BRITISH VETERINARY ONCOLOGY STUDY GROUP
The 4th meeting of the up and coming British Veterinary Oncology Study Group took place on Sunday (!) June 8th at the Yew Lodge Hotel in Kegworth. The theme for the day was to be Limb Tumours.
Appetites were skilfully whetted by our first speaker, Dr. Jerry Davies of Davies White Veterinary Specialists who delicately guided us through tumours of the appendicular skeleton from a radiologist's perspective. The audience listened gratefully as Dr Davies briefly took us through basic radiological principles before exposing us to some of the more mentally taxing radiographic images from his own broad experience. 'Codman's Ruddy Triangle' took the limelight for a moment, but only long enough to remind us of the pitfalls of looking for such 'pathognomonic' signs.
Dr Laura Blackwood from Liverpool University was next in the hot seat speaking about the diagnosis and management of soft tissue sarcomas. Particular reference was made to the applications of radiotherapy and chemotherapy in this context. For many of us the possible utility of radiotherapy in this context was interesting news.
Digital tumours were next on the menu. A moderately entertaining insight was provided by Gerry Polton of Davies White Veterinary Specialists; while squamous cell carcinoma and malignant melanoma stirred few, the assembled throng were spellbound by descriptions of feline metastatic bronchogenic carcinoma and possibly even impressed by the histopathological images provided.
Dr David Peake, clinical oncologist at the Queen Elizabeth and Royal Orthopaedic Hospitals, Birmingham then gave us a fascinating insight into the management of skeletal tumours in humans. Limb conservation is more applicable in humans because the chemotherapy regimes in use allow surgery to be performed and stand an extremely high chance of effecting a local cure. In fact the death rate from osteosarcoma is incredibly low by comparison to the veterinary experience. The fact that osteosarcoma is frequently found in skeletally immature individuals has also led to an interesting conundrum; this has been resolved by the highly innovative development of titanium limb implants that can grow! All you require is a general anaesthetic and an Allen key. Dr Peake was also kind enough to bring a pair of real implants (limb implants, that is) for us to play with; they seemed very heavy to me but he assured us that a human femur was quite heavy too. I guess he'd know.
Lunch followed and was up to the usual high standard. An invitation to join us free of charge had been extended to some final year students from the RVC who had indicated an interest; it had been our plan to send them down the road to MacDonalds to remind them of their lowly status but the hotel didn't notice a couple of extra mouths to feed. Unfortunately, our intention to continue to offer free membership to veterinary students may result in larger numbers attending so this is likely to be a luxury that won't be repeated. Dr. Peake was typically representative of his profession in that he was sufficiently fascinated by the fact that we treat animals with cancer he changed his plans and remained with us for the rest of the day. The addition of his input into later discussions was immensely valuable.
Well aware of the post lunch soporifity problem our programme writers skilfully injected the now famous BVOSG case reports section into the post-prandial time slot. Ron Lowe of Ashleigh Vet Clinic courageously presented a pair of cases: a very early osteosarcoma in a greyhound and a synovial sarcoma in a GSDX. As he had planned, Ron generated the heated discussion we've learnt to enjoy and cleverly demonstrated the variability in approach to veterinary cancer patients and the critical importance of involving the owner in treatment making decisions.
Malcolm Brearley was next to step up to the microphone, calming the now excited audience with insights into canine and feline skeletal tumours. His great experience allowed him to speak authoritatively about the various novel approaches to osteosarcoma on this side of the Atlantic and the other. There was a very clear take home message: surgery is merely a neoadjuvant, or supportive therapy to the definitive treatment of these patients with systemic drug therapy. Some of the newer drug protocols being used are achieving markedly improved survival outcomes with median survivals in excess of 12 months. Malcolm did not spend too much time dwelling on the application of limb-sparing techniques as that was to be covered in well presented detail by our next speaker, Mr Jonathan Bray of the Animal Medical Centre, Yorkshire. After describing the pitfalls of limb-sparing techniques currently available the notion of veterinary limb prostheses was introduced. Jon is planning to construct, test and the implant limb prostheses in veterinary patients suffering osteosarcoma of the distal radius. At the moment this project is in the planning stages; phase I of the trial will be mechanical testing of the implants, these tests are planned to take place at the Biomechanics Department of Sheffield University.
To end the day we were cajoled into thought provoking debate by Sue Murphy of the Animal Health Trust as she presented a concise assessment of the concepts surrounding informed consent. Particular reference was made to medical investigations using banked pathology specimens, such as the notorious Alder Hey episode, and to clinical trials in human medical oncology. The debate that followed demonstrated the difficulties of incorporating these principles into practice; there was no disagreement though in recognising the need to strive to observe a code of ethics that respects an owner's independence and autonomy, perhaps more in the field of veterinary oncology than any other.
The meeting was as enjoyable as always with points to interest all levels of experience. The committee would like to thank all the speakers for sharing their wisdom and insight and the assembled audience for making the meeting the lively and interactive event that we come to expect.
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