Veterinary Surgical Oncology. Группа авторов

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Veterinary Surgical Oncology - Группа авторов


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       Tania A. Banks, Christine Mullin, and Craig A. Clifford

      A multi‐modal approach incorporates a combination of some or all of surgery, radiation, and chemotherapy as the backbone of therapy options, and encompasses less common treatments such as gene therapy, photodynamic therapy (PDT), cryotherapy, and immunotherapy on a case‐by‐case basis. Treatment protocols which involve multi‐modal therapy inherently require a planned and coordinated approach from the outset involving the surgeon, the radiation oncologist, the medical oncologist, and the Owner working together to achieve the best outcome. All specialists must know the animal’s status and special situation as well knowing the owner. This way nothing is “lost in translation” and confidence is maintained, resulting in a strong sense of trust. The surgeon, who operates on an animal with a solid tumor, then refers to a radiation oncologist to “mop up” residual disease has likely done the animal a disservice. Upfront surgical and radiation therapy planning minimizes surgical morbidity and minimizes normal tissue radiation injury while maximizing the efficacy of the union of modalities.

      Surgery remains the mainstay for treating many types of cancer in pets, and the value of a competent surgical oncologist cannot be understated. The type of surgical mindset, specific knowledge, and technical prowess required is a specialized skill. Such a surgeon appreciates and can deliver what is required to expertly attempt a surgical cure or completely change tack for a palliative or diagnostic approach and employ other modalities synergistically.

Image described by caption.

      Photo courtesy of AAPM.org.

      (d) CyberKnife Stereotactic Radiosurgical unit. A CyberKnife is a linear accelerator mounted on a robotic arm. This allows delivery of radiation from thousands of angles around a tumor. KV x‐ray sources are positioned at orthogonal angles above the CyberKnife, which allow for accurate tumor localization with sub‐millimeter accuracy.

      Source: Photo courtesy of Accuray.com.

Image described by caption.

      Source: Image courtesy of Siobhan Haney, DVM, MS, DACVIM (Radiation Oncology); Veterinary Cyberknife Cancer Center, Malvern, PA.

      (b) Stereotactic body radiation therapy (SBRT) plan for a nasal tumor, which demonstrates how the dose can be sculpted to treat the tumor with a high dose of radiation (red areas) and the normal tissues receive a significantly lower dose (blue areas). The graph in the top right corner is a dose volume histogram. The tumor


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