would you consider  cyberknife for this new case?  

Hi all,

Lurker since September but first time post to weigh in on our experience with stereotactic radiation (sometimes called CyberKnife depending on the facility). Before all that, I want to say how sorry I am that both of your dogs have been diagnosed- it’s just truly unimaginable and my heart goes out to you. It’s so cruel and unfair. 

First, there are two options for stereotactic radiation therapy (SRT). The first is called curative or definitive SRT. It’s high dose radiation given over one to three treatments and it’s intended to completely eradicate the primary bone tumor. The second option is palliative radiation. It’s lower dose radiation also given over several days and intended only to control the pain for a few months. It will not control the progression of the primary bone tumor for longer than a few months and then you’re back to square one. They do not recommend chemo if you go this route since it is not intended to be “curative” like amputation or curative SRT. It is cheaper, by several thousand dollars, than curative SRT. 

Our dog’s (Pee Wee, 62 lb, almost 15 year old lab mix) case is slightly unusual as she has scapular osteosarcoma which made it easier for us to choose curative SRT versus amputation as there is a much lower risk of pathological fracture due to the fact that the scapula is not a weight bearing bone. Additionally, Pee Wee displayed only very subtle changes in weight bearing on her affected leg and no symptoms of overt pain discernible by us or specialists before diagnosis so that also made it easier for us to choose this route. Lastly, we live in Denver so we only had to travel about an hour north to Fort Collins to access this treatment at CSU which also made this a viable option for us. 

For the actual treatments, Pee Wee went under general anesthesia the first day so the radiation oncologist could do a treatment planning CT to determine whether or not SRT would be an option. What they’re looking for is to make sure there is enough healthy bone surrounding the tumor and minimal degradation related to the tumor to give the dose necessary to blast the tumor while minimizing the risk of pathological fracture. They review the CT images slice by slice to make sure they have enough good bone to work with. For the next three days Pee Wee underwent general anesthesia for the treatments and was discharged about an hour after each treatment was completed. They also started her on carboplatin on the second day of radiation and gave her a zoledronate infusion to strengthen her bone. She tolerated everything really well which was a relief. Total cost for everything was about $5800. We were told the survival times are similar with amputation or curative intent SRT by multiple specialists. 

In the three months since we haven’t noticed a real change in Pee Wee’s weight bearing on that leg which isn’t really a huge issue for us since it was so subtle to begin with but if she had been painful or overtly lame before radiation and that wasn’t better pretty immediately afterwards that would be a huge problem. My understanding is that they generally they see a larger improvement in pain and functioning after the treatments but I can’t speak to that personally. Her tumor has definitely shrunk though and the area is progressively less hot to the touch. She was hiking five miles with us before treatment and immediately returned to the same activity level afterwards. 

Unfortunately it was suspected that Pee Wee’s cancer had already metastasized to the lungs at the time of the treatment planning CT but there was no way to confirm it as the spots were so small so we decided to proceed with the treatment anyways. Metastasis was confirmed on X-ray the end of October. Given the rapid progression and the fact that she hasn’t been able to tolerate Palladia (a post for another time), we are unlikely to make it to the point where you’d see most of the side effects of the radiation so I can’t weigh in on that aspect of things but there are some side effects, though rare, to consider. We don’t regret the path we chose though. For us, it was a good option given the lack of pretreatment pain, location of her tumor and the lower risk of fracture, immediate return to her pretreatment functioning, and easy access to a hospital that offered the procedure. 

There is a blogger, KB, who went through this with her dog about 7 years ago and also went the SRT route. Her dog’s primary tumor was in the ulna I think so you might check out her blog to read her thoughts. It’s http://www.romp.....ogspot.com. If you look back starting December 30, 2011 you’ll find the start of the radiation conversation. 

If you have any other questions I’m happy to give more information. 

Best of luck to you and your sweet pups,

Heather, Paul, and Pee Wee 

$5800 for curative cyberknife. Etc. Well done.   Remember when you do cyber knife the goal is to get the same result as amputation. So if you add in that price versus amputation and everything associated it sounds like a win-win to me. Especially if you start very very soon as symptoms show