From Walking toward the Light to Walking Down the Aisle

'Kuma' the Akita came to SARC collapsed and nearly dead with advanced cancer. Thanks to specialist surgical oncology and deep radiation therapy, Kuma will now be walking his mother down the aisle at her wedding.

Figures (to right from top):
Figure 1 - Illustration of Kuma's tri-portal radiation treatment strategy. This approach maximises delivery to the affected area while sparing healthy tissue.

Figure 2 - An x-ray port film from Kuma's actual treatment showing the area treated in one portal direction.

Figure 3 - Kuma happy and healthy during radiation treatment and following surgery.

Kuma, a 9 year old male neutered Akita, presented to the SARC collapsed and nearly dead. Kuma’s primary care veterinarian had discovered a mass in the perianal region which extended into the abdominal cavity.

Kuma’s owner visited Dr Charles Kuntz, world renowned veterinary surgical oncologist at the Southern Animal Referral Centre in Highett Victoria. Although Kuma was extremely sick and the disease process was significantly advanced, Kuma’s owner refused to accept that Kuma was on his way out.

During routine workup activities, laboratory results revealed elevated calcium levels (hypercalcaemia) and a marked a white cell increase (neutrophilia) indicating the presence of a possible significant disease process. A CT scan was performed at the in-house SARC advanced imaging facility which revealed a markedly enlarged sublumbar lymph node, along with a 6 cm left anal sac mass.

With a diagnosis in hand it was explained that Kuma would need to go through a series of operations to remove the cancer, followed by radiation therapy to kill off any remaining cancerous cells in the area of the primary tumour.

This course of treatment was explained to be quite involved, but Kuma’s owner was adamant that she was willing to accept the risks involved in order to give Kuma a chance. Most family bonds are strong, but Kuma’s was especially strong, as Kuma was due to walk his owner down the aisle in several months. Only expert attention and immediate intervention would give Kuma any chance to made it to the church on time.

Kuma proceeded to surgery that day and his sublumbar lymph node was removed. This was a particularly challenging procedure due to the fact that it was flanked by major arteries. He recovered well and returned the following week for resection of the anal sac adenocarcinoma. This was removed with complete surgical margins (i.e. the primary tumour was completely removed).

As was hoped, his calcium levels then dropped to normal a short time thereafer. This was accompanied by a return to the habits and behaviours that the happy and healthy Kuma displayed before his illness. He was soon a new dog!

In order to reduce the chance of recurrence, Kuma returned to the Southern Animal Referral Centre for deep radiation therapy. Deep radiation therapy is designed to ‘clean up’ microscopic metastasis (tumour spread) in the region of Kuma’s sublumbar lymph node. Radiation treatment had to be administered through two lateral apposed beams and a dorsal beam to reduce the skin side effects. His treatment protocol included 20 treatments in order to keep the daily dose level low enough that colonic side effects were minimal. This treatment will more than double the expected survival time for Kuma’s initial diagnosed condition.

Kuma has now completed the majority of his radiotherapy treatment and has taken a pause to attend his owner’s wedding. During radiotherapy we have seen Kuma daily and we are happy to report that he has been the same happy and active dog throughout. Although sporting a severe hair cut from the surgery, Kuma is otherwise a model ‘father of the bride’ and will be proudly accompanying his owner on her wedding day, where he is to walk her down the aisle. Luckily for Kuma, he will be sporting a YAP Wear tuxedo befitting the occasion.

The Southern Animal Referral Centre has treated over 40 patients with external beam radiation therapy since commencement of this service early in 2006. While follow-up time is relatively short, we are yet to see local tumour recurrence in any patient receiving full-course treatment. Side effects have been moderate and manageable in all cases and expected lenghh and quality of life is greatly extended.

We are inviting referrals for brain tumours for radiotherapy, as we are about to introduce a major advance in skin sparing technology with a new rotating head gantry designed by Charles Kuntz. Watch this space for further announcements! If you have any queries regarding this story or any of our services, please contact the Southern Animal Referral Centre on (03) 9532 5261.

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