WSAVA講稿.ppt

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墨呆衡
7 years ago
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2 Lymphoma, Malignant lymphoma, Lymphosarcoma Origin: lymphoreticular cells 7~24% of all canine neoplasia The most common hematopoietic neoplasms (83%) Incidence: 13~24/ dogs Age: Middle to older 1 2 2

The most common hematopoietic neoplasms (83%)

3 Multicentric form Combination therapy Single-agent therapy Protocols Induction therapy : dose-intense at short time Maintenance therapy : lower dose, long-term Rescue(reinduction) : induce 2nd or 3rd remission 1 4 3

short time Maintenance therapy : lower dose,

4 酶酶 4

5 酶酶酶酶酶 5

6 酶酶酶 6

7 7

8 CT MRI Nuclear scanning 3D conformal radiation therapy (3DCRT) Intensity-modulated radiation therapy (IMRT) Tomotherapy 8

9 Oral tumors Nasal tumors Brain tumors Tumors of the trunk and extremities Other tumors Lymphoma Canine acanthomatous epulis Reduce the impairment of the functional and cosmetic outcome Tumor control can be close to 90 % Total dose higher than 40 Gy longer survival time Canine SCC Total dose of 45 Gy resulted in tumor control at 1 year about 75% Site-dependent (sublingual and tonsil SCC are highly metastatic) Lymphatic structures may be included in the treatment field Unlikely to metastasis but can difficult to control locally Less radiosensitive than epulides and SCC Progression-free survival time at 1year 76%, 3 year 40% Radiation followed by surgery is recommended Initiating radiation can be immediately after surgery Suture line is tension free Seven cats with mandibular SCC that were treated with hemimandibulectomy and mandibular node excision followed by radiation therapy had a median survival time of 420 days Well vascularized tissue 38 dogs with oral melanoma without evidence of metastasis were treated with 48 Gy radiation, and the median progression-free survival was 17.8 months (stage-dependent) 39 dogs with incompletely resected oral melanoma treated with radiation therapy plus platium-based chemotherapy, the median survival time was 363 days Nasal tumors are challenging to treat because they are anatomically complex Surgery can be performed after radiation Median survival time of 47.7 month in a small group of dogs that underwent surgery after radiation therapy Feline lymphoproliferative nasal tumors in cats respond well and durably to radiation therapy Carcinomas and sarcomas in cats respond comparably to nasal tumors in dogs Chemotherapy administrated 1 hour before irradiation 9

highly metastatic) Lymphatic structures may be included in the treatment field Unlikely to metastasis but can difficult to control locally Less radiosensitive than epulides and SCC Progression-free

10 46 dogs with brain tumor with neurologic signs were treated with radiation alone Median overall survival time was 23.3 month 69 % survived 1 year, and 47 % survived 2 years Median survival time between 1-2 years in dogs Median survival time was 17.4 months in cats 19 dogs with various grade MCT were treated with radiation to the primary MCT and the regional LN result in a median disease-free survival time of 1240 days Pre-operative radiation Post-operative radiation Less hypoxic cells Delayed wound healing Resistance hypoxic cells Treatment Median disease free time Conservative surgery 2 month Wide margin surgery 9-16 months Surgery combine radiation months Treatment Protocol Definitive Palliative Total Gy 3 Gy / fraction Mon-Fri Total Gy 10 Gy / fraction Once per week 10

4 months in cats 19 dogs with various grade MCT were treated with radiation to the primary MCT and the regional LN result in a median disease-free survival time of 1240 days Pre-operative radiation

11 Progression-free survival 80% at 1 year and 72% at 3 years Median survival time was close to 2 years Longer survival time Human patients received combined modality treatment with radiation therapy and chemotherapy Radiotherapy of localized canine cutaneous lymphoma has been reported to result in prolonged remission time Radiation therapy on lymphoma Canine multicentric lymphoma Half-body radiation : cranial & caudal Using radiation alone seems no better than traditional chemotherapy Combined with chemotherapy may have better prognosis Side effect : bone marrow suppression & diarrhea Early effects Rapidly proliferating tissue Oral mucosa, intestinal epithelium, epithelial structure of the eye and skin Self-limiting Recovery is rapid Late effects Slowly proliferating tissue Bone, lung, heart, kidneys, brain, spinal cord Severe fibrosis, necrosis, loss of function Difficult to treat 11

radiation : cranial & caudal Using radiation alone seems no better than traditional chemotherapy Combined with chemotherapy may have better prognosis Side effect : bone marrow suppression & diarrhea

12 3 Clinical No. : Name : DIDI Species : Canine Breed : Golden Retriever Age : 6-year-old Sex : Intact male Weight : 36.4kg 72 12

13 3 3 Vincristine 3 3 Adriamycin Diphenhydramine Mitoxantrone No response IV Gemcitabine PO Diphenhydramine Decreased appetite and spirit 13

14 3 3 Vincristine Prednisolone Adriamycin Diphenhydramine 3 Case management - VAS Breed : Persian Sex : spayed female Age : 6 y/o BW : 4 kg Vaccine history : 5 in 1 Case management - VAS Mass on the neck noted by owner in May First surgery performed on 2008/6/9 ( 2 cm margin) Pathology non-capsuled fibrosarcoma Incomplete excision Tumor recurrence noted by owner on 2008/6/30 Second surgery performed on 2008/7/12 (3 cm margin with 1 fasicia) Clear margin 14

First surgery performed on 2008/6/9 ( 2 cm margin) Pathology non-capsuled fibrosarcoma Incomplete excision Tumor

15 Case management - VAS Case management - VAS Radiation therapy initiated on 2008/8/16 8 Gy / fraction, total 24 Gy Once per week Epilation and hyperpigmentation noted since 2 nd radiotherapy Local recurrence about 1 month later Outside the radiation field No obvious metastasis in X- ray 3 rd surgery was performed Pathology : clean margin Case management - VAS Case management - VAS 2nd radiation therapy performed 3 weeks later The same protocol Larger radiation field Case management - VAS No obvious metastasis on x-ray and CT No obvious local recurrence after 2 nd radiation therapy 2 month from 2 nd radiation to now No obvious systemic side effect Epilation mild improved after 2 month 15

management - VAS Case management - VAS 2nd radiation therapy performed 3 weeks later The same protocol Larger radiation field Case management - VAS No obvious metastasis on

16 Limitation Case Management - MCT One week per fraction Reduced efficacy of tumor control Like palliative control Larger dose per fraction Late effect Anesthesia 7 year old, M/C Labrador R Perineal mass noted Case Management - MCT FNA reveal MCT Difficulty in wide margin resection Owner willing to pursuit multimodality treatment Case Management MCT Radiation treatment Histopathology Three fractionation: 8 Gy, 10 Gy, and 5 Gy Surgery performed between 2 nd and 3 rd radiation Spare urethra and colon Symptomatic medication to control possible paraneoplastic syndrome 16

$Owner willing to pursuit multimodality treatment Case Management MCT Radiation treatment Histopathology Three fractionation: 8 Gy, 10 Gy, and$

17 7/13/10 Case Management - MCT Urinary incontinence occurred and subside within 4 weeks Continue follow up for 6 months Still in remission Stop all medication in 3 months 未來展望對於腫瘤發生機制的暸解將會發展出更精準的治療傳統醫學另類療法整體醫療增進個體之良善及生活品質 17

for 6 months Still in remission Stop all medication in 3

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聖馬爾定醫院正子中心健保開單診療指引（guideline）

聖馬爾定醫院正子中心健保開單診療指引（guideline）聖馬爾定醫院正子中心健保開單診療指引 (guideline) 2011.10.27 全身癌症掃描檢查 (2010 年 6 月 1 日起健保開始對下列正子掃描之適應症給付 ): 1. 乳癌淋巴癌之分期治療及懷疑復發或再分期 2. 大腸癌直腸癌食道癌頭頸部癌 (