Intralesional liquid brachytherapy in dogs with appendicular osteosarcoma
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Intralesional liquid brachytherapy in dogs with appendicular osteosarcoma . Henry CJ 1, 2 , Lattimer JC 1 , Selting KA 1 , Loy M 3 , Ketring A 4 , Axiak S 1 , Souza CHM 1 , Tate D 1 , Frank RK 5 , Simon J 5 , Dodson S 6 , Stearns S 3

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Intralesional liquid brachytherapy in dogs with appendicular osteosarcoma l.jpg

Intralesional liquid brachytherapy in dogs with appendicular osteosarcoma

Henry CJ1, 2, Lattimer JC1, Selting KA1, Loy M3, Ketring A4, Axiak S1, Souza CHM1, Tate D1, Frank RK5, Simon J5, Dodson S6, Stearns S3

1Department of Veterinary Medicine and Surgery, and 2Department of Internal Medicine, Hematology/Oncology Division, School of Medicine, University of Missouri, Columbia, MO; 3Valco Instruments Company, Inc., Houston, TX; 4University of Missouri Reseach Reactor Center, University of Missouri, Columbia, MO; 5IsoTherapeutics Group, LLC, Angleton, TX; 6Angleton Veterinary Clinic, Angleton, TX


Background l.jpg

Canine osteosarcoma osteosarcoma

Local disease

Limits quality and quantity of life

Some not amenable to amputation

Background


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Background osteosarcoma

  • Local therapies

    • Surgical limb salvage

    • Palliative care (pain management ± chemo)

    • Radiation therapy

      • Palliative vs. definitive

    • Radioisotope: 153Sm-EDTMP

    • Local (intraarterial) vs. systemic therapy


Background4 l.jpg
Background osteosarcoma

  • Holmium (166Ho) / Samarium (153Sm)

    • 1.8 MeV beta/0.7 MeV beta and 103 keV gamma

    • t ½= 26.8 h (Ho) and 46.3 h (Sm)

    • $$$$$$$$

  • Yttrium (90Y)

    • 2.2 MeV beta

    • t ½= 64 h

    • $


Hypothesis l.jpg
Hypothesis osteosarcoma

  • Intralesional liquid brachytherapy will effectively palliate bone pain associated with osteosarcoma, allowing dogs to retain their affected limbs longer.


Materials and methods l.jpg
Materials and methods osteosarcoma

  • Dogs

  • Appendicular OSA limited to one site

  • Evaluation:

    • Bloodwork

    • nuclear scintigraphy

    • thoracic and affected limb radiography

    • CT or PET/CT imaging of the tumor


Materials and methods8 l.jpg
Materials and methods osteosarcoma

  • Day -14: Doxorubicin 30 mg/m2

  • Day 0: Radioisotope in a colloid-like suspension- Target 50 Gy

    • improved dosimetry

    • decrease systemic myelosuppression

  • 4 cycles of chemotherapy

    • Combination doxorubicin 20 mg/m2 followed 3 hours later by carboplatin 200 mg/m2 q 3 weeks

    • Beginning 2 weeks after the intralesional therapy


Materials and methods11 l.jpg
Materials and methods osteosarcoma

  • Hand held, battery operated drill unit

    • Cutting tip formed on the end of a wire

    • 21 gauge guide needle

    • .017 diameter hole through cortical bone

    • Adapters facilitate multiple injection sites

    • Injection of radioisotope using a precision, glass HPLC syringe encapsulated within a shield


Results l.jpg
Results osteosarcoma

  • 14 dogs treated

    • MU (n=10) and Angleton (n=4)

    • 2 dogs (1/site) had multiple bone lesions at presentation

  • Holmium/samarium (n=3)

  • Yttrium (n=11)


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2 month interval osteosarcoma


Slide17 l.jpg

4 month interval osteosarcoma


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Results osteosarcoma

  • Response

    • CR (n=1) negative PET scan

    • Difficult to evaluate with standard criteria due to bony remodeling

    • PET scans may further define remission

    • No pathologic fractures post procedure


Results19 l.jpg
Results osteosarcoma

  • Amputation in 5 dogs

    • Time to amputation= 52 days (17-87 days)

  • 4 dogs still “leg-on” and still on study

    • Follow up time= 6 mo, 4 mo, 4 mo, 1.5 mo

  • 7 dogs still alive

  • 4 dogs dead due to disease

  • One dog died of DCM


Conclusions l.jpg
Conclusions osteosarcoma

  • Treatments were well tolerated

    • Minimal pain

    • Normal healing

    • Palliation of pain (subjective)


Future directions l.jpg
Future directions osteosarcoma

  • Other tumor applications of liquid brachytherapy

  • Combining radiation modalities such as brachytherapy and external beam

  • Assessment of response by PET scan

  • Dose escalation


Acknowledgements l.jpg

University of Missouri osteosarcoma

Jimmy Lattimer

Carolyn Henry

Alan Ketring

Carlos Souza

Angleton Veterinary Clinic

Funding

The Gabriel Foundation

Isotherapeutics

Valco Instruments Co., Inc.

Max Loy

Stan Stearns

Acknowledgements


Questions l.jpg

Questions? osteosarcoma


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