fibrosarcoma

Re: fibrosarcoma

Mark Norcott — Sun, 12 Feb 2012 19:07:46 GMT

I would like to recommend the use of Phaseal equipment (www.phaseal.com; sole UK importer is Cave Referrals, Wellington, Somerset) which is a closed system for handling chemo drugs. We have used it for quite a few years and it is utterly reliable and simple to use. I would not give a chemo treatment without it. Adds a few quid (around £20-25) to a chemo treatment but worth it to maintain our safety.

Re: fibrosarcoma

Martin Atkinson — Fri, 10 Feb 2012 09:50:03 GMT

[quote user="Simon Neuhoff"]

Shrug - not nanny state or litigation - just don't feel comfortable handling the drug. I've done it before but on reflection feel that its not something I want to do again.

Martin you may be the only one handling the drug directly but surely someone is restraining the animal during the actual administration?

[/quote]

Indeed, I am the only one who handles the bottle and loads the syringe, I do it over absorbent material, on a tray, on a tub table, I don't have a fume cupboard but the risk of causing an aerosol is minimal. Anyone else handling the patient also wears masks, gloves, goggles, long sleeves and an apron over their uniform, assisting during administration or nursing afterwards. The drug goes into a running drip so needle stick injury if the patient jumps during administration is eliminated. I cannot see what risk there is with that lot in place unless looking at it is dangerous but I guess that someone, someday will have a child with a foetal abnormality which is totally unrelated but a no-win, no-fee lawyer will jump on the bandwagon.

Re: fibrosarcoma

argyro koukouseli — Fri, 10 Feb 2012 07:10:24 GMT

i get your point ....i cant thank you enough ,all your posts where of great help to me.(there is no oncology specialist anywhere but the univercity,and i will get in touch with him).owners are stuck with me,so i have to do my best.

Re: fibrosarcoma

Rob Loxley — Fri, 10 Feb 2012 00:05:48 GMT

We have had a couple of fibrosarcomas - one non-resectable and another that recurred post surgery - on metronomic chemo, which seems to be fairly popular of late, pretty cheap and well tolerated. However, again, when these cases get beyond my level of good familiarity it's usually after discussion/ in conjunction with one of our friendly local medical oncologists.

Re: fibrosarcoma

argyro koukouseli — Thu, 09 Feb 2012 21:27:10 GMT

five years ago,i told the owners of a dog with lymphoma to go to univercitys' clinic to do the doxorubicin.And they could,and they did/ its 3 hours by car.But this time i ve decided to do it here,there is a good chance that my professor of small animal medicin ,who retired in december,will come in this saterday to see the dog and..help me.But either way i want to be ready,fully informed and make him proud!!!!!

Dog came in today,got x-rays again of limb,thorax,abdominal u/s.They were clean.Owners,after being informed, seem to prefer chemo rather than amputate.As i already said,mass regrew after surgery ,its five times smaller than before and seems to be not getting any biger ...for now.

I found in my notebook ,as a student,that dextrazosane(cardioxane,novartis) can be used as a heart failure preventative,antihistamines as you suggested,metoclopramid,and NS0,9%(25ML/KG/H x 3h before and 1h after administration to protect kidneys)

Re: fibrosarcoma

Simon Neuhoff — Thu, 09 Feb 2012 20:24:35 GMT

Shrug - not nanny state or litigation - just don't feel comfortable handling the drug. I've done it before but on reflection feel that its not something I want to do again.

Martin you may be the only one handling the drug directly but surely someone is restraining the animal during the actual administration?

Re: fibrosarcoma

Rob Loxley — Thu, 09 Feb 2012 20:13:09 GMT

[quote user="Robin Grimmer"]What about a fume cupboard? [/quote]

But don't you have the same aerosol risks drawing up the vincristine? Dox used to need reconstituting but now can be obtained ready-made. There are also some closed system kits for drawing up & administering cytotoxics.

[quote user="Robin Grimmer"]as I understand it doxorubicin is a lot more toxic than say vincristine or cyclophosphamide[/quote]

I believe that is the case, but sensible handling protocols shouldn't automatically preclude its use.

Re echo before dox, this thread is interesting: http://www.vetsurgeon.org/groups/samsoc/forum/t/6717.aspx

Re: fibrosarcoma

Robin Grimmer — Thu, 09 Feb 2012 19:59:08 GMT

[quote user="Martin Atkinson"]

What is the nanny state driving us to? Will we end up referring everything except routine surgery to specialists for fear of litigation? In an age when our routine procedures are so price sensitive this sort of thing is what puts the jam on the bread. So long as you have proper protective clothing: gloves, goggles, masks and long sleeved overall, and contaminated material is disposed of appropriately why is everyone so scared? I'm the only one allowed to handle the syringe, vials and sharps so no-one else is taking a risk.

[/quote]

What about a fume cupboard?

It's not about litigation btw - but as I understand it doxorubicin is a lot more toxic than say vincristine or cyclophosphamide.

Any oncologists out there care to clarify this?

Re: fibrosarcoma

Martin Atkinson — Thu, 09 Feb 2012 19:31:04 GMT

Re: fibrosarcoma

Simon Neuhoff — Thu, 09 Feb 2012 18:53:25 GMT

When I was"young and dumb" I used to administer doxorubicin. Have decided to leave that to others with better equipment now.

Re: fibrosarcoma

Robin Grimmer — Thu, 09 Feb 2012 18:13:03 GMT

Should we really be handling doxorubicin in general practice? Or is this best left for the oncologists?

Re: fibrosarcoma

Martin Atkinson — Thu, 09 Feb 2012 18:05:13 GMT

[quote user="Richard Fox"]

Doxo is pretty cardiotoxic so be careful and infuse very slowly! I have seen cases of DCM after Doxo

[/quote]

I had a CKCS fall off the end of the needle with doxo. from cardiac failure - OK it was a CKCS but it had no evidence of cardiac disease. It did lead the owner to have his other cavalier examined and found it had significant heart disease so something was gained. I would now recommend a chest X-ray, ECG and NTproBNP now before embarking on a course especailly in breeds prone to heart disease.

Re: fibrosarcoma

Richard Fox — Thu, 09 Feb 2012 09:50:40 GMT

Doxo is pretty cardiotoxic so be careful and infuse very slowly! I have seen cases of DCM after Doxo on PM :( FSA are never encapsulated and are usually infiltrative making them very difficult to excise without very wide margins even though they rarely metastasise :(

Re: fibrosarcoma

argyro koukouseli — Tue, 07 Feb 2012 20:52:20 GMT

thanx again.I havent decided anything.I ll see the dog in a couple of days and get some x rays again and give the owners the information needed.After all its their decision to make,after being fully and properly informed about what they are facing at the point.

Re: fibrosarcoma

Martin Atkinson — Tue, 07 Feb 2012 19:16:48 GMT

It sounds like you've made your mind up already and just needed confirmation that someone else would do the same. I would wait to see if there are any other ideas but if you go for Dox then yes: 30mg/msq every 3 weeks by slow IV infusion of 20 mins, up to a maximum of 240mg/msq. Make sure there is not a pre-existing heart condition first, pre med with antihistamine before dosing, be ready for some unpleasant diarrhoea and vomiting and check WBC and platelet counts after 7-10 days. Of course warn the client that it may have serious side effects and that it may still not be effective.

Re: fibrosarcoma

argyro koukouseli — Tue, 07 Feb 2012 18:45:21 GMT

THANK YOU SO MUTCH MARTIN.DOXORUBICIN PROTOCOL?ONCE EVERY THREE WEEKS?

Re: fibrosarcoma

Martin Atkinson — Tue, 07 Feb 2012 18:22:37 GMT

Sounds to me if its in the axilla it will likely have already be in non-limb tissue so amputation would be of limited benefit however if it is clear of the axilla and associated lymph nodes I would amputate and give it some doxorubicin but check for chest mets first. I saw a fibrosarcoma of a distal part of a limb and advised amputation and chemo with dox. Owner requested referral to Cambridge Uni where they were advised: fibrosarcomas don't metastasise and gave it palliative treatment with radiotherapy. Six months later it was a lot worse, suffered a pathological fracture and had mets in the chest. I offered palliative amputation again but they took it back to Cambridge who then amputated the leg and gave it Doxrubicin. Dog died 6 weeks later. It may have had the same outcome if I'd been allowed to amputate the limb at the start but it goes to show that those in ivory towers don't always know best.