New radiation technology developed by a team of experts, among them 2017 CSIRO Breakout Female Scientist Dr Yolanda Surjan, looks set to change the face of cancer treatment across veterinary clinics. By Chloe Warren
In animals—as in humans—for every cancer diagnosis there is a diverse range of treatment options and prognoses—and the news often isn’t good. It is no wonder explaining a beloved pet’s cancer diagnosis to their distressed owner is one of the hardest jobs a vet has to do. The treatment options available can cause stressful side-effects and, sometimes, permanent disfiguration. Some pet owners, quite understandably, just aren’t willing to take the risk.
Easy the Belgian shepherd was eight years old when he developed a common canine cancer. “I would never have said yes to cancer treatment if it affected the dog in any way—if the dog was to feel sick or stressed,” recalls Easy’s owner, Elga. “I was determined to never put him through chemo. I’ve known of so many other people who have tried it and it didn’t work. Their dogs looked so ill and then they passed away anyway. We’d never had let him suffer that way,” she says.
“To me, a dog’s cancer diagnosis meant the end, and that’s it. We were so upset. The vet’s face turned white as he gave us the diagnosis. It was a huge shock.”
Elga’s vet happened to be Dr Rob Zammit of Vineyard Veterinary Hospital, one of the few vets in Australia with a unique treatment option at hand. Dr Zammitt is part of a specialist research team that includes University of Newcastle academic, radiation therapist, business owner, and 2017 CSIRO Breakout Female Scientist, Dr Yolanda Surjan. This team of experts is looking to change the face of cancer treatment across veterinary clinics, having developed radiation therapy protocols that can be administered onsite, independently of the large machines typically used for external beam radiation treatment.
Onsite radiation therapy
“It’s the very first time that this type of equipment and these type of radiation protocols are being developed for animals, so it’s an Australian first—and potentially it’s a world first, too,” clarifies Dr Surjan. “There are linear accelerators that are being used to treat more deep-seated tumours, but in terms of skin cancer treatment in a veterinary clinic, no-one is doing this.”
Radiation therapy is a specific branch of cancer medicine used in hospitals to treat various cancers including those of the cervix, prostate, head and neck, breast, and brain. Throughout the treatment, cancerous cells are exposed to ionising radiation, which introduces DNA damage and activates cell death. It can be used independently, or in conjunction with other therapies, such as surgery and chemotherapy.
Currently in Australia, there are only a few linear accelerators available for veterinary use. “Pet owners might travel to these locations and stay for five or six weeks while their animals are being treated,” explains Dr Surjan. “We deliver our treatment over a much shorter period of time, and we don’t need to be treating the animals every single day. We’re still in Phase I trials but we can deliver the therapy onsite to horses, dogs and cats.”
“It’s the very first time that this type of equipment and these type of radiation protocols are being developed for animals, so it’s an Australian first—and potentially it’s a world first, too.”—Dr Yolanda Surjan, founder, RadVet
As for Easy, after his three-week course of treatment, his biopsies came back clear and Elga and her family couldn’t be happier. “When Rob told us about this clinical trial, I asked, ‘What does it do to the dog?’ and he said, ‘Well, the dog should be fine,’ and he was! Easy would hop into the car after each treatment and come home with us. We went to the beach, he did his agility training—he was just a normal dog.”
As with any treatment though, some patients are unsuitable. Not all cancers respond to the treatment, and there’s a careful screening process involved.
“We had one case where a patient came in with a giant tumour on the inner thigh, and you can’t irradiate that sort of area, it’s just too big,” recalls Dr Zammitt. “But then on another occasion, we’d been looking at a cancer in and around a dog’s mouth. We’d already had to debulk but couldn’t get in there to remove it. One of the specialists actually suggested removing half the jaw. The people weren’t prepared to put the dog through that kind of trauma—and now we won’t have to.”
RadVet was born out of Dr Surjan’s PhD project. She knew that as a clinician and academic, this was the next step in her career. “I knew it had to be something I loved. Really, I landed on my feet in that I found something I was interested in and that could make a difference to animal treatment,” she says. She was inspired when a colleague told her about a NSW veterinary clinic that used radiation therapy on horses. Dr Surjan went on to perform a comprehensive literature review—a huge summary of how vets across Australia were using radiation therapy—and gained very useful insight into what was happening and how it could be improved.
With the help of industry contacts, veterinarians, and consumers, she was able to combine all of that insight with what is already known about radiation therapy for humans and streamline it into radiation therapy protocols for animals.
When she was selected as part of CSIRO’s ON accelerator program, she learned how to turn her idea into a reality. “From there, getting this up and going has come from having conversations with the right people who are interested in taking things further.”
Among these ‘right people’ were Dr Rob Zammit and Dr Christine Smith, the managing director of the Agnes Banks Equine Clinic. “It was great to be able to bring all of Yolanda’s knowledge from working with humans into the veterinary clinic,” says Dr Smith.
“We’ve used humans as the guinea pigs. We can say to our clients, ‘It’s been thoroughly tested on humans, so it ought to be safe for animals now!’”—Dr Rob Zammit, vet, Vineyard Veterinary Hospital
“We’ve had to completely re-adapt what we’re used to doing,” says Dr Surjan. “So if you can imagine my normal work in a hospital, where I can tell Mrs Jones to sit very still while I do what I need to do – going to working with 700kg horses which are standing up and sedated… it all makes my research even more exciting.”
One of Dr Surjan’s research team’s first equine patients was Willow the six-year-old warm-blood mare, who developed a sarcoid in her shoulder region. “She was completely un-rideable just a year after I bought her,” remembers Willow’s owner, Julie. “People often disregard sarcoids, especially in the online forums. They’ll say, ‘Oh well, mine just fell off,’ or, ‘Just use some turmeric powder!’”
Willow’s sarcoid was particularly aggressive, and failed to respond to numerous treatment attempts, including chemotherapy and laser treatment. These caused an array of painful side-effects, so when Julie saw an article about the radiation therapy trial at Agnes Banks, she took Willow in for an assessment.
“I know there is no such thing as a miracle cure, and radiation therapy doesn’t work for everyone, but if we had used that option first, it would have made a big difference,” she says. “After the chemo, I had to put a cradle on her for four weeks to stop her attacking the sores. But with the radiation therapy, there was absolutely no pain—we just put her in the paddock after treatment and she hasn’t looked at the sarcoid since. It’s now completely gone. I’m just waiting for the scar tissue to mature so I can put a saddle on her.”
The RadVet team is looking forward to making these protocols affordable and accessible for clinics across the country. In order to make this a reality, they need to enrol more trial participants so they can move on to the next step of implementation.
“We’ve used humans as the guinea pigs,” says Dr Zammit. “We can say to our clients, ‘It’s been thoroughly tested on humans, so it ought to be safe for animals now!’”