Caring for a Three Legged Dog or Cat
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We need some advice about radiation treatment. We are trying to decide whether to do radiation treatment for our 9-year-old cat Castiel. He underwent an amputation of his left front arm and we got clean margins but they are only 1.5 cm margins versus the 3-5 cm margins that doctors really like. We don't know if we are fighting a vaccine associated sarcoma (VAS) or a non-vaccine associated general bad luck sarcoma. The pathology showed no markers indicative of a VAS but apparently that's not definitive. No knowledge or records of a vaccine in that area but it is a front arm so the docs are suspicious it could be a VAS.. A VAS is more aggressive than a non-VAS. We don't know whether to do radiation; and if so, what type -- the low dose for a short period five days a week for three weeks or a the new higher dose focused dose for 1-2 visits. The first oncologist recommended the first type, the second oncologists was neutral on whether we should do radiation, the radiation oncologist thought we should do the second type. The second type involves less travel, less anesthesia, but it's a higher dose and there's no data on how well it works and how safe it is.
Does anyone have experience with radiation treatment after a fibrosarcoma or other sarcoma? Castiel's was a grade II and it appeared aggressive. If you have any experience going through this with your sweet pea -- good, bad, whatever -- we would really like to hear from you. Please tell us about side effects -- short-term, long-term. We don't know what do, if anything. Please share your experiences with us. Help us understand what to ask, what to think about.
Thank you,
Michelle and Brian
It's such a tough decision to make!
So regarding the higher dose radiation therapy, I assume that you mean stereotactic radiation therapy? Yes, it's shorter and much easier on the patient. It's breakthrough treatment.
there's no data on how well it works and how safe it is.
Do you mean how well it works for this type of cancer?
As for safety, it's my understanding that this type of treatment is much safer for the patient than the older type of radiation therapy.
Does anyone have experience with radiation treatment after a fibrosarcoma or other sarcoma?
I looked up sarcoma tumors and radiation and found these results in the Forums. We have quite a few examples to sift through, but some examples of cats who had it, and whose people struggled with the decision that come to mind include
and Little Man
I am pretty certain though that none of them did radiation therapy, but went on to live long, happy lives despite the odds.
When faced with a tough decision like this, it helps to ask yourself: what does Castiel want? What would make him happy? How does he want to spend his time?
The thing about cancer therapy is that when it comes to animals, it's much easier on them than it is for humans. This is because quality of life is the main focus. If a treatment is making them miserable, it can be stopped. The goal is to manage the disease, not necessarily eradicate it because oftentimes doing that would mean a poor quality of life. So, oncologists always have the patient's quality of life as the #1 priority. And, if you don't like how it's affecting him, you can always stop.
One way you can break the tie is to talk to the experts at Colorado State University's Argus Institute. They are a free counseling service that is here to help people making serious medical decisions for their animals. We love them.
I hope this helps. I think I'll put a call out on our social media channels to see if anyone has done radiation for this type of cat cancer. Stay tuned.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
I posted in the blog will add it here too -
Maceo had radiation at UC Davis; you can always post on the blog. Hopefully, Susan will get back to you.
https://maceo.t.....ipawds.com
(((Hugs)))
Oh thank you Holly! I don't know why he didn't come up in search results. Much appreciated!
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Thank you Jerry. I found just a few journal articles on the SRT radiation, and especially in cats. Castiel might be a candidate for SRT, which would mean only two appointments, one for the CT scan to determine if he is a candidate and set radiation boundaries and a second appointment for the radiation. The doctor cautioned though that peer-reviewed scientific data on its efficacy and safety is just not there yet. It appears to work well but can have significant short and long term side effects. Not every cat will have adverse side effects but it is a possibility that must be considered. It's a much higher and focused dose of radiation in one shot rather than the 15 day regimen that was our other alternative. It would mean less anesthesia, which is good but the question is, could he tolerate the higher dose.
Some concerning short term effects were limited mostly to the skin (flaking, soreness, burning, poor suture healing) and to a form of pneumonia. These were usually treated successfully. Late term side effects sounded more concerning and included spine and nerve damage, fibrosis, and organ damage -- and these effects, if they occur, are irreversible.
The treatment did seem to extend life significantly, but surgical excision with good margins was the biggest factor in survival. One good article was by Nolan and Geiger, Update in Veterinary Radiation Oncology 2019. Vet Clin Small Animal, 49, pp. 933-947. It mentions that a concern with using SRT for ablative doses after surgery is the risk of excessive toxicity or risk of reoccurrence from radiation fields that are too small or doses that are too low. It's harder to apply this type of radiation when there isn't a visible (bulky) tumor. Nolan and colleagues has two other publications that also deal with SRT.
Another article we found was useful for general information was Cronin et al, 1997. Radiation Therapy and surgery for fibrosarcoma in 33 cats. College of Veterinary Medicine, North Carolina State University, Vol 39 No 1.m pp 51-56. This one is somewhat out of date but still provides good information on the other radiation regimen.
We are going to ask some more questions of the radiation oncologists. However, we are seriously considering careful monitoring every 1-2 months. Castiel would not do well with the 5x week treatment. It may be that he doesn not need radiation and we'd hate to do harm when it might not be necessary, but on the other hand, what if it is necessary???
We have been agonizing over this. Meanwhile Castiel is curled up in a lovely basket with a bright red blanket comforting him. He seems happy and content. We are keeping him a little warmer as he feels the cold more with his haircut. Thank you again for being a sounding board as we puzzle this out.
Cheers,
Michelle and Brian
Kudos to you Michelle, you do great homework! Do you do research professionally?
These are all helpful articles, thank you for sharing. I need to make a blog post out of this info!
The doctor cautioned though that peer-reviewed scientific data on its efficacy and safety is just not there yet. It appears to work well but can have significant short and long term side effects.
Hmm. I'm not a vet, but I'm not 100% in agreement as far as the overall feedback you received about SRT. Only because based on oncologists I have interviewed from Colorado State University (one of the first clinics in the U.S. to install this technology over a decade ago), and pet parents we've met here, I cannot recall anyone discussing any kind of serious side effects that made them regret the decision to proceed with SRT. The side effects described in your post are things that do happen with the older, multi-session type of radiation therapy, which is a big reason why SRT was developed. One more thing to consider is that SRT started with people, and it's standard for many types of cancer treatments. Not saying you should do it, but I just want to make sure you know that we haven't heard of any negative experiences among Tripawds members. That's not to say that it can't happen of course, but overall, SRT is a pretty awesome therapy.
Still, you need to consider Castiel's needs and even two visits for SRT are probably two visits too many in his mind. So if you are leaning toward monitoring there is nothing wrong with that. Trusting your gut carries a lot of cred in this journey.
Let us know what comes of your next discussion with the radiation therapist.
Thank you for sharing and give your parlor panther some extra lovin' from us 
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
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