Palliative chemotherapy for sciatic nerve neoplasia?

RE: Palliative chemotherapy for sciatic nerve neoplasia?

George Cooper — Sun, 03 Mar 2019 14:57:10 GMT

[quote user="Iain Richards"]

Treat the animal, not the unknown tumour. If you can't amputate, all you can do is manage the pain until PTS. No point using chemo if you don't know exactly what the mass is. Is the muscel wastage bilateral, or just the affected limb? If the latter, it's not your steroids. If the former, you need to discuss PTS now.

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Agree completely. Treat what you are seeing before you. You dont treat lab results or X-rays - you treat the patient. The preds dose could be upped, opioids added, and various other targeted analgesia regimes - but given what has been suggested it sounds like PTS will be sooner rather than later. Be humane.

RE: Palliative chemotherapy for sciatic nerve neoplasia?

Anthony Todd — Sun, 03 Mar 2019 14:53:09 GMT

Test with a high dose of a short-acting injectable corticosteroid and then assess.

There will be an obvious response, or not, in a maximum of 48 hours, usually 12 and injectables always give a more obvious and quicker response than oral doseage, particularly pred.

RE: Palliative chemotherapy for sciatic nerve neoplasia?

Iain Richards — Sun, 03 Mar 2019 13:34:11 GMT

RE: Palliative chemotherapy for sciatic nerve neoplasia?

Darren Long — Sun, 03 Mar 2019 11:35:34 GMT

Sorry if this case is already sorted, I just saw this and thought I’d add my thoughts.

Could you image again eg with CT/MRI for progression? Could you obtain a FNA if the lesion? Hypertrophic neuritis, as you mention should improve with immunosuppressive doses of glucocorticoids. There are several case reports of the treatments for this condition In dogs.

Unfortunately in suspected PNST our oncologists first line treatment is amputation of the affected limb when we see changes compatible with something like a peripheral nerve sheath tumour for example. We obtain biopsies wherever possible prior to this.

i would be reluctant to start any chemotherapy, even palliative, in any patient without cytological confirmation of neoplasia. If this is cancer, it is likely something like a peripheral nerve sheath tumour so surgery would be our first line of treatment. If neoplasia was confirmed and surgery was a no go, metronomic chemotherapy could be considered with the sole aim of slowing disease progression then we have used cyclophosphamide 10mg/m2 SID PO with metacam daily. if we resect them eg limb amputation then we often follow up with more traditional protocols such as epirubicin therapy for 6 cycles Then restage for metastasis.

there is a case report of a Shih Tzu with a PNS tumour that recurred post surgery and was treated with metronomics and was alive over 20 months post surgery. I think in your case of the sciatic nerve, then progressive limb atrophy +/- neuropathic pain will be a life limiting factor unfortunately Influencing your decisions.

if there has been no response to steroids then I would move onto NSAIDs and continue effective doses of gabapentin or pregabalin to manage neuropathic pain.

Again apologies if this is too too late to be of any use,

Darren