 25mth)
LN mets (95 3mth vs 731d 24mth)
grade (I = 41 1.5 mth, 2 = 268 9mth, 3 = 731d- 24mth)
T stage (T1= NR, T2 = 731d 24mth, T3=522d 17mth, T4=158d 5mth)
chemo did not change outcome
Tolerability and outcome of palliative treatment for metastatic pulmonary carcinoma in cats
chemo, steroids, NSAIDs, or no tx
MST 64 days
Presence of respiratory signs decreased survival
Treatment tolerated, response not really evaluated (table shows mostly SD in cats with recheck cxr or PD; no PR/CR)
Bronchial Stent Placement for Palliative Treatment of Pulmonary Carcinoma with Bronchial Obstruction in a Cat
successful palliation to get rt - lived 323 d
mets to liver and lung
Hydropulsion as Palliative, Long-Term, Last-Resort Treatment of Nasal Carcinoma in a Dog and a Cat
used for resolution of clinical signs
dislodged the tumor
Computed tomography imaging characteristics of canine nasal chondrosarcoma
“ring-and-arc” or “popcorn” calcification in canine nasal tumors may suggest prioritizing chondrosarcoma as a diagnosis
Treatment of advanced-stage canine nasal carcinomas with toceranib phosphate
Stage III and IV only
OST 139d 4.5 mths
Epistaxis associated with longer survival 116d 4mths vs without 83d <3mth
CB rate 72.2%
ct findings of orofacial tumors
Epithelial tumors may have increased blood volume and blood flow compared to mesenchymal tumors
post IMRT findings of sinonasal tumros
in field failure is the most common pattern for local recurrence
some sub volume of tumors within the GTV that makes it radio resistant
Clinical-dosimetric relationship between lacrimal gland dose and keratoconjunctivitis sicca in dogs with sinonasal tumors treated with radiation therapy
20% developed kcs
Minimum dose to develop kcs 23.75 gy
No eyes <20 gy developed kcs
Outcomes and adverse effects associated with stereotactic body radiation therapy in dogs with nasal tumors
3 daily 9-10 Gy or once 20 Gy
MST any cause 388d; 58% d/t local disease progression.
another study showed up to 542d mst with multimodal treatment
another study showed 354d
745d with two courses of srt
AE acute: skin 26%, oral 30%, eye 26%, KCS 4%
AE late (>6 mo): unilateral cataract 18%
SRT associated with lower acute AE than fRT
(Palladia) as a primary or adjuvant agent in the treatment of canine nasal carcinoma
Fractionated 42 Gy RT (10 fractions)
CR/PR rate 80% in palladia+RT group and 69% in RT alone which is significantly better than palladia alone at 22%
CB rate better in palladia + RT 97% than RT alone 80%
MST palladia + RT 615d,
RT alone 368d,
palladia alone 298d - NOT sig different
Palladia with RT did not result in more AE
Canine intranasal tumours treated with alternating carboplatin and doxorubin in conjunction with oral piroxicam
mst
pfi
ae
Response rate
MST 8 mths for any tumor
carcinoma - 280 d - 9 mths
TCC - 5 mths
SCC/undiff - 2 months
sarcoma - 448 d - 15 mths
PFi 211 d
AE in 69% of dogs and 28% of treatments 24% Gr III or IV
RR 55%
Retrospective evaluation of intranasal carcinomas in cats treated with external-beam radiotherapy
palliative verse SRT verse fRT
Pfs pRT = 198d - 6.6 mth
OST pRT = 284 d - 9 mth
Pfs SRT= 504d - 17 mth
OST SRT = 721d - 24 mth
PFS fRT 269 d - 9 mth
OST fRT 452d - 15 mth
Second course of RT improved outcome - 824 -27 mths vs 434 d - 14 mth
most common nasal tumor in cats
Lymphoma is the most commonly diagnosed tumor type in the feline nasal cavity and sinuses, followed by epithelial neo- plasms (carcinoma, adenocarcinoma, SCC)
majority of cases were B-cell (68%) and 20% were T-cell, with 12% having a mixed population of B- and T-cells
ct findings of feline nasal tumors
osteolysis of paranasal bones, extension of disease into the orbit of facial soft tissues, the presence of a space-occupying mass, and turbinate destruction may suggest a CT diagnosis of neoplasia over rhinitis
met rate of nasal cancer in cats
low
~17%
RT for feline nasal tumors
mst 12 mths 44% alive at 1 year and 16% 2 year
what virus has been associated with nasal cancer in people
HPV has been identified in 25% to 49% of oropharyngeal head and neck cancers and is associated with a sig- nificant survival difference compared with HPV-negative oropha- ryngeal cancers
what molecular marker in people has been shown to be associated with worse dfs in people
with nasal tumors???
EGFR
what breeds are over represented for larygotracheal tumors
arctic breeds - husky, alaskan malamute
what cat breeds associated with larynx tracheal tumors
siames, dsh - lsa
DLH adenocarcinoma
tumor types found in the canine larynx
Rhabdomyosarcoma, SCC, adenocarcinoma, osteosarcoma (OSA), chondrosarcoma (CSA), fibrosarcoma, mast cell tumor (MCT), solitary extramedullary plasmacytoma, and granular cell tumor have been reported in the canine larynx
you dogs develop what in the trachea
benign masses
tracheal chondromas, osteochondromas, and osteochondral dyspla- sia
location and tumor type of tracheal lesions in the dog
Tracheal malignancies are more commonly located on the ventral wall, and adenocarcinoma, MCTs, extramedullary plasmacytoma, OSA, CSA, and lymphoma have all been reported