The Veterinary Cancer Care Clinic has moved to the east wing of the Small Animal Clinic of the VMTH (where the blood donor/isolation wards used to be) so that we can have more space for our patients.
We have added staff as well as space. The new residents and fellows in medical and surgical oncology are profiled in this bulletin. We have combined medical and surgical oncology into one functional unit because we believe that veterinary students will learn more from seeing a case worked up and treated with all available modalities, from start to finish.
We hope that you will feel free to call for consultations. With our increased staffing, we have designated a "phone consult" person every day to improve turnaround. Also, we invite you to visit us in the Cancer Care Clinic if you are in the neighborhood.
We want the veterinarians in Illinois to be as proud of our service as we are. Your comments and suggestions for ways that we can serve you better are also very welcome!
Barbara Kitchell, DVM, PhD, DACVIM
Assistant Professor of Medicine
Dr. Elaine R. Caplan, a oncologic surgical fellow, graduated
from Texas A & M College of Veterinary Medicine in 1981. She completed
a small animal internship and surgical residency at the Animal Medical
Center in New York City and practiced there and in Austin, Texas. She became
a diplomate of the American Board of Veterinary Practitioners (Dog and
Cat) in 1987. Last year she served as clinical surgery instructor at Iowa
State University.
She has practiced veterinary acupuncture since 1989 when she became
an I.V.A.S. certified Veterinary Acupunturist. Acupuncture is defined as
the insertion of very fine needles into specific predetermined points on
the body to produce physiologic responses. Acupuncture has been practiced
for several thousand years. Most common indications in veterinary practice
include pain from degenerative joint disease, intervertebral disc syndrome,
paralysis, paresis, allergies, lick granuloma, epilepsy, chronic respiratory
disease, gastrointestinal disease, and peripheral nerve injuries. She is
also an A.V.C.A. certified Animal Chiropractor since 1993.
Dr. Tim Fan, oncology medicine fellow, received his veterinary degree from Virginia-Maryland Regional College of Veterinary Medicine in 1995. He then completed an internship at the University of Illinois and a residency in internal medicine at Cornell University.
At Cornell, working with Drs. Sharon Center, John Randolph, and Kenny Simpson, Dr. Fan found a love for internal medicine, especially oncology-related cases and so he returned to the University of Illinois to work with Barbara Kitchell in a two-year fellowship position.
He may eventually pursue additional postdoctoral training or seek
an academic faculty position.
Dr. Tara Lynne Haddad, resident in oncologic medicine, received
a bachelorâs degree in biology from the University of California at Irvine.
She graduated from Oklahoma State University College of Veterinary Medicine
in 1997. Dr. Haddad completed her internship at All Care Animal Referral
Center in Fountain Valley, California.
Dr. John Hintermeister, resident in oncologic medicine, graduated from the University of Illinois College of Veterinary Medicine in 1995. Before returning to Illinois for an oncology residency, John was in a referral practice in the Chicago area. While at Illinois John will be working toward a masterâs and be engaged in a project using hyperthermia to treat canine sarcomas.
By John Hintermeister, DVM
Hyperthermia is the act of raising tissue temperature above 42 C (the level of a very high fever) for a set period of time to cause neoplastic cell death. It is known that if tissue temperatures are high, this will have a cytoxic effect, most likely due to protein alterations. There are many factors that can affect a tumor's response to hyperthermia. Blood perfusion, pH of the tissues, heat-shock proteins, thermoregulatory ability of the tumor, and the ability to repair sub-lethal thermal damage all can affect a tumor's response to hyperthermia.
Whole body as well as local hyperthermia has been used to treat cancer. Local hyperthermia can be supplied by microwave, ultrasound, ferromagnetic, and infrared methods to deliver heat. Heat can be applied superficially or interstitially by using various delivery devices.
The clinical application of hyperthermia as a single modality in the treatment of canine cancer has been disappointing. The best results have been seen when hyperthermia has been combined with other modalities, such as chemotherapy or radiation therapy. When hyperthermia and radiation therapy has been combined, an increased complete response rate has been seen compared to radiation therapy alone. Unfortunately, hyperthermia involves increased acute side effects.
The University of Illinois College of Veterinary Medicine will soon have the capability to use hyperthermia as a treatment modality for canine cancer. By utilizing advances in hyperthermia delivery systems and various imaging modalities such as CT scan or MRI, we hope to increase local control of tumors while minimizing side effects.
The study we are planning to conduct requires dogs with large
tumor masses for evaluation. Financial subsidy for radiation therapy will
be available to support case accrual. Please contact us for consultation
regarding dogs with bulky carcinoma or sarcoma lesions
By Marie-Eve Nadeau, DVM
Nasal-sinus tumors represent less than 2 percent of all canine neoplasms. Eighty percent of these tumors are malignant. Because of a low incidence of metastasis at the time of diagnosis, radiation therapy with or without surgery has been the treatment of choice for these tumors. Previous studies on megavoltage radiation have cited 1- and 2-year survivals rates of 60 percent and 25 percent, respectively, and have shown that surgical debulking did not significantly alter survival.
Attempts to improve head and neck tumor response to radiation therapy in human patients have led to the investigation of various chemosensitizers (chemotherapy agents which enhance the cytotoxicity of ionizing radiation). The theory behind concomitant administration of chemotherapy and radiation therapy is a decreased ability of cellular repair of radiation damage through direct interaction of chemotherapy and radiotherapy or direct cytotoxic activity of chemotherapy against radioresistant cells (e.g., hypoxic cells). The goal is to overcome the mechanisms of radiation resistance at the locoregional tumor site. Cisplatin has been reported to enhance the cytotoxicity of radiation in a number of studies.
In the study performed, 45 dogs with nasal-sinus malignancies
were evaluated. The dogs received an average of 49 Gy of cobalt 60 radiation
over 4 weeks with or without low- dose cisplatin (7.5-10 mg/m2). The results
obtained did not suggest that low-dose cisplatin at the schedule administered
improved the response to radiation. However, the median overall survival
duration was 449 days, with 38 percent of the patients still alive at the
completion of the study. These results are encouraging and show that megavoltage
radiation is the treatment of choice for nasal-sinus malignancies. Further
work will be done with chemosensitization and nasal tumors in the hopes
to find an appropriate scheduling or chemosensitizer that would improve
survival and increase cure.
Kristin L. Boyce, DVM, and Barbara E. Kitchell, DVM, PhD, DACVIM
Gemcitabine (2â, 2â-difluorodeoxycytidine) is a synthetic pyrimidine nucleoside analogue that has a structure similar to that of deoxycytidine and cytosine arabinoside. It exerts its antitumor activity by multiple mechanisms which include inhibition of replication and cell growth, masked DNA chain termination which leads to DNA fragmentation and several self-potentiation mechanisms which increase intracellular concentrations of the active compound. Preclinical experiments have shown a broad range of activity against tumor cell lines in culture. Furthermore, clinical protocols utilizing gemcitabine have been designed for advanced human non-small-cell lung cancer, pancreatic cancer, and mammary cancer.
Preliminary studies in beagles as well as phase I trials in human beings have demonstrated that the drug is well tolerated. The most common dose-limiting toxicity was myelosuppression. The purpose of this pilot study was to assess the applicability of this compound in veterinary medicine and to identify future directions for prospective clinical trials.
All cases that received gemcitabine at the University of Illinois and All Care Animal Referral Center, Fountain Valley, California, between February 1997 and August 1998 were evaluated. Animals were routinely staged before initiating therapy. The majority of patients had previously failed standard chemotherapeutic protocols and were assessed as having progressive disease. Gemcitabine was administered intravenously on a weekly basis at a dose of 60mg/m2 for dogs and 45mg/m2 for cats. A maximum of five successive treatments was administered. Response to therapy and toxicity were evaluated at each subsequent visit.
Twelve dogs and three cats received gemcitabine chemotherapy. Hepatocellular carcinoma was the histologic diagnosis in one-third of the patients (6). Other tumor types treated included; biliary carcinoma (2), lymphosarcoma (2), cholangiocarcinoma (1), metastatic carcinoma (1), pancreatic carcinoma (1), mammary carcinoma (1), and broncho-alveolar carcinoma (1). Toxicity was minimal and no animals died from treatment-related causes. Response to therapy is currently being evaluated. A prospective clinical trial is currently under development to evaluate the use of gemcitabine and platinum agents in combination for the treatment of carcinomas.
Illinois Veterinary Bulletin
Volume 6, Number 2, November 1998