Referral

A 14-year-old female Jack Russell Terrier presented to discuss radiation therapy for a progressive nasal carcinoma that had failed chemotherapy.

Patient History

The patient presented to her primary vet early Feb 2017 with epistaxis from her right nostril. She was evaluated by the oncology team in March 2017 and at the time definitive fractionated radiation therapy in Brisbane was declined. She was started on chemotherapy instead and after two doses of mitoxantrone and a dose of carboplatin the tumour was noted to be progressive resulting in significant facial deformity. The owner was considering euthanasia before hearing of stereotactic radiotherapy option.

Observations

At presentation the patient had marked facial deformity and swelling over the dorsal bridge of the nose between the eyes. Both eyes retro pulsed normally and there was no evidence of protrusion into the oral cavity. The mass effect was resulting in prominent stertor on inspiration. No obvious discharge was noted on exam. CT simulation for radiation planning was done on the 29/5/2017.

Outcome

The patient tolerated the treatment well with no acute effects noted on completion of therapy. She had a very good response with marked resolution of the facial swelling during therapy and marked improvement in breathing. She was seen on recheck 6 and a half months later and was doing very well. Some nasal discharge returned 11 months post treatment and the patient was doing well 17 months post treatment with supportive care.

Stereotactic radiation therapy (SRT) 3 day course of treatment to the right maxilla and intranasal extension

SRT was prescribed to the right nasal cavity as a non-surgical alternative. Treatment was delivered via volumetric arc therapy (VMAT)

30Gy in 3 fractions to the right nasal cavity

VMAT fields are used to provide excellent treatment. preserving healthy tissue and critical surrounding structures.

Treatment was planned via CT planning scan.

15 minute treatment time with daily image guided radiation therapy (IGRT) used to verify the accuracy and precision of treatment.