We have no idea what to do. It’s not even 8 pm and my husband has gone to bed. We can’t take the stress. No one is eating dinner again. The laundry from the weekend is still in the dryer growing mildew. We’re depressed, we’re miserable, and we don’t know what the right decision is and neither do the experts. We just want our little panther to be healthy and well and live a good long life.
We had a consult today with a radiation oncologist at SAGE about whether to do adjuvant radiation therapy; and if so, what type. The oncologist yesterday said that if it’s a vaccine associated sarcoma (VAS) we should do the radiation therapy. If it’s not a VAS then we probably don’t need the radiation. The oncologist said there is no way of knowing which it is. We’ve had two tests that don’t show markers of a VAS but apparently these tests are not definitive. The location makes the doctors suspicious that it’s a VAS. No record of vaccines in that spot but he could have had a vaccine there before we adopted him at 6 months. However, the literature suggests a VAS would show up probably sooner but maybe not until 10 years later. My husband spoke with the oncologist yesterday because I had to go into work. He said he thought she was leaning against radiation, although she was careful to sound neutral.
The doctor today recommended radiation but it wasn’t a strong recommendation. He is concerned that the tumor seemed aggressive. From the time we noticed it and the time we did the first surgery, it grew fast. It was a grade II – intermediate. The margins on the amputation were 1.5 cm, if they had been 3-5, he probably would have been less likely to recommend radiation. He thought the chance of reoccurrence was around 20 percent which sounds low but if you end up in that 20 percent, the outcome is unlikely to be good. Rounding up to 25 — if there were four plates of food and one was poisoned and would lead to death, would you chance eating supper? So do we take the chance that he’ll be fine or try to prevent that 20 percent chance of a bad outcome?
He said we could have our local vet monitor Castiel every 1-2 months but he also said an X-ray wouldn’t detect the cancer cells early — it would just detect spread to the lungs. He said a CT would likely detect it, but you can’t just do CTs all the time. He said microscopic cancer cells were best treated when they are small but that we could use radiation later also, if needed. It might not be as successful though.
However, he also said radiation has significant side effects too, the worse being several years later. He said organs could be affected, as well as the spine and nervous system. It sounded really scary. On the flip side, our cat would be living long enough – years- to get potential side effects. And not every radiation patient gets these adverse effects, but he didn’t say these late effects were uncommon.
We discussed two types of radiation. The first involved Castiel going in for short low dose treatments five times a week for three weeks. This is the kind of radiation the oncologist before the surgery recommended. The second type involves 1-2 treatments of higher dose focused radiation; however, there is no good data on the efficacy, safety, and long-term effects of this kind of radiation. That is not to say it doesn’t work or that it isn’t safe; it only says the data hasn’t been peer reviewed and published yet. It hasn’t been scrutinized. Radiation treatment requires the cat be put under anesthesia each time – low dose anesthesia but fully out all the same, which has its own risks — although the doctor thought the risk of anesthesia problems was very low. Not zero but low.
If we did radiation, the lesser treatments sound like a good option and the doctor thought they would be best option for Castiel, although they need to do a second CT to understand where to focus the beam and probably other things I don’t know and failed to ask. He said which type he would ultimately recommend would depend on the CT. Castiel hates to travel and travelling for radiation daily would be extremely difficult. He’d have to be boarded if we went to Campbell, maybe not if we went to UC Davis. We hear Davis is very good too, but we worry about a teaching hospital. I know doctors have to learn but no one wants a serious illness treated by a first year intern if there is a experienced physician available. The second type of radiation would be easier on the humans and possibly on Castiel, but is it safe? All our decisions have been made on data and now we’re considering a treatment with no data. My husband is comfortable with that. He trusts doctors explicitly. I know that medicine is not an exact science. I question things more — I don’t know if that is better or worse, it’s certainly not easier.
We’re a mess tonight. Castiel is napping on his favorite chair with his belly in the air. He’s happy and ridiculous.
Hello gorgeous boy and lovely family- that is very hard, I have no help with what decision you will make but I am sure in your hearts you know what you want to do and you will make it happen.
Thinking of you, much love guys 🧡🧡
Aw, thank you so much!
I just gave you some feedback in the Forums. I’m so sorry you guys, I know this is a tough decision. Check out my answer for some thoughts.
Regarding UC Davis: don’t worry, the folks who are doing the radiation treatments are not students, they are DVMs, boarded, professional radiation oncology therapists who have been doing it a long, long time. Teaching hospitals have the brightest minds in vet medicine, and the only time you will be dealing with newbies is for general care, but even then they always have instructors and residents overseeing their work. We have had nothing but excellent experiences at teaching hospitals, often far better than private practice. If UCD is an option for therapy, I would personally go for it. They are literally ranked #1 in the world in vet med.
Thank you Jerry. I will check out the forum responses too… it’s just so difficult to know what to do. Thank you for the information on UC Davis. We were worried, so this is reassuring. If we choose to do radiation, it would be between SAGE Campbell and UC Davis, both are about equal distance from our house but Davis probably has less traffic. We just don’t know if careful monitoring might be better. Castiel is doing well right now, aside from some anxiety about going to the vet hospital. The pathologist thought the margins were sufficient. The first oncologist before the surgery recommended radiation and chemo. The second oncologist after surgery said we could do careful monitoring or radiation; she didn’t strongly recommend radiation and seemed to lean away from it. She did not recommend chemotherapy. Our local vet, while deferring to the oncologist, said she personally wouldn’t recommend radiation, and she knows Castiel well. She didn’t think Castiel would like the 5x a week regime for sure. Our vet friend said he would not recommend radiation either. He felt that there was a decent chance it wouldn’t reoccur and emphasized quality of life. If we knew it was a Vaccine associated sarcoma for sure we would do the radiation but not knowing and not having any markers that it is, we are less certain. We are concerned about the short and long term effects of radiation and Castiel’s current anxiety. But we are also concerned about the cancer coming back and not being able to detect it early enough to do much — and it maybe being harder to battle when the cells aren’t microscopic. No matter what we do, we will wonder if we should have done something else. It is an impossible decision.
Thank you for hearing us and helping us along this path! We’re so grateful.
Cheers,
Michelle and Brian
Thank you, all this is really good to know.
I’m sorry, that makes this harder when they are unsure about the diagnosis!
Your three options
1. Intensity-modulated radiation therapy (IMRT)
5 days a week, 2 days off. Sedating each visit for three weeks for a kitty who stresses leaving the house.
2. Stereotactic radiation therapy (SRT)
I assume?
1-2 treatments sedation 1-2 times.
What determines 1 or 2 treatments the ct?
Did they give you a percentage of reoccurrence with the SRT or other radiation? That may help with further clarity.
3. Do nothing more – 80 % chance of it not reoccurring
20 % it may return.
Which choice is best for Castiel? Write down the best and the worst-case scenarios for all 3 options! See what you have. What can you all move forward with and sleep at night?
As for the teaching hospital, DITTO Jerry, We and many others have had excellent care at universities. They have brilliant vets. On top of technology, the latest treatments, etc., they have the equipment. You are fortunate to have the SRT option. Many don’t have this option.
My prayers are for you to see your clear path forward for Castiel.
Make a decision, HOPE, have FAITH, and plow ahead, enjoying every blissful day furward regardless.
Maceo had radiation at UC Davis; you can always post on the blog, and hopefully, Susan will get back to you.
https://maceo.tripawds.com
((((Hugs ))) chin scratches & smooch to Castiel!
Hello Purrkins,
You are right, we are trying to decide between IMRT, SRT, or careful monitoring. We have narrowed it down mostly to SRT (if he is a candidate…this would need to be determined by a CT) and careful monitoring. We don’t think Castiel would do well with the five days a week radiation. Castiel doesn’t travel well. He panics and loses control of his bowel and bladder. We would have to travel at least an hour each way, possibly double that with traffic. It would be incredibly stressful and because he would have to be sedated on the other end, we wouldn’t necessarily want to sedate him before. He is also a larger cat and he had asthma as a kitty so we worry about that much anesthesia. The SRT is what the radiation oncologists recommended. It would mean only two trips — one for the CT and one for procedure, but he warned there could be significant long-term effects and that there wasn’t a lot of data on this form of radiation at this time. I did a literature search and I found three useful articles. From my reading, it appears that the main factor in addressing a fibrosarcoma is complete surgical incision. Adjuvant radiation treatment does appear to lengthen life span or time to reoccurrence but there are significant side effects, and these are seen 6 months to years later. The paucity of data and the potential severity of some of these late side effects are concerning. Part of me thinks, well late side effects means surviving long enough to have them — the other part of me thinks Castiel is doing well right now and he might not be after the radiation and we don’t even know if the radiation is needed in his case. Do I want to put him through something really difficult when it might not be needed? I feel like I’ve been left to flip a coin. We just don’t know what is right. Thank you for being a sounding board for us.
Cheers,
Michelle and Brian
I keep re-reading your message. It is difficult knowing what to do. I’m not much of a gambler. I am employing every kind of luck I can think of for Castiel and gathering what information I can. If only wanting him to always remain healthy and well was enough to make it true. Fingers crossed.
How are you all doing?
Hi Samantha and Benjamina,
Castiel is doing great. He got his stitches out Wednesday and the doctor said he can move around more. He’s not to jump up on the cat tree too much though. We are trying to limit him on the stairs but he wants full roaming privileges. Hi humans are still trying to decide if we should do radiation or not. we have received mixed opinions from various medical professionals. Castiel is just happy to recover at home peacefully with his silly tiger siblings.
Cheers,
Michelle and Brian
We’re doing great. Castiel has persevered through all of this and has adapted well. I can’t help but wish I could explain it all to him though. I’m just so grateful that he still loves us through all this. He seems very happy.