Pioneering Veterinary Radiation Therapy

Introduction:

Veterinary radiation therapy is a growing field that addresses the unique medical needs of pets. In this discussion, Dr. Lyndsay Kubicek and Imran Shah shed light on how radiation therapy for animals is evolving, with a focus on patient care, safety, and precision. They emphasize the importance of anesthesia and advanced technology in ensuring accurate treatments, tailored specifically for pets like dogs and cats.

 

 

Tell us about your patient population: 

Lyndsay Kubicek

So our primary patient populations are dogs and cats. We don’t have an exotic specialist here at this time, so it’s really going to be dogs and cats. Then occasionally we get an animal from the Denver Zoo, but it’s going to be, I’d say 75% of our caseload is dogs and about 25% cats at this point. 

 

What is different about treating animals? 

 

Imran Shah

Well, one of the primary differences, of course, we’re treating animals, so the anatomy is different, like for humans, if we’re treating, an adult human like, the sizes are about the same, and the anatomy is pretty similar. But for animals, you know, we treat anywhere from between, like a chihuahua to a dane and with vastly different anatomies, and we have challenges associated with small and the large. Another issue we have is animal type fur. So for humans, we put marks on the skin, usually to localize [to the initial simulation]. But with fur, it makes it challenging. And usually, as opposed to humans, when we’re treating animals, they’re under anesthesia all the time. So, if it’s a simulation and treatment on the same day, you have to work really fast, and so that is another one of the differences.

 

Walk us through a standard treatment process.

Lyndsay Kubicek

So I think our patient population is different from human medicine, where [the animals are] under anesthesia. That’s a big part. And a lot of, I think coaching goes up front with clients about the anesthesia involvement in treatments. Because when I sit down and tell a client, I’m going to anesthetize your dog daily for four weeks, the eyes get big and we kind of go into panic mode. And so [for] our typical patient, there’s a lot of education that’s happening up front in their initial consults, talking about the treatments, and once we get into the actual treatment process. Patients are dropped off in the morning. They all come in, usually at a set time, depending on if they have an anesthesia port already placed or not. They get their IV catheters placed for their week of treatment or the day of treatment. And then we set our lineup, dependent on organizing with surgery and chemotherapy, sometimes even just my schedule for new starts, and then those patients are brought down to the layer accelerator where they’re anesthetized. In the vault, all their anesthesia monitoring equipment goes on – that actually takes up the bulk of the time. So [with] humans, we really have to worry about your beam on time. We have our patients coming in under anesthesia with all the monitoring equipment. And then we also will generally do a cone beam CT for positioning for all of our patients. And then most treatments are either going to be a seven field arrangement or rapid Arc type of treatment. Sometimes we’ll do 3d conformal. And then those patients are under anesthesia for about 15 to 20 minutes of treatment. And then they wake up pretty quickly because our drugs that we’re using are fast acting, and so most patients 30 to 45 minutes after treatment are munching on their brunch, and one to two hours after treatment are ready to go home. 

What is medical physics?

 

Imran Shah

So [in] Medical Physics we oversee the quality of treatment and safety of the treatment. So that includes chart checks, checking every plan, being involved in the treatment plans that we do, doing quality assurance tests on the plans, and at the same time, we make sure the machine is running within established specs. So we do daily QAs, monthly QA, annual QAs. On top of that, we also are the problem solvers in the department where, if something [that] is just not standard, [or if] it’s something that you don’t see quite often, and questions come up, we jump in and we try to help out.

 

How does medical physics support you in practice?

Lyndsay Kubicek

Man, I would die without medical physics!

I think it’s something that early on in our residency, in our training, you were just kind of thrown into this world of physics, and it scares you very much, because physics just inherently is scary to most people, but Medical Physics is our mainstay and our safety. It helps us in terms of making sure that we’re treating patients appropriately. It’s our double check system. I mean, Imran and I are bouncing things off of each other constantly. You know, [did] you mean to do this? Or, you know, what were your goals? Or I’m telling him in advance before he checks the plan [that] I know this is gonna look weird to you, this is why this is what I’m doing. And I think you can’t safely and appropriately do radiation therapy in veterinary medicine without medical physics support.

 

Tell us about what is on the horizon for Vet Rad Onc.

Imran Shah

So I am currently the co-chair of the APA work group for veterinary and radiation oncology, and I’m also working with Dr Kubicek in the VRTOG which is a Veterinary Radiation Therapy Oncology Group, and we’re designing a study treat small lung lesions on cats and dogs. So like stereotactic racial therapy treatment, hopefully we’ll have a study that gear towards animals as opposed to taking human data. 

 

Lyndsay Kubicek

We rely on all the AAPM guidelines and medicine for our dosing constraints. And so we, right or wrong, are using human data to derive our radiation protocols for veterinary medicine, and so we’re now trying to kind of flip it over and have our own veterinary branch of AAPM, where we’re actually focusing on our patients with dogs and cats, and what are their true dose tolerances, what are the appropriate, you know, physic guidelines and support for us. So hopefully, in the next five years, we’re going to have our own AAPM, TG, something.

 

What should pet owners know about Vet Rad Onc?

 

Imran Shah

Well, from personal experience, even though we’re working with animals here, we absolutely give it everything we have in terms of quality, safety and the quality of treatment that we’re delivering. You know, if you send your animal here, you’re in good hands. We have great people working here. 

 

Lyndsay Kubicek

I think the biggest kind of myth busting that we do is [that] it is similar to human medicine – but it is not the same. Our patients can’t consent to this treatment. They can’t agree with what they may go through, whether it’s chemotherapy or radiation, and so we focus very heavily on quality, where human medicine may be more on quantity, because again, they can make that call. And so I spend a lot of my time counseling that, yes, it is daily treatment, yes, we do get side effects, but we’re not treating [animals] to the same high doses. We’re not treating for six to eight weeks like humans. We’re doing more hypofractionated protocols, and so we’re balancing that quality of life. And so our goal is that we’re coming in for treatment, we’re doing a very safe treatment, and that our patients are going home in between their doses and are maintaining a good quality of life. And so if they want to go for their W – A – L – K – S, they can. You know they are eating, they’re drinking, and if we’re not meeting those goals because of radiation, nor from the anesthesia, then we don’t treat. And knock on wood, that’s happened never where we can’t get a patient comfortable with nerves coming into the hospital, or, you know, tolerating their anesthesia. There’s a lot of different options that we can do. We have dogs who are really scared to come in, and some of them are just fine and routine, because dogs are such routine oriented creatures, and cats to a lesser extent. But dogs, [they] know where they are after a few days of coming in. They know Melissa, who takes care of them, they know Rose, who meets [them] in the morning, they know Deb, who’s doing their treatment. So they know their people, and they know their routine. So most dogs jump right into it without any worries. For the ones who don’t, we have anti-anxiety medications that [are] used for thunderstorms and fireworks to take that edge off. For patients who are very fearful, we even have instances where, you know, they come at a very certain time, [then] we sedate them in the room, we bring them back, we treat them here, and we bring them right back to recover with their owners.

 

Imran Shah

I think one of the main things people have misconceptions about radiation, that when you get radiation, you’re radioactive but that’s not the case with what we do. Like with the linear accelerator we have behind me, radiation is like a light switch. You turn on the radiation, you treat and you’re done. But in terms of treatment itself, like with radiation treatment, you can avoid surgeries in a lot of cases. So not that kind of scar recovery time as we would see, if you actually had surgery done. Yeah, I think radiation, in lot of cases, can be more beneficial than surgery and provide more beneficial research.

 

Thank you! 

Imran Shah

It really is a happy place, because we work with animals here, and everybody’s just really nice, sweet, and I don’t know, it’s just something about working with animals just makes you a little more bubbly during the day. 

 

Conclusion

As veterinary radiation oncology progresses, the commitment to enhancing animal care through research and specialized protocols remains strong. Dr. Kubicek and Imran Shah highlight ongoing efforts to establish guidelines tailored to veterinary patients, aiming to improve outcomes and maintain high standards of safety. This field is poised to offer pets better treatment options and improved quality of life, all while reducing invasive procedures like surgery.

 

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