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adjuvant radiation may not be necessary. A recombinant canarypox virus expressing feline
Il-2 (Oncept IL-2) improved tumour control in cats treated with surgery and radiation therapy in one study (4). The addition of chemotherapy (doxorubicin or epirubicin) may improve outcomes, but the true benefit is not clear.
Options for non-resectable tumours
C. Ward1
1University of Georgia College of Veterinary Medicine, Small Animal Medicine and Surgery, Athens, USA
Cynthia R. Ward, VMD, PhD, DACVIM (SAIM) University of Georgia College of Veterinary Medicine Athens, GA 30602 USA
Hyperadrencorticism and diabetes mellitus often occur concurrently and these patients can be a challenge to diagnose and manage.1 They have similar clinical signs and the diagnostic tests are affected by the clinical diseases. Additionally, treatment of one disease will affect the treatment of the other. So, how to proceed with such challenging cases. Diabetes mellitus is
usually diagnosed first as it is the easiest to recognize. Clinical signs include polyuria/polydipsia, weight loss, persistent or recurrent urinary tract infections, weakness and muscle wasting, cataracts (usually dogs), and peripheral neuropathies (usually cats). Diagnosis can
be made by recognition of appropriate clinical signs,
and demonstration of persistent hyperglycemia and glucosuria. One confounding factor to this diagnosis
is stress. Stress, alone, can cause hyperglycemia, that can be high enough to be cause spill over into the
urine and glucosuria. Should the clinician have any
doubt of whether hyperglycemia and glucosuria are
due to diabetes mellitus, s/he should check a serum fructosamine level. This value gives the average of the blood glucose over the preceding 2-3 weeks. If elevated, then diabetes mellitus can be diagnosed. After diagnosis, stable diabetics may be sent home with insulin to begin therapy. Optimal insulins for dogs include NPH, Lente (VetsulinR), Detemir (LevemirR). Of these, VetsulinR is the only one approved for veterinary use by the FDA. NPH insulin is an inexpensive option for owners, although
the duration of action may not be optimal in some dogs. VetsulinR and Detemir are more appropriate choices if insulin can only be given once per day. The optimal diet for diabetic dogs is one high in insoluble fiber. This diet slows glucose absorption from the gut and postprandial hyperglycemia. The patient should be re-examined in 7-10 days to determine insulin effect. Optimal monitoring includes evaluation of a glucose curve.2-4
Concurrent HAC in the diabetic patient is usually suspected if the diabetes mellitus is not controlled with insulin doses climbing over 1.5 U/kg (insulin resistance)
· Palliative RT is often effective at shrinking FISS in the short term, though there is often progression within a few months. Adding chemotherapy (doxorubicin) may improve response rates and duration. Doxorubicin alone will also be effective in some cases, with response rates of 40-50%, though again these do not tend to be durable. Metronomic chemotherapy has not been. IL-2 vaccine may slow progression in unresectable feline STS (unclear if FISS were included in this abstract) (7).
1 Dennis MM, McSporran KD, Bacon NJ, Schulman FY, Foster RA, Powers BE. Prognostic factors for cutaneous and subcutaneous soft tissue sarcomas in dogs.Vet Pathol 2011; 48:73-84
2 McSporran KD Histologic grade predicts recurrence for marginally excised canine subcu- taneous soft tissue sarcomas. Vet Pathol 2009;46:928-33
3 Elmslie RE, Glawe P, Dow SW. Metronomic therapy with cyclophosphamide and piroxicam effectively delays tumor recurrence in dogs with incompletely resected soft tissue sarco- mas J Vet Intern Med 2008;22:1373-1379
4 Jas D, Soyer C, de Fornel-Thibaud P, Oberli F, Vernes D, Guigal P-M, Poulet H, Devachelle P Adjuvant immunotherapy of feline injection-site sarcomas with the recombinant canary- pox virus expressing feline interleukine-2 evaluated in a controlled monocentric clinical trial when used in association with surgery and brachytherapy Trials in Vaccinol 2015;4:1-8
5 Cancedda S, Marconato L, Meier V, Laganga P, Roos M, Leone VF, Rossi F, Rohrer
Bley C Hypofractionated radiotherapy for macroscopic canine soft tissue sarcoma: A retrospective study of 50 cases treated with a 5x6 Gy protocol with or without metronomic chemotherapy Vet Radiol Ultrasound 2016;57:75-83
6 Leach TN, Childress MO, Greene SN, Mohamed AS, Moore GE, Schrempp DR, Lahrman SR, Knapp DW. Prospective trial of metronomic chlorambucil chemotherapy in dogs with naturally occurring cancer Vet Comp Oncol 2012;10:102-12
7 Athanasiadi I, Kaser-Hotz B, Buchholz J, Ruess-Melzer K, Herzog A. Combination of Pal- liative Radiation Therapy and Local Application of Oncept IL-2 (Merial) for the Treatment of Feline Soft Tissue Sarcoma (STS). Proceedings of the Veterinary Cancer Society 2016; October 20-22; Orlando FL
Your Singapore, the Tropical Garden City
Canine STS
· Radiation therapy (RT) can be used with a definitive or palliative intent. With definitive type protocols, control rates are approximately 50% at 1 year and 33% at 2 years. Generally, radiation is used in macroscopic STS with a palliative intent, and approximately 50% respond with a median time to progression of approximately 5-10 months. One study in dogs treated with palliative RT +/- metronomic chemotherapy found that the addition of metronomic chemotherapy improved survival time but not progression free interval, so the true impact is hard to determine (5)
· Chemotherapy: Doxorubicin in macroscopic
STS is associated with an overall response
rate of 20-30%. Mitoxantrone and ifosfamide may be effective in some dogs. Metronomic chemotherapy with chlorambucil may shrink STS or maintain stable disease in some dogs (6)

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