Cystic nasal adenocarcinoma in a cat treated with piroxicam and chemoembolization

Retrospective evaluation of intranasal carcinomas in cats treated with external-beam radiotherapy: 42 cases

Background

Little is known regarding the comparative efficacy of various irradiation strategies used to treat intranasal carcinomas (INC) in cats.

Objectives

Investigate outcomes and prognostic factors associated with survival for cats with INC.

Animals

Forty‐two cats with INC that underwent radiotherapy (RT).

Methods

Single‐arm retrospective study. Medical record review for cats with INC that underwent RT at 1 of 7 veterinary RT facilities. Irradiation protocols categorized as: definitive‐intent fractionated RT (FRT), definitive‐intent stereotactic RT (SRT), and palliative‐intent RT (PRT). Median overall survival time (OST) and disease progression‐free survival (PFS; documented by advanced transverse imaging, or recurrence of symptoms) were calculated. Associations between tumor stage, RT protocol/intent, and adjunctive treatment usage and outcome were calculated.

Results

Cats underwent SRT (N = 18), FRT (N = 8), and PRT (N = 16). In multivariate modeling, cats received definitive‐intent treatment (DRT; FRT/SRT) had significantly longer median PFS (504 days, [95% confidence interval (CI): 428–580 days] vs PRT 198 days [95% CI: 62–334 days]; p = 0.006) and median OST [721 days (95% CI: 527–915 days) vs 284 days (95% CI: 0–570 days); p = 0.001]). Cats that underwent second DRT course at time of recurrence lived significantly longer than cats that received 1 RT course (either DRT or PRT [median OST 824 days (95% CI: 237–1410 days) vs 434 days (95% CI: 277–591 days); p = .028]).

Conclusion

In cats with INC, DRT is associated with prolonged OST and PFS as compared to PRT. If tumor progression occurs, a second course of DRT should be considered.

Definitive-intent radiotherapy for sinonasal carcinoma in cats: A multicenter retrospective assessment

Treatment of epithelial sinonasal tumours in cats is not commonly reported. In the newer reports, palliative radiation protocols have been described more often than definitive-intent protocols. In this multi-institutional retrospective study, we included 27 cats treated with single-modality radiotherapy. Cats were irradiated using 10 daily fractions of 4.2 Gy. Three cats (11.1%) experienced a complete clinical response and 17 (63%) had a partial clinical response. Stable clinical disease was noted in three cats (11.1%). Four cats (14.8%) showed progression within 3 months following treatment. The median time to progression for all cases was 269 days (95 % confidence intervals [CI]: 225; 314). The proportion of cats free of progression at 1 and 2 years was 24% (95% CI: 22%; 26%) and 5% (95% CI: 5%; 6%), respectively. None of the prognostic factors evaluated were predictive of outcome (anaemia, tumour volume at the time of staging, modified Adams stage, intracranial involvement, facial deformity, epistaxis, inappetence or weight loss). Median overall survival (OS) for all deaths was 452 days (95% CI: 334; 571). The proportion of cats alive at 1 and 2 years was 57% (95% CI: 37%; 77%) and 27% (95% CI: 25%; 29%), respectively. Surprisingly, cats with epistaxis had a longer median OS of 828 days (95% CI: 356; 1301) compared to 296 days (95% CI: 85; 508) in cats without epistaxis, (P = .04, Breslow). Radiation therapy used as a single modality for the treatment of feline sinonasal carcinoma improved clinical signs and was well tolerated but progression within a year was common.

Functional endoscopic sinus surgery in a cat with nasal tumor

An 11-year-old, 5.8-kg, male European cat was presented with a 4-month history of sneezing, nasal discharge, respiratory distress and bilateral conjunctivitis. Physical examination showed bilateral hemorrhagic mucopurulent nasal discharge and stertorous respiratory sounds. An irregular shaped mass involving the aboral portion of the right nasal cavity and sphenoidal sinus was identified by computed tomography. The mass was localized endoscopically in the medium meatus and an endoscopic-guided biopsy was performed. B-cell lymphoma was diagnosed by histopathological and immunochemistry exams. Functional endoscopic sinus surgery allowed to completely remove the tumor and restore a normal nasal flow. The cat showed no recurrence of the neoplasia for 15 months after the functional endoscopic sinus surgery.

Imaging in Non-neurologic Oncologic Treatment Planning of the Head and Neck

Imaging is critical for the diagnosis and staging of veterinary oncology patients. Although cytology or biopsy is generally required for diagnosis, imaging characteristics inform the likelihood of a cancer diagnosis, can result in a prioritized list of differentials that guide further staging tests, and assist in the planning of surgery, radiation, and chemotherapy options. Advanced imaging, such as CT and MRI, can better define the extent of disease for surgical and radiation planning for head and neck cancer cases in particular. Additionally, new imaging technologies are continually being translated into veterinary fields, and they may provide more options for cancer patients as they become more widely available.

Metastatic pulmonary carcinomas in cats ('feline lung-digit syndrome'): further variations on a theme

CASE SERIES SUMMARY

The aim of this retrospective case series was to describe seven cases where cats with primary lung tumours were presented because of metastases to extra-pulmonary sites ('feline lung-digit syndrome'). Specifically, we wanted to emphasise less typical case descriptions where tumour emboli resulted in lesions developing in the musculature (including the muscles of the head), skin or distal aorta.

RELEVANCE AND NOVEL INFORMATION

The cases are presented to increase clinical awareness of this entity in feline practice, especially when characteristic combinations of clinical signs are present. When clinicians have a high index of suspicion for these presentations, radiology (thorax and digits) or ultrasound (distal aorta), combined with collection of fine needle aspirate specimens for cytology, are usually sufficient to secure a definitive diagnosis. Novel information in this series includes CT and MRI findings from some cases. Typically, needle aspiration or biopsy targeting the skin, digits and lesions in musculature is far easier compared with sampling the primary tumour site in the lungs. The differential diagnosis and investigation of multiple digital lesions is also considered.

Advances in diagnostic and treatment modalities for intracranial tumors

Intracranial neoplasia is a common clinical condition in domestic companion animals, particularly in dogs. Application of advances in standard diagnostic and therapeutic modalities together with a broad interest in the development of novel translational therapeutic strategies in dogs has resulted in clinically relevant improvements in outcome for many canine patients. This review highlights the status of current diagnostic and therapeutic approaches to intracranial neoplasia and areas of novel treatment currently in development.

Nasopharyngeal disease in cats: 2. Specific conditions and their management

PRACTICAL RELEVANCE

Nasopharyngeal disease is a common presenting problem in feline medicine.

CLINICAL CHALLENGES

The management of feline nasopharyngeal disease can be challenging at a number of levels. In many cases, a specific diagnosis may remain elusive. Some conditions may not be curable so owners need to understand the requirement for long-term management. In addition, treatment may be compromised by poor patient compliance.

AUDIENCE

This review, which is directed at any clinicians involved in the management of cats with nasopharyngeal disease, discusses acute rhinitis (cat 'flu) and a variety of conditions causing chronic rhinosinusitis/chronic nasopharyngeal disease. The intention is to assist treatment decision making by reviewing the most appropriate therapies from the options available for these patients.

EVIDENCE BASE

The information presented in this article is based on peer-reviewed publications and the clinical experience of the authors.

Snots and snuffles: rational approach to chronic feline upper respiratory syndromes

PRACTICAL RELEVANCE

While the most common cause of chronic upper respiratory disease signs in cats is viral disease, with subsequent, self-perpetuating inflammation, other, more discrete causes need to be ruled out. These include foreign bodies, bacterial or fungal infections, oral-dental diseases and neoplasia. Any factors contributing to alterations in the structure or function of the upper airways, including inflammation of any cause, will compromise normal function and predispose to chronic damage if the cat is unable to resolve the underlying factors.

CLINICAL CHALLENGES

The chronic feline snuffler is a frustrating patient to treat. The longer the course of disease, the more severe the consequences to affected tissues, and the more debilitated the patient becomes. A logical diagnostic plan to differentiate probable etiologies and to rule out non-viral causes results in appropriate therapeutic choices. Even with a viral etiology, therapies to reduce the pathological consequences of infection may modulate and help control the clinical signs. Some novel choices and drug combinations are discussed in this review.

PATIENT GROUP

Cats of all ages may be affected. Cats with conformational (breed or malformation) characteristics, such as short or convoluted nasal passages or very small nostrils, are predisposed to unresolving inflammation. Fungal disease is more relevant in specific geographic regions, making inclusion of a travel history important in history collection. Older cats are more likely to have neoplasia-induced signs.

AUDIENCE

This review is directed at all veterinarians who see cats with chronic, recurrent upper respiratory disease.

Evaluation of adverse events in cats receiving long-term piroxicam therapy for various neoplasms

The role of cyclo-oxygenase 2 (COX-2) and prostaglandins (PG) in carcinogenesis has been documented in many species. Piroxicam has shown efficacy against several neoplasms and is frequently prescribed for chronic use. There are no studies investigating chronic piroxicam administration in cats and the chronic use of non-steroidal anti-inflammatory agents in this species has long been cautioned against. This retrospective study aimed to evaluate adverse effects in cats receiving long-term daily piroxicam. Seventy-three cats received daily piroxicam at doses of 0.13-0.41mg/kg. Treatment duration ranged from 1 to 38 months. Treatment with piroxicam was found to significantly increase frequency of vomiting during the first month of therapy, though this was most significant for cats receiving concurrent chemotherapy. Piroxicam administration was not significantly associated with hematologic, renal or hepatic toxicities. Adverse events were not correlated with dosage. Adverse events were reported in 29% of cats, and were generally mild and transient. Eight percent discontinued piroxicam due to adverse reaction, and 4% due to difficult administration. This study indicates that long-term daily piroxicam is generally well tolerated in cats at conventional doses.