Transcript Nuclear Oncologic Imaging in Cancer Management

Molecular Imaging in Cancer
Chaitanya Divgi, MD
Professor of Radiology & Radiation Oncology
Chief, Nuclear Medicine & Clinical Molecular Imaging
Department of Radiology
University of Pennsylvania
[email protected]
Overview
Molecular Imaging is critical to cancer patient
management:
• Diagnosis may be made earlier and more
accurately
• The extent and location of the disease
may be more accurately estimated, before
and after treatment.
• Treatments may be better selected, and
unnecessary procedures avoided.
• The effect of treatment, and the severity
of the disease, may be better assessed.
Positron Emission Tomography (PET)
• PET revolutionized functional imaging by
providing exquisite snap-shots
•
18FDG
PET/CT standard of care for staging
disease and response evaluation
• May be the best indicator for recurrent
disease
PET and PET/CT
• Medicare and CMS has approved the use of
FDG PET/CT for a variety of cancers.
• A recent study showed that imaging with
FDG PET/CT could affect patient care
significantly in about a third of patients with
cancer.
Tumor definition by PET
Vander wel et al. Int J
Radiat
Oncol Biol Phys. 2005;
61: 649-55.
Guide therapy by evaluation of
metabolic response
Cachin, F. et al. J Clin Oncol; 24:3026-3031 2006
Staging for therapy
• Staging with
PET/CT is
superior to either
modality alone
Response to therapy
Esophageal cancer
Response to Hormonal Therapy
Pre-Rx
Example 1
Post-Rx
• Recurrent sternal
lesion
• ER+ primary
• Recurrent Dz
strongly FES+
Example 2
FES
FDG
FDG
• Newly Dx’d met
breast CA
• ER+ primary
• FES-negative bone
mets
University of Washington
(Linden, J Clin Onc, 2006)
Surgery may be avoided or tailored
based on tumor characteristics
Divgi et al, Lancet Oncol. 2007; 8 : 304-10.
Response evaluation by PET
Changes in tumor
characteristics precede
structural change and predict
overall therapeutic outcome
Thank you.