Cardiology and Oncology Services Pool Expertise to Save Boston Terrier

Treating a Boston Terrier’s heart base tumor took the specialized expertise and close collaboration of the Cardiology and Harrington Oncology services at Henry and Lois Foster Hospital for Small Animals (FHSA) at Cummings School of Veterinary Medicine at Tufts University. The teams jointly came up with a plan to treat the tumor compressing the dog’s heart and blood vessels. After surgery and radiation therapy, Arnie is now back to living his best life. 

“Ever since he was a puppy, Arnie's always been on 10. It was impossible to get him settled down. He has a lot of personality. He’s really loving,” says Arnie’s owner, Marc Cannata.

Cannata has always kept close tabs on Arnie’s mild heart disease. The 11-year-old Boston Terrier was otherwise healthy until four years ago, when an ultrasound showed a mass had formed at the base of his heart. The tumor slowly grew, and his heart disease worsened. Two years ago, Arnie began chemotherapy in hopes of stunting the tumor’s growth, but Arnie did not tolerate it well, so Cannata elected to stop treatment. 

Last fall, Cannata noticed Arnie’s breathing was labored. He had an arrhythmia, and an ultrasound showed the tumor had grown so substantially that it was impeding his heart and compressing all the major blood vessels. Arnie’s cardiologist told Cannata that the dog would not survive unless a stent was placed (a metallic implant that expands inside an obstructed vessel to restore blood flow). 

“She said that it was beyond her scope, and if anybody were able to do it, it would be Tufts,” recalls Cannata.

Arnie met first with FHSA’s Cardiology service. Because of the tumor’s proximity to the heart and major blood vessels, a biopsy would be risky to confirm a diagnosis, but FHSA clinicians suspect it’s a chemodectoma, a slow-growing, heart base tumor fairly common in Boston Terriers. Chemodectomas often show no clinical signs, unless the tumor begins compressing the heart or obstructing vessels, as in Arnie’s case. The Cardiology team pulled in the Radiation Oncology team to develop a treatment plan.

“We would not have been able to do the things we did with Arnie without both teams involved,” says Dr. Bradley Whelchel, cardiology resident in the Department of Small Animal Clinical Sciences at Cummings School. “Whenever we have a patient that needs radiation therapy, we walk 30 seconds down the hallway and talk about what’s best for the patient.” 

Dr. Celina Morimoto, assistant clinical professor of radiation oncology in the Department of Small Animal Clinical Sciences, adds, “There is a great advantage when pets are under the care of different specialists within the same hospital. This allows better communication between teams.” 

Stent placement was recommended as the first step, so that his heart and blood vessels could undergo anesthesia more safely for the second step, five radiation treatments under anesthesia. 

“The stenting aims to improve heart function and vascular compression immediately. Radiation takes many weeks to start to show shrinkage of the tumor; so we recommended stenting first and then radiation therapy,” says Dr. I-Jung Bernard Chi, assistant professor of cardiology in the Department of Small Animal Clinical Sciences.

Radiation therapy posed risks because the tumor is so close to Arnie’s heart and lungs, and anesthesia is riskier in older dogs. However, without interventions, Arnie’s tumor was expected to continue growing and cause more health problems. Cannata decided to move forward with the procedures.

“I was constantly in an emotional state throughout the surgery, treatments, scans, and even regular visits, but the straightforward nature and confidence that the doctors showed really put me at ease,” says Cannata. “They were also quite sensitive and supportive when they saw how difficult these decisions were for me, and they never made me feel pressured. That blend of confidence and sensitivity was exactly what I needed to make a decision and feel at peace with it.” 

Clinicians from both services planned vascular stenting and radiation treatments using FHSA’s cardiac computed tomography (CT) scanner, with the advanced capacity to capture the motion of the heart, providing clearer scans of the tumor and compressed blood vessels. From the scans, the clinicians could determine the exact location of the tumor, the extent of the obstructions, and the types and sizes of stents needed. 

“This is something not available everywhere, so we're lucky here at Tufts,” says Dr. Patricia Gualtieri, radiation oncologist at FHSA and assistant clinical professor in the Department of Small Animal Clinical Sciences.

If we didn't have the CT, we wouldn't have sufficient imaging to do the combo therapy of vascular stenting and radiation. It was critical to know the ideal diameter and length of the stent, and Oncology needs to see the heart and surrounding organs well to preserve the healthy organs and just target the tumor itself.

–Dr. I-Jung Bernard Chi

In January, Chi and Whelchel placed a stent in the pulmonary artery, the most severe site of compression, followed by two stents into the caval veins (the two biggest veins connected to the heart). In early February, Arnie underwent stereotactic body radiation therapy, in which tumors are precisely targeted by high-dose radiation beams. 

Arnie tolerated the treatments well and celebrated at the Oncology service’s traditional graduation ceremony. 

“Arnie came out with the entire Oncology department. They played that Black-Eyed Peas song, and I was just bawling my eyes out,” recalls Cannata. “They care so much. They do such extraordinary work. I'm so grateful to them for giving me my dog back. I cannot express enough gratitude to that institution, to those doctors.”

Cannata saw the difference in Arnie right away. “His whole demeanor changed. He started playing more, he was more affectionate. It was awesome to see.” 

Arnie had a few minor issues post-treatment that resolved, but in May, Cannata noticed Arnie’s belly distended. FHSA clinicians could not find the source of the fluid in his abdomen on the CT scan, but did observe marked shrinking of the tumor—70 percent since his initial scan.

“Seventy percent is a great success,” says Gualtieri. “Hopefully, his stents are going to maintain a good quality of life, and the magic of radiation is that it's one and done.” 

Arnie remains on medication to address his heart disease and fluid accumulation. The Cardiology team will monitor his heart function and stents every few months, while Oncology will check in to continue the cancer monitoring.

Despite having heart disease, irregular heart rhythm, and a big tumor over his heart, Arnie did well. We have all the support in the hospital to make that possible. Without the Anesthesia and Cardiology teams helping us get Arnie safely through the procedures, this wouldn't be possible. I like that we're able to do an interdisciplinary team approach to these cases because ultimately the results have been great.

–Dr. Patricia Gualtieri

Cannata is thrilled to see Arnie back to himself again. “I've been to so many doctors with him over the years, and inevitably, there's always a point where they say, ‘I don't know. That's not what we do here.’ At Tufts, that never happened in any visit. They have the technology, but more importantly, they have the skill and experience to be able to handle virtually anything.”