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tvpjournal.com | January/February 2016 | Today's VeTerinary PracTice elemenTs oF oncology Peer reviewed 53 Table 2. anatomic tumor location, Side effects, & expected Pain Scores associated with Defnitive Radiation Therapy in Dogs & Cats anatoMiC loCation CoMMon tUMor tYPeS eXPeCteD SiDe effeCtS of raDiation tHeraPY eXPeCteD Pain SCore a Potential DrUg interventionS b Brain Meningioma Glioma p ituitary macroadenoma Minimal, if any; many human patients report the sensation of a headache 0–3 (pain diffcult to detect) prednisone Tramadol Gabapentin Buprenorphine Head/neck Squamous cell carcinoma Oral fbrosarcoma Mucositis, dry mouth, halitosis and, potentially, moist desquamation (skin of face) 7–10 NSAids Tramadol Gabapentin Amantadine o TM buprenorphine o ral hydrocodone, hydro- morphone, or morphine nasal Nasal adenocarcinoma (60% dogs) Sarcoma (40% dogs) lymphoma (most common nasal tumor in cats) *Acute side effects in cats tend to be less severe than in dogs depends heavily on treatment technique employed: pain may range from minimal to nonexistent (modern techniques) to severe desquamation (traditional techniques) 7–10 (traditional radiotherapy) 0–3 (advanced conformal radiation therapy) NSAids Tramadol Gabapentin Amantadine oTM buprenorphine o ral hydrocodone, hydromorphone, or morphine Transdermal fentanyl liquid Skin/ subcutis Soft tissue sarcoma Mast cell tumor vaccine-associated sarcoma (cats) *Acute side effects in cats tend to be less severe than in dogs Moist desquamation and sloughing of pads on digits (depending on location treated) 7–10 NSAids Tramadol Gabapentin Amantadine oTM buprenorphine oral hydrocodone, hydromorphone, or morphine Transdermal fentanyl liquid Perianal/ pelvis Anal sac adenocarcinoma Transitional cell carcinoma depends on treatment site but can range from mild to moderate stranguria/hematuria to diarrhea and severe moist desquamation of perianal skin 7–10 NSAids Tramadol Gabapentin o TM buprenorphine oral hydrocodone, hydromorphone, or morphine Transdermal fentanyl liquid a. Pain scores: 0 = no pain; 10 = worst pain possible b. Drugs listed are given concurrently; clinical signs of acute side effects do not occur until approximately 2 weeks into the course of treatment and are not at their peak until 1 week after completion of treatment. Therefore, drugs are added sequen- tially as needed as clinical signs progress. Treating Side Effects Three general principles apply when treating acute side effects of radiation: 1. administer pain medication 2. restrict activity until lesions have healed 3. Prevent self-trauma. it is important to counsel owners that lesions will heal if these recommendations are followed. First-line treatment for acute side effects is administration of an nsaid, such as carprofen (4 mg/kg Po Q 24 H, given with a meal). in cats, acute side effects in rapidly proliferating normal tissues, such as the skin, are not as severe as those seen in dogs (Figure 3). recently, a new nsaid for cats, robenacoxib, has become available in both injectable and oral tablet formulations. robenacoxib is labeled for use Q 24 H for up to 3 days in cats. 14 as time and treatment progress, patients undergoing defnitive radiation therapy require additional oral pain medications, such as tramadol, buprenorphine, gabapentin, and amantadine.