Misc & Others Flashcards by Greg Almond

Concerning tumors of the digit, what is the most common tumor in the dog?

SCC

followed by melanoma, STS, MCT, OSA

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In a study of 15 patients with ceruminous gland carcinomas (dogs and cats), patients treated with surgery and/or RT:
mean PFS?
1 yr PFS?

40 mos
56%
(27% local recurrence, 20% mets)

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In what breed is melanoma the most common digital tumor?

Scottish terrier

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List 3 drugs that have been used for treating insulinoma and their MOA.

Streptozotocin - cytotoxic to ß cells
Diazoxide - not cytotoxic, inhibits insulin secretion (not synthesis)
Octreotide - somatostatin receptor ligand, inhibits synthesis & secretion of insulin

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What is the ORR for non-splenic HSA involving soft tissues?

Which patients live longer, retroperitoneal mass or ST mass, MST?

70%

retroperitoneal mass…13 vs 3 mos

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With stage II splenic HSA, using Sx + doxo vs Sx + low-dose cytoxan/etoposide/piroxicam, which group did better (MST/PFI)?

Incr. MST for low dose group

PFI not different

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In cutaneous HSA treated with sx alone, what were the MSTs for dermal, SQ, muscle invasion?

26, 6, 10 mos

Invasion into SQ or muscle worse px

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What are the staging criteria for cutaneous HSA?

I: confined to dermis √
II: extension into SQ
III: invades underlying muscle

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Regarding cutaneous HSA?
Excision rate: Stage I = ____%, Stage II/III = ____%
Metastatic risk: Stage I = ____%, Stage II/III = ____%

…23

30. …60

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Regarding cutaneous HSA, the MST for Gr I is ____ mos and for Gr II/III is ___mos

26….5-10 mos

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Answer the following for salivary gland tumors in cats AND dogs:
Most commonly affected glands?
LN met rates?
Distant met rates?

mandibular…parotid
39%….17%
16%…8%
(Sx + RT 17mos cat, 18 mos dog)

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Thymoma paraneoplastic syndromes?

Myasthenia gravis w 2º megaesophagus (40% dogs)

Exfoliative dermatitis, erythema multiforme, hypercalcemia in cats

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Flow cytometery of thymoma reveals:

Thymic lymphocytes simultaneously express CD4 & CD8 (vs peripheral lymphocytes)
(conventional histopath shows neoplastic epithelial cells dispersed w large # of small mature lymphs)

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In the treatment of thymoma with RT, what % had MG and what % resolved post RT?

14-18%….67%
(MST RT in mos: dog 8, cat 24
MST SX in mos: dog 26, cat 61)

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List 3 positive prognostic factors with thymoma

Resectable w/o megaesophagus
tumors with significant lymphocytic infiltrate
cystic thymomas in cats

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Aural tumors: in a study of 11 dogs/cats w ceruminous gland ACA, Sx +RT or RT alone, what was MST, local recurrance, met rate?

40 mos, 27%, 20%

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TVT:
How is it transmitted?
Metastatic rate?
Remission?
Genetic characteristic?

Horizontally - sexually
5-17%
spontaneous - can occur w/i 3-6 mos
All have a long interspersed nuclear element (LINE-1) upstream from c-myc (used in PCR for dx)

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Treatment of TVT with course fx RT: protocol and cure rate?

orthovoltage: 10-30 Gy, 100% durable CR for >25 mos
√√ 10 Gy initial fx cures 88% of dogs √√
MV: 5 Gy x 3, 100% durable CR 24 mos

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What are the ranges of local recurrence and metastatic rates for MLO?

47-58% local recurrence
56-58% metastatic rate
Both of these vary with tumor grade
(MST 21-26 mos)

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Regarding px of MLO:
MST of mandible (____mos) vs. other sites(____mos)?
General effect of grade?
General effect of incomplete excision?

Mandible better MST (50 vs 18 mos)
Incr gr - decr MST, incr recurrence, incr mets
mets & local recurrence more likely

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In a study of 16 dogs w TCC & perianal ACA tx w Sx + IORT followed by fx RT:
What happened to ureters in field?
What happened to bladder?
IORT dose to ureters should be kept below what Gy?

became stenotic, fibrotic, w º hydroueter & hydronephrosis (uniform at ≥ 25 Gy)
fibrotic, inflamed, edematous….urinary incontinence
25 Gy

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PVACs vs. SVAPs in 20 dogs w fx RT…which one prefered?

PVACs…decr time to implant, fewer complications

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In 13 dogs w infiltrative lipoma tx w Co-60:
Formula for tumor volume?
% durable long-term control?
Effect of microscopic vs. gross on control?

(XxYxZ) x π/6
92%
micro have long-term control; gross have stable or PR

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In 30 dogs treated for nasal tumors, STS, and other tumors of head with PROTONS, what % developed radiation-induced cataracts?

50%

MST 13 mos

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In a study of 37 dogs & 7 cats, Sn & Sp of regional LN assessment for various tumors: PE? FNA? Needle core bx?

``` Sn and Sp: 1. 60/72 2. 100/96 3. 64/96 So LN FNA is best ```

``` Regarding 2nd opinion histopathology: agreement? partial agreement? complete disagreement? % change in tx or px based on review? ```

70% 20% 10% (7% malignancy, 3% cell type) 17%

In a study of 80 dogs/cats, 4 Gy x 5 M-F, what was the response compared to historical palliative protocols?

Similar response, but shorter duration

In a study of 51 cats/dogs re-treated w ortho, Co, brachy, tumor free time & MST were correlated w what 3 things?

1. CR @ 2 mos 2. reirradiation field size ≤ 10 cm2 3. doses ≥ 40 Gy

In a study of 51 cats/dogs re-treated w ortho, Co, brachy, what % had late complications: moderate (fibrosis)? severe?

43% | 12%

In a study of 51 cats/dogs re-treated w ortho, Co, brachy, the complication rate was increased with what tumor and what 2 other factors?

1. SCC 2. field size > 30 cm2 3. time of < 5 mos between RT courses. **re-tx time should always be > 5 mos

51 cats/dogs re-treated w ortho, Co, brachy resulted in a MST of ____ x longer than if no re-tx?

3.5

In a study of 115 horses with periocular tumors treated w Ir192, what variable affected PFS

T-stage | T2 had 1.8x & T3 had 3.4x increase risk of recurrence vs T1

In a study of 38 horses with corneolimbal SCC tx w Sx + Sr90: Local control/mos? Local recurrence/mos?

83% for 58 mos | 17% at 15 mos

In a study of 19 rabbits treated for thymoma w MV RT, what was the only prognostic factor found?

Rabbits w body wt < 1.57 kg on admission had MST 10 mos (vs 24 mos)

In a study of 15 horses imaged w CT vs. radiographs for sinonasal tumors, what were two short-comings of radiographs:

1. Rads do not identify masses in sphenopalatine sinus, cranium, retrobulbar space vs. CT. Rads are effective screening modality for identifying paranasal sinus masses in patients w clinical signs. 2. Rads underestimate features of malignancy such as osteolysis osteoproliferation

In a study of 15 horses imaged w CT vs. radiographs for sinonasal tumors, what tumor type comprised 1/3 of the neoplasms?

Neuroendocrine/neuroblastomas

In a study of dogs treated w IORT + fx RT, what % developed RITs?

26%

In a study of 119 dogs tx w DRT to appendicular sites using orthovoltage, what percent developed RITs?

In a study of dogs tx w MV RT for acanthomatous epulides, what % developed RITs?

3.5%

Summary question of RIT % rates: IORT + fx? Ortho for appendicular? MV for epulus?

26% 8% 3.5%

``` In a study of 29 dogs treated for nasal/orbital neoplasia w MV RT and eye in the field: Cataracts developed when? KCS developed more at ___Gy vs ___Gy? ___% developed ocular complications ___% were refractory to tx ```

9 mos 48 vs 40 75% 64%

Regarding RT changes in bone: In mature bone, cellular & vascular changes lead to _____. Removal of dead bone leads to ______. Deposition of new bone on dead trabeculae leads to ____ & ____.

osteopenia decreased opacity increased bone opacity; coarse trabeculae

In a study of 37 dogs treated for nasal/intracranial neoplasms w Co60 RT, what % had ocular complications and what % were vision threatening?

84% | 57%

In a study of 37 dogs treated for nasal/intracranial neoplasms w Co60 RT, KCS occurs as an acute and late effect. Explain how this damage occurs at each time frame.

Acute: The direct effect of radiation on lacrimal tissue, meibomian glands, and conjunctival goblet cells. Late: damage occurs due to atrophic or late radiation vascular & connective tissue changes.

In a study of 37 dogs treated for nasal/intracranial neoplasms w Co60 RT, damage to eyes was discussed. Damage to the lens may not be clinically apparent for 2-3 months because....

of slow lens epithelial turn-over rate after radiation damage

In a study of 37 dogs treated for nasal/intracranial neoplasms w Co60 RT, anterior uveal changes were discussed. They occur as a late effect due to...

vascular damage and breakdown in blood ocular barrier rather than true inflammation. Poor response to medical tx because of this.

In a study of 37 dogs treated for nasal/intracranial neoplasms w Co60 RT, it was discussed that vision loss by posterior segment lesions result from....

damage to blood vessels rather than direct effect on resistant retina/optic nerve

Radiation pneumonitis in 3 dogs following MV RT. Radiographic signs developed when? What were they?

1-2 mos post RT (normal at end of RT) bronchiactasis, alveolar infiltrate, decr lung volume, unsturctured interstitial pattern all dogs clinically normal

Radiation pneumonitis in 3 dogs following MV RT: acute pneumonitis due to damage to _______(cell type) & _______ ____% pneumonitis at ____Gy ___% increase incidence w ___% increase in RT dose

alveolar epithelium (type II pneumocytes)......vascular endothelium 50. ...33 12. ....5

Radiation pneumonitis in 3 dogs following MV RT: Late fibrosis: ____months post-RT less than ____% of the lung can be safely irradiated to high doses

2-24 | 25

In a study of 16 dogs given MV RT to the pelvis: ___% had diarrhea post RT, ____% had colitis ___% had chronic colitis ___% had GI perforation (all received OPLA-Pt) Incidence of severe effect incr with incr __________. All dogs w severe or life-threatening side effects received ___ or ___Gy/fx and ____% received radiation potentiators

``` 8....75 56 19 dose/fx 3...3.3....80 ```

In a study of 16 dogs given MV RT to the pelvis, it was concluded that to minimize risk, what 2 things should be done?

Give < 3 Gy fx | No RT potentiators

In 9 dogs treated for brain tumors comparing photon vs. proton 3D plans: NTCP was always smaller for photon or proton plans? At 5% NTCP, ____Gy for photons and ___Gy for protons could be achieved. For a complex PTV shape, degree of conformity clearly superior for...?

proton 50.2.....58.3 protons

In a study of 10 cats and 15 dogs given 50-53 Gy M-F w twice weekly gemcitabine IV: ___% of dogs required decr or postponed drug, ___% hemo toxicity ___% of dogs had to stop RT early d.t. local tissue tox (___GI tox) 40% of cats required decr or posptpone due to _____. 20% of cats required dose reduction/postpone due to ________.

80.....73 67......no hemotologic toxicity decreased appetite/activity/clinical values

In a study evaluating cutaneous mucosal flaps in RT fields, List the 3 complications in decreasing order of occurrence. Risk of complication incr in dogs receiving ____ flapping procedure Increased severity of complication if ___Gy/fx vs ___Gy/fx Dogs w tumors in what body location had incr severity of complications

1. dehiscense (62%), necrosis (35%), infection (27%) 2. salvage 3. 4....3 4. oral cavity

In a study evaluating cutaneous mucosal flaps in RT fields, Complication risk difference in pre vs post op RT? Complication severity difference in pre vs post op RT?

No difference | Pre-op RT increased severity; post-op RT decreased severity

In a review article of skin reactions, list the skin changes in order:

erythema - inflammation - dry desquamation - moist desquamation

In a study of 22 dogs comparing prednisone to placebo for radiation-induced dermatitis: 1. difference between 2 groups w respect to acute rad. morbidity? 2. 94% developed ___ ___. 3. 45% developed ___ ___. 4. Effect of pred on decreasing ARID severity, clinically or histopath

1. none 2. bacterial infection 3. yeast dermatitis 4. none (no literature to support any specific tx for ARID)

In a review article of acute oropharyngeal effects: 1. Order of acute changes 2. Cause of increased susceptibility to dental caries

1. injection w/o inflam - patchy mucositis - confluent mucositis - ± necrosis, hemorrhage, ulceration 2. decreased salivary function post-RT

In a study of 7 dogs w incompletely excised tumor on forelimbs tx w DRT, comparing ARS (VTOG) and VAS/GCMPS: 1. As ARS incr w incr rad dose, did VAS/GCMPS? 2. Was ARS a sig predictor of VAS/GCMPS scores? 3. Can ARS predict a range of VAS/GCMPS values? 4. What do these finding suggest?

1-3: yes | 4: Because ARS ~=VAS/GCMPS, suggest need for more effective pain managment.

In a study of 51 dogs receiving DRT on the pelvis: 1. ___% had complications. 2. dogs w _____ tumors were more likely to have a complication. 3. the median E.S. field size was _____ in dogs w complications.

1. 39% 2. perianal 3. larger (12.5 vs 9.9 cm2) (Arthur paper)

In a study looking at VAPs in dogs receiving RT: 1. 17% were ______ 2. 36% were associated w ___ ___, 13% had ___ ___, 7% had ___ ____, 4% had ___ ____. 3. can use _____ to position VAP 4. Induction time shorter for VAP in what location 5. ___% grew Staph, ___% with withdrawal occlusion grew Staph

1. malpositioned 2. seroma formation, sutures break, partial occlusion, fatal septicemia 3. fluoro 4. jugular (vs. lateral saphenous) 5. 33....80

In a study of 65 dogs evaluating adverse effects of RT + carbo in spontaneous tumors: 41% developed ___ and 61% developed _____. 8% of dogs were tx for presumptive ____. ___% did not finish RT protocols; ___% experienced delays in RT delivery. 10% had grade ____GI toxicity

neutropenia...thrombocytopenia sepsis 8....43 III - V

In a study of 172 dogs & cats using SVAPs during RT: ___% had infections. 1. (M/F) were 5x more likely to have major complications. 2. (receiving/not receiving) propofol 19x more likely to have a major complication. 3. 5% of animals w complication requiring _____. 4. __% had complication that made SVAP unusable 5. 3 complications?

less than 1% 1. F 2. not receiving 3. second surgery 4. 6 5. perm. loss of patency, temporary lose of patency, seroma formation

Regarding Heinz formation in cats, formation is caused by? What stain shows Heinz bodies?

oxidative injury to Hb due to limited glucuronide conjugation capability in cats. New methylene blue

In a study of 31 dogs using IV propofol for induction for DRT, what were the changes in PCV, RBC, Hb, MCHC, and MCV?

all decreased, except MCV increased