Tratamento de um mastocitoma de alto grau na língua de um cão por meio de radioterapia e quimioterapia: relato de caso / Treatment of a canine high grade lingual mast cell tumor with radiation therapy and chemotherapy: case report

Um canino da raça Boxer, fêmea, de oito anos de idade, foi atendido com salivação, halitose e disfagia. No exame clínico, foi observada uma massa ulcerada no terço médio da língua medindo 3,5 x 4,0cm. A histopatologia e a imuno-histoquímica levaram ao diagnóstico de um mastocitoma de alto grau. O tratamento cirúrgico (glossectomia parcial) foi declinado pelo proprietário, sendo a radioterapia indicada em seu lugar. O protocolo radioterápico empregado foi 15 frações de 300cGy, realizadas cinco vezes por semana. O equipamento utilizado foi de ortovoltagem. A lesão neoplásica apresentou remissão clínica completa a partir da quarta sessão radioterápica. O único efeito colateral observado foi mucosite leve na região irradiada, que, entretanto, não levou a sintomas clínicos. A quimioterapia sistêmica consistiu de vimblastina e lomustina, alternadas a cada 14 dias, durante quatro meses. Até o momento (22 meses após o tratamento), não há evidências de recidiva local ou metástases do mastocitoma. A associação da radioterapia e da quimioterapia pode ser considerada uma alternativa terapêutica nos casos de mastocitomas irressecáveis, já que, neste caso, levou à remissão completa e duradoura de um tumor agressivo, com ótima tolerância do paciente ao tratamento e posterior qualidade de vida.(AU)

An 8 year old female boxer was presented with salivation, halitosis and dysphagia. In the clinical examination, an ulcerated mass in the middle third of the tongue was observed, measuring 3.5 x 4.0cm. Histopathology and immunohistochemistry the confirmed diagnosis of a high-grade mast cell tumor. Surgical treatment (partial glossectomy) was declined by owner, and radiotherapy was indicated. The protocol consisted of fifteen daily fractions of 300 cGy each. The equipment used was an orthovoltage unit. The tumor had complete clinical remission after the fourth session, and mild mucositis was the only side effect observed. Systemic chemotherapy was performed with vinblastine and lomustine, alternated every 14 days, during four months. There is no evidence of local recurrence or metastasis in this patient twenty-two months after treatment. The combination of radiation therapy and chemotherapy can be considered as an alternative therapy in cases of unresectable mast cell tumors. It led to complete and durable remission of an aggressive tumor, with great quality of life.(AU)

Additional local therapy with primary re-excision or radiation therapy improves survival and local control after incomplete or close surgical excision of mast cell tumors in dogs.

OBJECTIVE: To compare survival and local recurrence outcomes in dogs with mast cell tumors with incomplete or close margins treated with primary re-excision or radiation therapy of the primary site versus no additional local therapy. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 64). METHODS: Outcomes of canine mast cell tumor cases that had incomplete or close surgical resection and presented to the Ontario Veterinary College Health Sciences Centre (2001-2010) were evaluated after additional local therapy (primary re-excision or radiation therapy) or no additional local therapy (comparison). Follow-up was performed through evaluation of medical records and telephone contact with referring veterinarians and owners. RESULTS: Tumors (n = 70) in 64 dogs were studied. Median survival times for the primary re-excision (2930 days) and radiation therapy (2194 days) groups were significantly longer than for the comparison (710 days) group. Local recurrence occurred in 13% of the re-excision group, 8% of the radiation therapy group, and 38% of the comparison group. Although local recurrence rate was not statistically significant for the re-excision group, time to local recurrence was statistically longer for both the re-excision and radiation groups. Adjunctive chemotherapy was not associated with improved survival or local control. CONCLUSION/CLINICAL RELEVANCE: There is significant improvement in survival and duration of local control when additional local therapy is performed after incomplete or close resection of mast cell tumors. These follow-up therapies should be recommended to owners when mast cell tumors are incompletely or closely resected.

Radiation therapy for incompletely excised grade II canine mast cell tumors.

Forty-five dogs with incompletely excised grade II mast cell tumors were treated with radiation using a cobalt 60 teletherapy unit (15 fractions of 3.2 Gy for a total of 48 Gy). Twenty-four of the dogs underwent prophylactic regional lymph node irradiation. Three (6.7%) dogs had tumor recurrence, two (4.4%) dogs developed metastasis, and 14 (31%) dogs developed a second cutaneous mast cell tumor. No difference in overall survival rate was observed between the dogs receiving and not receiving prophylactic irradiation of the regional lymph node.