• To radiate or not to radiate...

    Hi,

    I am struggling with the decision of whether or not to have radiation therapy for my 6+ year old cat. June was diagnosed with (likely inoculation induced) soft tissue sarcoma in November 2016. My vet performed surgery in December and then again in January due to not going wide enough the first time. The tumor came back within 6 months and a specialist performed her third surgery 3 weeks ago. She is healing well, is loving life in her garden and is happy and content.

    However, the oncologist and my vet have informed me that without radiation therapy, the chances of the tumor returning is 99%, and it will most likely be quicker than last time. They told me that sarcoma is a nasty form of cancer and is very aggressive, so they need to treat it aggressively. The decision for me weighs heavy on me based on the following:

    1) The radiation site margin is touching her spinal cord. Since they can't avoid the spinal cord, they need to add three days to the treatments so they give lower doses. There is a 10% chance she will become paralyzed in her hind legs within 3-5 years of the treatment (the guilt would be unbearable to me if this happened and I know I would feel like I did this to her).

    2) The failure rate of this treatment is 25% (It's better to think of it as a 75% success rate, though, right?).

    3) She would have to live at the hospital for 18 days, which is an hour away from our house in London. She could only go home on the weekends. I am worried that she would feel like I abandoned her there--especially since I am in the USA until August 13 so would not even be able to visit her until then. (And we can't wait until I get back to get started--they feel like waiting that long is too high a risk as the it has already been three weeks since her surgery).

    4) I am not insured. I have to add this as a factor here but money really is the least of my concerns. I am £4,000 in debt for the surgeries, and the radiation treatment is about £5,500 more. Not a good scenario but I don't really care.

    I love my cat very much. My priority for her is quality of life. I want June to be happy and of course I would like her a very long time. My vet said that if face with this decision for his own pet, he would be "tempted" to go with the radiation therapy. My oncologist won't give an opinion. I really don't know what to do. I am leaning towards not doing it because of the risks involved---and then I feel guilty because when you do the math, the odds are in her favor, right? When this feeling takes over, I want to go for it. And then I start feeling guilty for wanting to do this to her. And on and on...

    I need to decide before Sunday. I know that no one here can tell me what I should do. But if anyone does have some light to shed on this situation, I would appreciate your feedback.

    Little Black Manx('s Mama)

Responses

  • 9 days ago

    RE: To radiate or not to radiate...

    Hi littleblackmanx,

    I'm sorry that I just saw this and it is likely too late for your decision making. I hope you know that there is no right or wrong thing to do here. It is a terribly difficult decision to make ... one that all of us cat owners hope we never have to make. I always try to remind people in this position that for your cat, the most important thing in life is your love. As long as you love her, she will be happy with any decision that you make.

    Vaccine Associated Sarcomas (VAS ... aka: "FISS" Feline Injection Site Sarcomas) are terrible, aggressive tumors ... and without very large margins during surgery, the prognosis is generally not good.

    I live in Raleigh, NC ... near the NC State Univ Vet School (ranked the 3rd best vet school in the US). A couple years ago, I had the opportunity to write an article for the NCSU Vet School magazine on radiation oncology and their new (at the time) linear accelerator, used to give radiation treatments. It was amazing to learn about the capabilities of that machine ... particularly the ability to "shape" the radiation beam to match the exact shape of the tumor and minimize radiation to surrounding tissue. I don't know if they have the same type of linear accelerators in the UK, but I assume they do.

    One other aspect of treatment that I don't know if they mentioned to you ... is a type of immunotherapy treatment ... actually a type of "vaccine" that can help treat the tumor. It is produced by Merial (which was recently sold to Boehringer Ingelheim ... I assume this vaccine was included in the sale) ... and is called, "Oncept IL". You can Google it for more info. It is used in conjunction with surgery and radiation treatment. It was released as a product in the UK and Europe several years ago, before it was available in the US. Here is a link to one of the sites describing Oncept IL ... though there are others as well:
    http://www.2ndchance.info/fibrosarcomaMerialALVAC-IL2.htm

    It is completely understandable if you have decided not to pursue further treatment. I think that the reality is that with most of the possible treatments ... they only buy the cat a bit more time (may be a year or more, but also may be much less), and if the tumor has already come back one or more times after surgery, I suspect that the prognosis is not great. But I also understand the depth of love for a cat and can understand your desire to do as much as possible.

    Just one final note. While some may say that it is not known what the "exact" mechanics are that result in a fibrosarcoma ... the reality is that it IS known that a major factor in genetically susceptible cats is the presence of chronic inflammation ... which causes a mutation to the p53 gene (tumor suppressor gene). One cause of long-term chronic inflammation is the chemical adjuvant found in most killed (inactivated) vaccines. A study published in 2012 concluded that the use of a recombinant vaccine (non-adjuvanted) rather than a killed (adjuvnated) vaccine ... reduced the risk of a fibrosarcoma by AT LEAST 10 times. If you have other cats ... it is strongly recommended that, in the future, if they need a vaccination, use only non-adjuvanted vaccines ... i.e. modified live for the basic core vaccines for panleukopenia, herpesvirus and calicivirus ... and only the Merial Purevax recombinant rabies or FeLV vaccines which are the only non-adjuvanted vaccines available for rabies and FeLV.