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Piroxicam, Mitoxantrone, and Hypofractionated Radiation Therapy with Volumetric Modulated Arc Therapy for Treating Urinary Transitional Cell Carcinoma in a Dog: A Case Report

  • Hwang, Tae-Sung (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • An, Soyon (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Choi, Moon-Young (Yangsan S Animal Cancer Center) ;
  • Huh, Chan (Yangsan S Animal Cancer Center) ;
  • Song, Joong-Hyun (College of Veterinary Medicine, Chungnam National University) ;
  • Jung, Dong-In (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University) ;
  • Lee, Hee Chun (Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University)
  • Received : 2021.10.19
  • Accepted : 2022.01.28
  • Published : 2022.02.28

Abstract

A 12-year-old spayed female beagle dog was presented with pollakiuria and stranguria. Abdominal ultrasonography identified irregular a marginated, hyperechoic mass in the urethra and trigon area of the bladder. Computed tomography (CT) revealed a heterogeneous mass in the trigone area leading to a urethra. There was no evidence of regional or distant metastasis. Cytologic analysis suspected transitional cell carcinoma (TCC). The patient was treated with piroxicam, mitoxantrone, and once weekly fractionated radiation therapy (RT) with volumetric modulated arc therapy (VMAT). A follow-up CT scan at 6 months after RT revealed a reduction in tumor size. At 17 months after the start of RT, the patient became severely anorectic and lethargic. Ultrasound examination revealed a hyperechoic mass in the apex area of bladder while the trigone area of the bladder and urethra appeared normal. Multiple hypoechoic nodules of various sizes were found in the liver and spleen. The patient was humanely euthanized at the request of the owner. A combination of piroxicam, mitoxantrone, and hypofractionated RT with VMAT protocol was well tolerated. This case described tumor response and survival time of a canine TCC treated with piroxicam, mitoxantrone, and once weekly palliative RT using computer-assisted planning and VMAT.

Keywords

Acknowledgement

This work was supported by the Animal Medical Institute of Gyeongsang National University and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2020R1G1A1007886).

References

  1. Choy K, Fidel J. Tolerability and tumor response of a novel low-dose palliative radiation therapy protocol in dogs with transitional cell carcinoma of the bladder and urethra. Vet Radiol Ultrasound 2016; 57: 341-351. https://doi.org/10.1111/vru.12339
  2. Evans MDC. Computerized treatment planning systems for external photon beam radiotherapy. In: Podgorsak EB, editor. Review of radiation oncology physics: a handbook for teachers and students. Vienna: IAEA. 2005: 387-406.
  3. Farrelly J, Shi Q. Retrospective analysis of nonradiation complications in dogs undergoing radiation therapy. Vet Radiol Ultrasound 2018; 59: 116-123. https://doi.org/10.1111/vru.12556
  4. Fulkerson CM, Knapp DW. Management of transitional cell carcinoma of the urinary bladder in dogs: a review. Vet J 2015; 205: 217-225. https://doi.org/10.1016/j.tvjl.2015.01.017
  5. Henry CJ. Management of transitional cell carcinoma. Vet Clin North Am Small Anim Pract 2003; 33: 597-613. https://doi.org/10.1016/S0195-5616(03)00032-9
  6. Henry CJ, McCaw DL, Turnquist SE, Tyler JW, Bravo L, Sheafor S, et al. Clinical evaluation of mitoxantrone and piroxicam in a canine model of human invasive urinary bladder carcinoma. Clin Cancer Res 2003; 9: 906-911.
  7. Jose CC, Price A, Norman A, Jay G, Huddart R, Dearnaley DP, et al. Hypofractionated radiotherapy for patients with carcinoma of the bladder. Clin Oncol (R Coll Radiol) 1999; 11: 330-333. https://doi.org/10.1053/clon.1999.9075
  8. Knapp DW, Glickman NW, Denicola DB, Bonney PL, Lin TL, Glickman LT. Naturally-occurring canine transitional cell carcinoma of the urinary bladder A relevant model of human invasive bladder cancer. Urol Oncol 2000; 5: 47-59. https://doi.org/10.1016/S1078-1439(99)00006-X
  9. Knapp DW, Henry CJ, Widmer WR, Tan KM, Moore GE, Ramos-Vara JA, et al. Randomized trial of cisplatin versus firocoxib versus cisplatin/firocoxib in dogs with transitional cell carcinoma of the urinary bladder. J Vet Intern Med 2013; 27: 126-133. https://doi.org/10.1111/jvim.12013
  10. Knapp DW, Ramos-Vara JA, Moore GE, Dhawan D, Bonney PL, Young KE. Urinary bladder cancer in dogs, a naturally occurring model for cancer biology and drug development. ILAR J 2014; 55: 100-118. https://doi.org/10.1093/ilar/ilu018
  11. Knapp DW, Richardson RC, Chan TC, Bottoms GD, Widmer WR, DeNicola DB, et al. Piroxicam therapy in 34 dogs with transitional cell carcinoma of the urinary bladder. J Vet Intern Med 1994; 8: 273-278. https://doi.org/10.1111/j.1939-1676.1994.tb03232.x
  12. Ladue T, Klein MK. Toxicity criteria of the veterinary radiation therapy oncology group. Vet Radiol Ultrasound 2001; 42: 475-476. https://doi.org/10.1111/j.1740-8261.2001.tb00973.x
  13. Marconato L, Nitzl DB, Melzer-Ruess KJ, Keller MA, Buchholz J. Chemotherapy and radiation therapy in 4 dogs with muscle-invasive transitional cell carcinoma of the urinary tract. Can Vet J 2012; 53: 875-879.
  14. Mutsaers AJ, Widmer WR, Knapp DW. Canine transitional cell carcinoma. J Vet Intern Med 2003; 17: 136-144. https://doi.org/10.1892/0891-6640(2003)017<0136:CTCC>2.3.CO;2
  15. Nolan MW, Kogan L, Griffin LR, Custis JT, Harmon JF, Biller BJ, et al. Intensity-modulated and image-guided radiation therapy for treatment of genitourinary carcinomas in dogs. J Vet Intern Med 2012; 26: 987-995. https://doi.org/10.1111/j.1939-1676.2012.00946.x
  16. Norris AM, Laing EJ, Valli VE, Withrow SJ, Macy DW, Ogilvie GK, et al. Canine bladder and urethral tumors: a retrospective study of 115 cases (1980-1985). J Vet Intern Med 1992; 6: 145-153. https://doi.org/10.1111/j.1939-1676.1992.tb00330.x
  17. Owen L. TNM classification of tumours in domestic animals. Geneva: World Health Organization. 1980.
  18. Poirier VJ, Forrest LJ, Adams WM, Vail DM. Piroxicam, mitoxantrone, and coarse fraction radiotherapy for the treatment of transitional cell carcinoma of the bladder in 10 dogs: a pilot study. J Am Anim Hosp Assoc 2004; 40: 131-136. https://doi.org/10.5326/0400131
  19. Rostom AY, Tahir S, Gershuny AR, Kandil A, Folkes A, White WF. Once weekly irradiation for carcinoma of the bladder. Int J Radiat Oncol Biol Phys 1996; 35: 289-292. https://doi.org/10.1016/0360-3016(96)00063-6
  20. Shaffer R, Vollans E, Vellani R, Welsh M, Moiseenko V, Goddard K. A radiotherapy planning study of RapidArc, intensity modulated radiotherapy, three-dimensional conformal radiotherapy, and parallel opposed beams in the treatment of pediatric retroperitoneal tumors. Pediatr Blood Cancer 2011; 56: 16-23. https://doi.org/10.1002/pbc.22649
  21. Teoh M, Clark CH, Wood K, Whitaker S, Nisbet A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol 2011; 84: 967-996. https://doi.org/10.1259/bjr/22373346
  22. Vassiliou V, Charalambous H. Curative intent versus palliative intent radiation oncology. In: Lutz S, Chow E, Hoskin P, editors. Radiation oncology in palliative cancer care. West Sussex: Wiley-Blackwe. 2013: 31-42.