Veterinary Surgical Oncology. Группа авторов
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fair outcome, and 2 had poor outcome (Weisse et al. 2006). Self‐expanding nitinol stents were successfully placed in 17 of 19 dogs with urethral obstruction due to TCC, MST 78 days, complications included incontinence in 7 dogs, reobstruction from continued growth of urethral TCC (3 dogs), acute reobstruction shortly after the procedure (1 dog), and stent migration (2 dogs) (McMillan et al. 2012). In 42 dogs with obstructive carcinoma (TCC, prostatic adenocarcinoma [ADC], or urinary carcinoma) of the urethra treated with a self‐expanding metallic stent, resolution of urinary tract obstruction was achieved in 41 dogs, in one dog the stent dislodged from the urethra and migrated to the bladder. Severe incontinence occurred in 11 dogs and stranguria in 2 dogs. Stent length, diameter, and location were not associated with incidence of incontinence or stranguria. MST after stent placement was 78 days, and treatment with NSAIDs before and chemotherapeutics (carboplatin, adriamycin, mitoxantrone, Cytoxan, gemcitabine, or vinblastine) after stent placement increased MST to 251 days (Blackburn et al. 2013). Permanent cystostomy: for palliation of obstruction also reported (Smith et al. 1995). Long‐term urethral diversion using a low‐profile gastrostomy tube was used to relieve urethral obstruction in a dog with granulomatous urethritis (Salinardi et al. 2003). Abdominal wall TCC: TCC of the urinary tract, as well as abdominal wall TCC occurred in 24 dogs, and developed significantly more often in dogs that had undergone cystotomy (18/177 or 10%) compared to dogs that had not (6/367 or 1.6%). In 1 dog that had not undergone cystotomy, TCC had invaded through the urinary bladder wall and spread down the median ligament to the abdominal wall. None of the 18 dogs that received anti‐cancer drugs had remission of the abdominal wall TCC, MST after abdominal wall TCC detection was 57 days. It is crucial to minimize the risk of TCC seeding at surgery. Percutaneous sampling of TCC should be avoided (Higuchi et al. 2013). Radiation: Complications of urinary incontinence and cystitis occur with whole‐bladder intraoperative radiation (Walker and Breider 1987; Withrow et al. 1989). Coarse fractionation external beam radiation (with mitoxantrone‐piroxicam) showed no benefit over mitoxantrone‐piroxicam chemotherapy alone (Poirier et al. 2004b). Laparoscopically implanted tissue‐expander radiotherapy shows promise in reducing radiation damage to surrounding tissues (one dog still alive at 21 months) (Murphy et al. 2008). Neoadjuvant chemotherapy, external beam radiation therapy, and adjuvant chemotherapy were reported in 4 dogs (Marconato et al. 2012). Adaptive radiotherapy techniques spared rectal irradiation and maximized bladder irradiation (Nieset et al. 2014). Intensity‐modulated and image‐guided radiation therapy for treatment of genitourinary carcinomas (bladder, prostate, urethra) in 21 dogs resulted in a MST of 654 days (Nolan et al. 2012). Medical: Mitoxantrone‐piroxicam combination with minimal toxicity has a MST of 291 days (Henry et al. 2003). Cisplatin‐piroxicam is not recommended (Greene et al. 2007). For piroxicam alone, MST is 181 days (Knapp et al. 1994). For deracoxib alone, MST is 323 days (McMillan et al. 2011). Gemcitabine‐piroxicam combination – MST was 230 days (Marconato et al. 2011), and carboplatin‐piroxicam combination –MST was 161 days (Boria et al. 2005), and vinblastine alone, MST 147 days (Arnold et al. 2011). In another study there was no significant difference in MST of dogs treated with mitoxantrone‐piroxicam versus carboplatin‐piroxicam combination; however, dogs with prostatic involvement had shorter MST than TCC in other locations (Allstadt et al. 2015). In 14 dogs treated with cisplatin‐firocoxib combination, the remission rate was 57% and MST 179 days, in 15 dogs treated with cisplatin the remission rate was 13% and MST 338 days, and in 15 dogs treated with firocoxib alone the remission rate was 20% and MST 152 days. Renal and gastrointestinal toxicoses were common in dogs receiving cisplatin or cisplatin/firocoxib (Knapp et al. 2013). In another study of 30 dogs, most of which had failed other treatments, metronomic chlorambucil resulted in partial remission in 1 dog, stable disease in 20 dogs, and progressive disease in 9 dogs. The MST of dogs from the time of the start of chlorambucil treatment was 221 days (Schrempp et al. 2013). Subcutaneous 5‐azacitidine treatment – MST not reported, 18 dogs – partial remission in 4, stable disease in 9, and progressive disease in 4 (Hahn et al. 2012). Intravesical administration of mitomycin C in 13 dogs with bladder TCC – 2 dogs had severe myelosuppression, 5 had partial remission, 7 had stable disease (Abbo et al. 2010). Intralesional interleukin‐2 injected via ultrasound guidance or after surgical debulking in combination with meloxicam, piroxicam, or firocoxib, +/− mitoxantrone resulted in an overall MST of 170 days (Konietschke et al. 2012). Folate‐targeted vinblastine conjugate (EC0905) (investigational). Scintigraphy showed folate uptake in both primary and metastatic lesions, partial remission occurred in 56% of dogs (5 dogs), and stable disease in 44% of dogs (4 dogs) (Dhawan et al. 2013). Intra‐arterial carboplatin chemotherapy may be preferable compared to the intravenous route for rapid reduction in tumor volume, however, follow‐up is short and MST is not reported (Culp et al. 2015). Concurrent antibiotics are commonly needed (Budreckis et al. 2015). PDT: PDT is currently under investigation (Lucroy et al. 2003c; Ridgway and Lucroy 2003). Prostatic carcinoma: Prostatectomy is performed for early‐stage disease confined to prostate capsule (but there is a high rate of urinary incontinence) (Hardie et al. 1984; Basinger et al. 1989). Other treatment modalities include transurethral resection (TUR) (electrosurgical and investigational; relieves urethral obstruction, but 2 of 3 dogs had perforated urethra) (Liptak et al. 2004a); Nd:YAG laser (investigational: 8 dogs had MST of 103 days; 3 died from complications within 16 days) (L'Eplattenier et al. 2006); stenting (investigational but very promising, with good to excellent outcome in 8 dogs) (Weisse et al. 2006); bypass obstruction (prepubic catheter); chemotherapy (investigational); non steroidal anti‐inflammatories (NSAIDs) (MST 6.9 months in 16 dogs, compared to 0.7 months with no cancer therapy in 15 dogs) (Sorenmo et al. 2004b); intraoperative prostatic radiation (MST for 10 dogs was 114 days) (Turrel 1987a); PDT (investigational) (Lucroy et al. 2003a; L'eplattenier et al. 2008); and palliative radiation for skeletal metastasis. One dog with ductus deferens and prostate TCC treated with removal of both ductus deferens and long‐term meloxicam lived for 9 months (Guerin et al. 2012). Cats: Bladder TTC in 11 cats treated with meloxicam had a MST of 311 days (Bommer et al. 2012), in another paper of 20 cats with bladder TCC treated with piroxicam, chemotherapy, or surgery, the MST was 261 days (Wilson et al. 2007).