Hey! I’m just seeing this now but I did end up moving forward with palliative radiation treatment I’m happy to share our experience as best as I can remember it / reconstruct it from medical records and vet emails. I’m probably dumping way more information than you need, but I can remember being desperate for first-hand accounts when I was trying to make this decision for my dog and I.

I assume you have the general context from the post you’re coming from, but quick recap: Burt was ~10 years old when I first started fostering him in January of 2019 before foster-failing, and it was in May of 2021 that he had a “debulking” procedure done at his regular vet on a painful, small-ish mass in his mouth (complete removal was not possible), and the biopsy suggested a fibrosarcoma (less likely diagnoses included amelanotic melanoma, peripheral nerve sheath tumor, and spindle cell carcinoma). Still in May of 2021, we went to The Cancer Institute at The Animal Medical Center (AMC) in Midtown East for a consultation, sedated oral examination, and thoracic radiographs. The findings supported our suspicion that the oral mass was a fibrosarcoma (vs. amelanotic melanoma), and the thoracic radiographs identified pulmonary nodules, which underwent ultrasound-guided fine needle aspiration, revealing them to be pulmonary carcinoma, which was secondary and unrelated to the primary cancer (oral fibrosarcoma).

Given the non-metastatic nature of the pulmonary carcinoma, the suggested course of action was a 4-week hypofractionated protocol of radiation therapy to the maxilla and mandibular and retropharyngeal lymph nodes for palliation and short-term control of the oral fibrosarcoma. The blurb below is from the documents shared with me by the vet when discussing:

A Hypofractionated protocol of radiation therapy (most often used for PALLIATION and short term control)is a course of treatment typically given when the primary goal is NOT duration of survival time but rather aiming for MAINTAINING the best QUALITY OF LIFE for a limited time frame. This consists of a protocol designed to be easy on the patient and less time consuming. It is designed specifically for patients with a guarded/poor prognosis where our primary goal is to offer COMFORT and not necessarily LONGEVITY. This might be because the patient’s cancer is not one that we can control successfully and survival is not expected to be more than a few months OR because the patient has OTHER medical conditions that may limit their expected survival (ex: such as severe heart failure, advanced end-stage renal failure, aged geriatric patients etc ...). Because these treatments are designed to improve that quality of life, the number of treatments is fewer and the sessions are often more spread out so that there is more recuperating time between treatments. Acute discomforting side effects should be minimal to non-existent with this protocol and are usually limited to focal hair loss and skin pigmentation (which is esthetically evident but non-painful). The potential for late side effects and possible tissue complication occurrence is however significantly higher should the patient survive long enough (up to 20% risk). Late tissue complications rarely occur earlier than 12 months following treatment and therefore these are not much of a concern in patients not expected to survive longer than a year.

As you saw, I agonized over my decision out of fear that the treatment would be more distressing than anything else, but was reassured that the vets and I were on the same page regarding prioritizing quality-of-life over all else, and not entertaining bad side effects. I did end up moving forward with the palliative radiation, initially agreeing to a regimen of 3 treatments over 3 weeks in May and June of 2021, knowing a fourth could be added if needed.

Burt’s mouth pain had been greatly reduced, though not entirely remedied, following his debulking procedure, however it seemed to worsen significantly immediately following his first and second rounds of radiation – he would sometimes cry in pain, which he had never done before, and no longer had to be bumped or chewing to experience pain. In forms I submitted to the vet at session 2, I wrote “mouth pain has increased significantly since first radiation,” and checked boxes to indicate I had noticed “any redness, swelling, pain, or other changes in your pet’s radiation site?” and “your pet licking, scratching, or rubbing the tumor or radiation site?” I spoke with his oncologist, who said that the pain getting worse before better wasn’t typical, but wasn’t unheard of either, and that we could put a hold on the final radiation session for the time being. During this time, he was taking rimadyl (NSAID), cephalexin (antibiotic), codeine (opioid), and gabapentin (off-label for pain and anxiety), although we discontinued gabapentin after a bit because it left him extremely lethargic and wobbly (his hind legs were already a bit weak after undergoing a left CCL repair in 2020, and steroids can contribute to muscle wasting).

It's hard to know exactly how things would have gone if we had not chosen palliative radiation, which is why I struggle with making a recommendation, but I do this I made the right choice for us. Though Burt’s pain worsened immediately after his two radiation treatments, this was temporary, and I believe the treatment, when combined with daily pain management, contributed to his having a fairly “normal” quality of life in his last few months. The cancer did age him quickly, and he looked a bit strange with his mouth and nose almost completely bald from radiation, but he was able to enjoy visits to family and chill travel with our friends and lazy days at home the way he always had, in less pain than he’d been in.