Today's Veterinary Practice

JAN-FEB 2016

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tvpjournal.com | January/February 2016 | Today's VeTerinary PracTice elemenTs oF oncology Peer reviewed 51 cells (such as keratinocytic stem cells in the skin) due to radiation damage. as radiation therapy progresses (usually 2 weeks into treatment course), acute side effects begin to appear as mild redness and dry, faky skin in the treated area, which results from the inability of stem cells to adequately repopulate the keratinocytes that have naturally progressed through their life cycles and shed. 11 as treatment and time continue, these effects become more severe (Figure 3). acute side effects due to radiation are best managed proactively, with the knowledge that, although they may appear severe, their occurrence is transient and self-limiting. cats are generally more resistant to acute side effects than dogs (Figure 4), and their side effects and discomfort tend to be less severe. Late Effects deeper-seated tissues, such as muscle, nerve, and bone, are slowly proliferating in adult animals, and the effects of radiation therapy on these tissues may not appear for many years after treatment, if at all. These late effects of radiation therapy, like acute effects, are expected to occur only in the area of normal tissue near the treated tumor. if the smallest area of normal tissue possible is irradiated with small fraction sizes, the potential for late side effects in these tissues is less than 5%. 12-13 clinical evidence of late effects includes fbrosis, stricture, necrosis and, potentially, a second cancer in the organs surrounding the irradiated area. clinically signifcant late effects are irreversible and potentially life threatening, depending on their locations. Figure 3. Moist desquamation after canine patient received 19 fractions of defnitive radiation therapy for soft tissue sarcoma, excised with "dirty" margins from the distal forelimb. The limb is swollen, and several focal areas of redness and edema can be seen (A). One week after completion of defnitive radiation therapy, the reaction has become more severe, with radiating redness, edema, crusting, and serum seepage (B). Two weeks after completion, note the near- complete resolution of moist desquamation; the skin is pink and smooth with a few areas of crusts and redness (C). Four weeks after completion, clinical signs have resolved completely (D). Figure 4. Cat that has completed fraction 20/20 of defnitive radiation therapy for a vaccine- associated sarcoma on the left paralumbar-fank region; dry, faky skin is present with mild redness ( A). Same cat 1 week after fnishing defnitive radiation therapy; note that dry, faky redness has progressed and additional alopecia is present. No confuent moist desquamation is present as in the dog in Figure 3 (B). Same cat approximately 2 weeks after fnishing defnitive radiation therapy; lesions have healed and hair is beginning to grow back (C). This patient was prescribed OTM buprenorphine (80 mcg/kg), as needed. A B C D A B C

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