Name: 用於治療狗狗肥大細胞瘤的癌症療法 Stelfonta - VLOG 132 (Cancer Treatment Stelfonta in Action for Mast Cell Tumors in Dogs - VLOG 132)
Uploaded: 2024-09-03T05:01:45.000Z
Duration: 9 min 15 s

I'm Dr. Sue, Cancer Vet, and I'm here to share another story of one of my Stelfonta cases.

我是癌症獸醫 Sue 博士，在此與大家分享我的一個 Stelfonta 案例。

程度副詞

I think it's really helpful to see a case go from treatment to week four for follow-up, just to see what goes on with him, because those pictures, what to expect, are hopefully gonna help you make the decision whether or not Stelfonta is the right treatment option for you if your veterinarian tells you that your dog is a candidate for Stelfonta.

我認為，看到一個病例從治療到第四周的隨訪情況真的很有幫助，因為如果獸醫告訴您，您的愛犬適合接受斯通塔治療，那麼這些圖片和預期結果有望幫助您做出決定，斯通塔是否是適合您的治療方案。

So be sure to check out Vlog 130, because it has so much information about Stelfonta.

所以一定要看看 Vlog 130，因為裡面有很多關於 Stelfonta 的資訊。

So let me tell you about beautiful, gorgeous Teddy.

讓我來給你們講講美麗動人的泰迪吧。

He is a six-year-old golden retriever, and I met Teddy to find out some treatment options for his mast cell tumor.

它是一隻六歲大的金毛獵犬，我見到泰迪是為了瞭解它的肥大細胞瘤的治療方案。

He originally had a mast taken off the top of his head in August of 2020.

他最初是在 2020 年 8 月從頭頂上取下一根桅杆的。

Unfortunately, it was not submitted for biopsy, so we didn't know what it was at the time.

不幸的是，它沒有被送去做活檢，所以我們當時並不知道它是什麼。

It did grow back a couple of months later and was taken off.

幾個月後，它又長了出來，並被取了下來。

He had a second surgery in December of 2020, so about four months later, and at that time, it was determined that it was a grade two, high-grade mast cell tumor.

他在 2020 年 12 月進行了第二次手術，也就是大約四個月後，當時確定這是一個二級、高級別肥大細胞瘤。

So there's those two grading systems for the mast cell tumor.

是以，肥大細胞瘤有兩種分級系統。

Be sure to check out, I'll put the link below for my mast cell tumor vlog, where I talk about the different grading systems.

請務必查看我的肥大細胞瘤視頻博客，我將在下面附上鍊接，在那裡我將講述不同的分級系統。

So it grew back a month later in January, kind of at the edge of the incision, sort of right over the ear pinna, the base of the ear pinna.

一個月後的一月，它又長了出來，長在切口的邊緣，就在耳廓上，耳廓的底部。

And then she came to see me in the beginning of January, and this was a big mast, and it measured about seven centimeters.

然後，她在 1 月初來找我，這是一根很大的桅杆，大約有 7 釐米長。

When I did a preliminary assessment of his tumor volume,

我對他的腫瘤體積進行了初步評估、

I knew that it would be too big for Stelfonta.

我知道它對斯特豐塔來說太大了。

It was greater than 10 cubic centimeters, which again, in vlog 130, I talk about as the requirement is the cutoff for being a candidate for Stelfonta.

在第 130 期視頻中，我再次提到了這一要求，即成為 Stelfonta 候選者的分界線。

But I thought maybe I could use steroids to shrink the mast cell tumor and get it into that size requirement.

但我想，也許我可以用類固醇來縮小肥大細胞瘤，讓它達到那個尺寸要求。

So I started him on steroids and I had him come back,

於是我開始給他服用類固醇，然後讓他回來、

It had a really good response to the prednisone.

And when he came back in and we measured it, it was about two and a half centimeter diameter, and the tumor volume on the day of treatment when he came in was 4.2 cubic centimeters, definitely below the 10 cubic centimeters.

當他再次來就診時，我們測量了一下，腫瘤直徑約為 2.5 釐米，治療當天的腫瘤體積為 4.2 立方厘米，絕對低於 10 立方厘米的標準。

So let me show you his treatment, because his treatment, Teddy's such a good boy, was beautiful.

讓我給你看看他的治療，因為他的治療，泰迪是個好孩子，非常漂亮。

You know, if you're a veterinary professional, you know, we talk about you wanna use a lure lock syringe, you're gonna use a 23 gauge needle, and you wanna put, when you inject, it's a single injection and you're gonna fan it throughout the tumor, because you wanna distribute the Stelfonta throughout the entire tumor in one injection.

如果你是獸醫專業人士，你知道，我們說過，你要使用誘餌鎖定注射器，你要使用 23 號針頭，注射時，你要一次注射，在整個腫瘤內扇形注射，因為你要在一次注射中將 Stelfonta 分佈到整個腫瘤內。

He has a recurrent mast cell tumor in a very challenging location to be able to get margin.

他患有複發性肥大細胞瘤，而且腫瘤位置非常難以切除。

His tumor volume length times width times height times a half was 4.2, and so they get half that of the Stelfonta, so he's getting 2.1 ml.

他的腫瘤體積長乘以寬乘以高乘以半是 4.2，是以他們得到的是施特豐塔的一半，所以他得到的是 2.1 毫升。

We're doing a 23 gauge needle with a lure lock syringe.

我們使用的是 23 號針頭和誘餌鎖定注射器。

It does sting a little, so we recommend that it goes up to room temperature.

它確實有點刺痛，是以我們建議將其加熱到室溫。

And then we're just gonna take it and fan the dose throughout the tumor to get it.

然後我們就把它吃下去，把劑量分散到整個腫瘤裡，這樣就能得到它。

So I keep in close touch with my patients following Stelfonta.

是以，我在斯特豐塔之後一直與我的病人保持密切聯繫。

I ask them to send me pictures, especially these early cases.

我請他們把照片寄給我，尤其是這些早期病例。

And Teddy's mom and I follow each other on Instagram.

泰迪的媽媽和我在 Instagram 上互相關注。

So she was sending me some direct messages.

所以她給我發了一些直接資訊。

And you know, he's having some swelling as we expect in the area.

你知道，他有一些腫脹，我們預計在該地區。

And I actually had her come in a couple of days earlier.

實際上，我讓她幾天前就來了。

And remember for Stelfonta, we expect inflammation and we expect oncolysis, so rupture of these cancer cells.

請記住，對於 Stelfonta 來說，我們期待的是發炎，我們期待的是腫瘤溶解，所以這些癌細胞會破裂。

But what with him is we were noticing that there was sort of a pocket under the side of his face.

但我們注意到，他的臉側下方有一個口袋。

And when he came in, when I pressed on that, we noticed that there was some pus purulent discharge.

他進來的時候，我按了一下，發現有一些膿性分泌物。

And I told you that most dogs, we take a hands-off approach.

我跟你說過，大多數狗，我們都是放手不管的。

So, you know, we have to use our assessment.

所以，你知道，我們必須使用我們的評估。

We have to use our judgment as clinicians.

作為臨床醫生，我們必須做出判斷。

And I did flush his out because I was worried that as his tumor was dying and necrosing that it was getting trapped under there.

我確實把他的腫瘤沖洗出來了，因為我擔心隨著他腫瘤的死亡和壞死，腫瘤會被困在下面。

And I did do a short course of antibiotics for Teddy.

我還為泰迪做了短期抗生素治療。

So again, we usually check at day seven and then at day 28.

是以，我們通常會在第 7 天和第 28 天再次進行檢查。

He's about four weeks after his Delfonda treatment.

他接受 Delfonda 治療大約四周後。

He has this little area right here that I just did an Asper trying to determine if he had a complete response.

他這裡有一小塊區域，我剛給他做了阿斯佩爾檢查，想確定他是否有完全反應。

When he came in on day 28, there was a 0.8 centimeter mass.

他在第 28 天前來就診時，發現了一個 0.8 釐米的腫塊。

When you see a mass, you know, little different than Tucker, who's in the one of the other previous vlogs that I have as a case study.

當你看到一個大塊頭時，你就會知道，他和塔克沒什麼不同，塔克在我之前的其他視頻錄像中也有一個案例。

You don't know if it's just some scar tissue or if it's residual mast cell tumor.

你不知道這只是一些疤痕組織，還是殘留的肥大細胞瘤。

So what do you think I'm going to do to figure out whether there's tumor there or if it's just healing scar?

那麼，你認為我該怎麼做才能弄清那裡是否有腫瘤，還是隻是疤痕癒合？

Of course, we're going to Asperate, collect some cells and look at them under the microscope.

當然，我們要進行透析，收集一些細胞，在顯微鏡下觀察它們。

And so on day 28, we did determine that there was residual tumor there.

是以，在第 28 天，我們確實確定那裡有殘餘腫瘤。

I looked at it myself, saw mast cells, also sent it out to the lab and the cytologist confirmed it as well.

我自己看了一下，看到了肥大細胞，還把它送到了實驗室，細胞學專家也證實了這一點。

With Delfonda, we have a 75% complete response rate with one treatment.

使用 Delfonda 一次治療後，我們的完全應答率達到 75%。

For dogs that get one or two treatments, the complete response rate goes up to 87%.

對於接受一到兩次治療的狗來說，完全應答率高達 87%。

And we want to wait a full four weeks before we do a repeat treatment.

我們希望等滿四周後再進行重複治療。

So I set Teddy up to come back in next week for a repeat treatment.

於是我安排泰迪下週再來複診。

They need to start their steroids at least two days before treatment.

他們需要在治療前至少兩天開始服用類固醇。

And when he came back in after being on steroids for two days,

I felt around, felt around, felt around and I could not find his mast cell tumor.

我摸了又摸，摸了又摸，就是找不到他的肥大細胞瘤。

And if you can't find a mast cell tumor and you can't measure tumor volume, you can't inject Delfonda.

如果找不到肥大細胞瘤，無法測量腫瘤體積，就無法注射德方達。

So we're going to taper Teddy off of his steroids.

所以我們要讓泰迪逐漸停用類固醇 So we're going to taper Teddy off of his steroids.

He did not get a repeat Delfonda injection.

I'm apprehensive that there, you know, his mast cell tumor is going to grow back, that there's still some cells there, but he didn't get a repeat treatment and mom was pretty happy about that.

我擔心他的肥大細胞瘤會再長出來，因為那裡還有一些細胞，但他沒有接受重複治療，媽媽對此非常高興。

His also was a subgrade high, was that high grade, grade two high mast cell tumor.

他的也是一種亞高分級，是高分級，二級高分級肥大細胞瘤。

So I do think he has more risk for metastasis.

是以，我認為他有更大的轉移風險。

So for him, unlike some of the cytologic low grade mast cell tumors, for Teddy, we are considering chemotherapy as well.

是以，對他來說，與一些細胞學低級別肥大細胞瘤不同，對泰迪來說，我們也在考慮化療。

Again, I have more information about the overall how we manage mast cell tumors in my mast cell tumor vlog.

同樣，在我的肥大細胞瘤視頻博客中，我還會介紹更多有關我們如何管理肥大細胞瘤的整體資訊。

There's a two part vlog and we'll put links below so you can follow up on those.

我們將在下面放上兩部分視頻的鏈接，以便您跟進。