Hemangiosarcoma in a cat

Re: Hemangiosarcoma in a cat

Mark Hedberg — Fri, 02 Sep 2011 21:15:40 GMT

Yay, peace pipes all around! Thanks again, friend feels a lot better about this, and beer's on me at the next conference. :)

Re: Hemangiosarcoma in a cat

Richard Fox — Fri, 02 Sep 2011 15:45:49 GMT

Woohoo

Re: Hemangiosarcoma in a cat

Andrew Kent — Fri, 02 Sep 2011 13:47:38 GMT

[quote user="Martin Atkinson"]I would conclude that in answer to the OP: yes it may be worth trying Doxorubicin so long as the client has been warned about the limitations and risk.[/quote] I couldn't agree more ;-)

Re: Hemangiosarcoma in a cat

Martin Atkinson — Fri, 02 Sep 2011 08:57:20 GMT

I would conclude that in answer to the OP: yes it may be worth trying Doxorubicin so long as the client has been warned about the limitations and risk.

Re: Hemangiosarcoma in a cat

Andrew Kent — Fri, 02 Sep 2011 00:10:18 GMT

[quote user="Martin Atkinson"] Don't dis. Gerry or I'll be round to sort you out![/quote] My criticism isn't of Gerry, it is people like him who are filling the void in evidence base behind oncology. My point is that we have very little decent hard evidence in support of any chemo protocols partly due to difficulties and ethics in trialling and partly due to low numbers in case reports. This is different to much of the evidence base behind other drugs we use and is an important distinction to make to clients in order to avoid false expectation. Andy

Re: Hemangiosarcoma in a cat

Richard Fox — Thu, 01 Sep 2011 18:35:24 GMT

Break it up, Break it up otherwise I'll have to take you both aside Seems to me your both really saying the same thing !

Re: Hemangiosarcoma in a cat

Martin Atkinson — Thu, 01 Sep 2011 17:18:55 GMT

[quote user="Andrew Kent"]

This is especially true as you are extrapolating work on fibrosarcomas to haemangiosarcomas through logic rather than data.

I am not saying that it won't work, nor that it shouldn't be tried. But these cannot be sold as things that will definitely work.

Andy

[/quote]

I believe Gerry's work is a bit more than case work it is inclusive enough to be considered a clinical trial and of course I'm aware that it is for FVSSs, I made it clear that this protocol was for soft tissue sarcomas and merely speculated that it could be transferred to HSCs. We don't after all have much else to go on and Richard's research seems to back this up. Don't dis. Gerry or I'll be round to sort you out!

Re: Hemangiosarcoma in a cat

Andrew Kent — Thu, 01 Sep 2011 11:07:46 GMT

I have nothing but a lot of respect for all of Gerry's work and I agree that he has spoken in support of these protocols and that that is reasonable reason to use them.

However, it is important especially in terms of client education to distinguish the results of case resports from those of published trials. They help with decision making but that is all and clients should be advised of this.

This is especially true as you are extrapolating work on fibrosarcomas to haemangiosarcomas through logic rather than data.

I am not saying that it won't work, nor that it shouldn't be tried. But these cannot be sold as things that will definitely work.

Andy

Re: Hemangiosarcoma in a cat

Martin Atkinson — Thu, 01 Sep 2011 09:30:44 GMT

[quote user="Andrew Kent"][quote user="Martin Atkinson"]there is good evidence[/quote] There is good anecdote, not sure there is good evidence yet. Not to say it doesn't work but these protocols are not backed up by published work.

[/quote]

The work by Gerry is not anecdotal, it is backed up by a lot of cases, he has lectured on it and committed it to hard copy, the fact that it is not formally published IMO does not detract from its validity.

Re: Hemangiosarcoma in a cat

Andrew Kent — Wed, 31 Aug 2011 22:19:52 GMT

[quote user="Martin Atkinson"]there is good evidence[/quote] There is good anecdote, not sure there is good evidence yet. Not to say it doesn't work but these protocols are not backed up by published work.

Re: Hemangiosarcoma in a cat

Mark Hedberg — Wed, 31 Aug 2011 20:54:20 GMT

Thank you very much!

Re: Hemangiosarcoma in a cat

Martin Atkinson — Wed, 31 Aug 2011 11:07:25 GMT

[quote user="Richard Fox"]

Says surgery is still main treatment and Doxo protocols induce tumour shrinkage but remission times not been well studied :)

[/quote]

Gerry Polton is reporting remission times of up to 7-8 years with feline vaccine site sarcomas treated with this protocol (i.e. shrink with dox 2 dose q 3 weeks before surgery, excise to below next tissue plain - so not too radical, and repeat 2 x dox).. Given FVSSs are about the most evil tumours we see if haemangiosarcomas respond half as well this would be great news.

Re: Hemangiosarcoma in a cat

Richard Fox — Wed, 31 Aug 2011 10:46:19 GMT

Had a read around and Doxo does seem to be recommended as a sole agent chemo in cats but its hard to find exact remission rates - goes off to consult Oncology book....

Says surgery is still main treatment and Doxo protocols induce tumour shrinkage but remission times not been well studied :)

Re: Hemangiosarcoma in a cat

Martin Atkinson — Wed, 31 Aug 2011 09:57:28 GMT

I would put the cat on Doxorubicin as sole agent, there is good evidence (Gerry Polton, NDSR)that it will give good remission for soft tissue sarcomas in cats but I'm not sure if this would apply to HSCs. Although its too late now, it would have been better to have done an incisional biopsy to make the diagnosis first and shrink it with the dox before excision. Dox isn't cardiotoxic in cats but nephrotoxic which is a bit easier to monitor and as a sole agent shouldn't be too expensive.

Re: Hemangiosarcoma in a cat

Mark Hedberg — Tue, 30 Aug 2011 22:42:16 GMT

Very grateful to all the replies here; we'll see what happens!

Re: Hemangiosarcoma in a cat

Andrew Kent — Mon, 29 Aug 2011 17:09:04 GMT

[quote user="Richard Fox"]I doubt that any chemo protocol is very effective[/quote]

Very true, with the exception of lymphoma I don't think there is much evidence for the benefit of chemo. But it can still be worth trying if the owner understands that they are going into it without strong expectations of success.

Andy

Re: Hemangiosarcoma in a cat

Richard Fox — Mon, 29 Aug 2011 12:09:08 GMT

I doubt that any chemo protocol is very effective - wide excision is usually favored or radiotherapy if the lesion is in a suitable site?

Re: Hemangiosarcoma in a cat

Andrew Kent — Mon, 29 Aug 2011 10:58:16 GMT

Sorry for the formatting in that - iPad doesn't like leaving spaces!

Re: Hemangiosarcoma in a cat

Andrew Kent — Mon, 29 Aug 2011 10:57:33 GMT

Cutaneous HSA is rarely reported in both cats and dogs so may well be a primary rather than met. In the literature the best outcomes were obtained with wide surgical excision, so I think my first thought would a radical surgical revision if the margins are not fantastic. Failing that then chemo would be a reasonable route, but there is very little to support how effective this might be, mostly anecdote. Options would include sole agent doxorubicin or something like metronomic chemo with cyclophosphamide. Feline cutaneous hemangiosarcoma: a retrospective study of 18 cases (1998-2003) J Am Anim Hosp Assoc. 2005 Mar-Apr;41(2):110-6. Kevin P McAbee1; Lori L Ludwig; Philip J Bergman; Shelly J Newman 1Departments of Surgery, The Animal Medical Center, 510 East 62nd Street, New York, New York 10021. Companion Notes Companion Notes are VIN generated expanded abstracts containing greater detail Article Abstract Cutaneous hemangiosarcoma (HSA) has been infrequently reported in dogs and cats. Medical records of 18 cats diagnosed with cutaneous HSA were reviewed. Age at the time of diagnosis, breed, sex, tumor location, tumor size, treatment type, survival time, disease-free interval, and cause of death were evaluated. Aggressive surgical excision of the tumor was attempted in 10 cats. A complete surgical excision was achieved in five of the 10 cats. Median survival times were statistically longer in cats that underwent surgery versus cats that did not. Cats with cutaneous HSA treated with aggressive surgical excision of their tumors may have a good long-term prognosis.

Re: Hemangiosarcoma in a cat

Mark Hedberg — Sun, 28 Aug 2011 23:29:45 GMT

So would you recommend going in again and getting a broader margin? Or would you recommend chemo?

Re: Hemangiosarcoma in a cat

Richard Fox — Sun, 28 Aug 2011 23:14:17 GMT

Cutaneous, s/c and soft tissue HSA have a worst prognosis than those is dogs, they behave as an invasive sarcoma would but their chance of met are generally moderate (usually haematogenous) and a high likelihood of recurring if narrowly excised. Also many esp on the ventrum are solar induced so others may pop up if arising in a poorly/non-haied area - wide excision is usually recommended but a solitary tumour is unlikely to be a met from a visceral tumour.

Re: Hemangiosarcoma in a cat

Utlendigur — Sun, 28 Aug 2011 23:02:41 GMT

[quote user="Mark Hedberg"] Amputation is a better margin than 3mm, though...[/quote]

Yes, sorry, I realised that as I was typing. With the stifle one there were several small suspicious red nodules in the subcut tissues extending up towards the inguinal skin fold, so despite removing all the affected tissue I could see I was sure I'd missed some and/or it would recur or metastasise within a few weeks - especially as it was a neighbour's cat! Just a cat being odd as usual I suppose.

I forgot to say before, that cats can get dermal or subutaneous haemangiosarcomas as primary tumours, so it may not be a secondary

http://www.ivis.org/proceedings/navc/2005/SAE/265.pdf?LA=1 (2005 so bit dated but lots of info)

Re: Hemangiosarcoma in a cat

Mark Hedberg — Sun, 28 Aug 2011 20:02:17 GMT

Thank you, Utlendigur! Amputation is a better margin than 3mm, though...

Re: Hemangiosarcoma in a cat

Utlendigur — Sun, 28 Aug 2011 10:05:38 GMT

I've seen it twice.

1. 12-18mnth old cat with recurrent stifle effusion (blood). Haemangiosarcoma on biopsy. Amputated leg. No chemo. Given poor prognosis. Lived about another 8-10yrs before pts for recurrence/metastasis (I didn't see it at this point so not sure of details)

2. Another young cat presented with what looked like a glass cut between its pads, haemorrhaging +++. Sutured, healed then represented a couple of weeks later exactly the same. Exploratory surgery just blood and clots everywhere but biopsies came back as haemangiosarcoma. Amputated the leg and as far as I know the cat is still alive several years later.

Costs were an issue in both cases so chemo wasn't a possibility.