Osteosarcoma greyhound

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By: Mrttt (110 month(s) ago)

Thanks so much for the very informative video,it has been helpful. No need to say my sweetest boy probably has got Osteosarcoma in his foot toe has been amputated , we await the results of the specimen sent to pathology.

Presentation Transcript

OSTEOSARCOMA: 

OSTEOSARCOMA Courtney Zwahlen, DVM, DACVIM

OSTEOSARCOMA: 

OSTEOSARCOMA Most common primary bone tumor Large and giant breed dogs Average age: 7-9 years Appendicular (75%) Axial (25%)

OSTEOSARCOMA: 

OSTEOSARCOMA Causes minor trauma to late closing physes genetic alterations radiation, implants, chronic osteomyelitis

OSTEOSARCOMA: 

OSTEOSARCOMA Appendicular sites: Distal radius Proximal humerus Distal or proximal femur Proximal tibia “away from the elbows and towards the knee”

CLINICAL PRESENTATION: 

CLINICAL PRESENTATION Progressive lameness Weight bearing to non-weight bearing Acute lameness Pathologic fracture Firm bony swelling

CLINICAL PRESENTATION : 

CLINICAL PRESENTATION Osteosarcoma of the proximal humerus

DIAGNOSIS: 

DIAGNOSIS Radiographs cortical bone lysis periosteal changes loss of trabecular detail sunburst effect mixed lytic and productive changes Often obtain a high level of suspicion with radiographs alone for a bone tumor

RADIOGRAPHS: 

RADIOGRAPHS

DIAGNOSIS: 

DIAGNOSIS Biopsy: ~90% accurate risk of fracture, increased pain several days to obtain result Aspirate: Blind or Ultrasound guided Smaller sample but faster results

STAGING: 

STAGING Thoracic radiographs (3 views) <10% pulmonary mets at time of diagnosis CBC, Chemistry panel, Urinalysis elevated Alk Phos baseline values before chemotherapy Bone scintigraphy <15% bone mets at time of diagnosis

TREATMENT: 

TREATMENT Surgery Amputation Limb sparing Radiation therapy Chemotherapy Immunotherapy Bisphosphonates

AM PUTATION: 

AM PUTATION TREATMENT OF CHOICE Alleviates pain Improves quality of life Controls primary tumor 95% owners report excellent quality of life post-amputation

LIMB-SPARING SURGERY: 

LIMB-SPARING SURGERY Option for tumors of distal radius Obesity Severe arthritis Neurologic deficits 80% report good to excellent limb use 40-50% infection rate ( survival) Implant failure Local recurrence

RADIATION THERAPY: 

RADIATION THERAPY Palliative 3-4 treatments 70-90% pain control 4-8 months Side effects fracture Full Course recent info suggests may be more successful but not conclusive

CHEMOTHERAPY: 

CHEMOTHERAPY Cisplatin Adriamycin Carboplatin Cisplatin/Adriamycin Carboplatin/Adriamycin Ifosfamide?

IMMUNOTHERAPY: 

IMMUNOTHERAPY Liposome encapsulated muramyltripeptide L-MTP-PE +/- cisplatin GM-CSF Simulates macrophages Not commercially available

BISPHOSPHONATES: 

BISPHOSPHONATES Decrease bone pain Stabilize abnormal bone May slow tumor cells (in vitro) Pamidronate Combination with palliative radiation and chemotherapy

PALLIATION: 

PALLIATION NSAIDS: Piroxicam Deramaxx Rimadyl Survival: <2-3 months Pain medications: Tramadol Talwin Fentanyl Patch

PALLIATION: 

PALLIATION Metastatecomy  3 nodules >30 day doubling time negative bone scan (ie no other mets) >300 days post-diagnosis survival post-metastatecomy: 6 months may also provide resolution for HO

CLINICAL TRIALS: 

CLINICAL TRIALS SURAMIN: May increase sensitivity to adriamycin Protocol: amputation, then suramin + adriamycin for 5 treatments given every 2 weeks Preliminary results: Similar survival times to traditional therapy Greyhounds seem to be living longer The Ohio State University Funded by Morris Animal Foundation

CLINICAL TRIALS: 

CLINICAL TRIALS SAMARIUM (153Sm-EDTMP) bone targeting radiopharmaceutical accumulates in areas of  bone activity best for: small lesions with minimal lysis metastatic lesions axial skeleton SE: myelosuppression x 4 weeks Hospitalized x 5-6 days Expensive, limited availability

CLINICAL TRIALS: 

CLINICAL TRIALS SAMARIUM (153Sm-EDTMP) Pain relief with single treatment >50% pain relief x 5 months Combined with radiation greater myelosuppression Combined with chemotherapy Stable myelosuppression Awaiting final study results University of Missouri-Columbia

CLINICAL TRIALS: 

CLINICAL TRIALS PAMIDRONATE Chemotherapy + Palliative Radiation Two studies: Germany : Carboplatin Illinois: Adriamycin Superior pain relief compared with RT alone Preliminary results are encouraging Illinois study funded by Morris Animal Foundation

SURVIVAL: 

SURVIVAL Amputation alone 5-6 months, 1 year: 11%, 2 year: 2 % Limb sparing alone 8 months, 1 year: 35%, 2 year: 15% if infected (plus chemo): 20 mo survival Palliative radiation  8 months

SURVIVAL: 

SURVIVAL CHEMOTHERAPY (plus surgery) 10-12 month average survival time 1 year: 40-50% 2 year: 20-25%

GREYHOUND STUDY: 

GREYHOUND STUDY RISK FOR GREYHOUNDS: Study of >200 retired racing greyhounds Compared with 10 other breeds Greyhounds: highest risk for OSA Rottweilers (2nd) and Great Danes (3rd) Age at greatest risk: >7 years

GREYHOUND STUDY: 

GREYHOUND STUDY Primary sites in Greyhounds: Distal radius (33%) Proximal humerus (24%) Proximal femur (19%) Pathologic fractures: 27% Average survival: surgery + chemo: 188 days ( ~ 6 ½ months)

DOG GENOME PROJECT: 

DOG GENOME PROJECT Investigating genetic causes of osteosarcoma and other cancers Blood samples from healthy dogs and dogs with cancer Registration and/or pedigree info www.dogdna.org

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