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Molecular Imaging in Cancer

Molecular Imaging in Cancer. Chaitanya Divgi, MD Professor of Radiology & Radiation Oncology Chief, Nuclear Medicine & Clinical Molecular Imaging Department of Radiology University of Pennsylvania chaitanya.divgi@uphs.upenn.edu. Overview.

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Molecular Imaging in Cancer

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  1. Molecular Imaging in Cancer Chaitanya Divgi, MD Professor of Radiology & Radiation Oncology Chief, Nuclear Medicine & Clinical Molecular Imaging Department of Radiology University of Pennsylvania chaitanya.divgi@uphs.upenn.edu

  2. 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.

  3. 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

  4. 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.

  5. Vander wel et al. Int J Radiat Oncol Biol Phys. 2005; 61: 649-55. Tumor definition by PET

  6. Cachin, F. et al. J Clin Oncol; 24:3026-3031 2006 Guide therapy by evaluation of metabolic response

  7. Staging for therapy • Staging with PET/CT is superior to either modality alone

  8. Response to therapy Esophageal cancer

  9. Response to Hormonal Therapy Post-Rx Pre-Rx Example 1 • Recurrent sternal lesion • ER+ primary • Recurrent Dz strongly FES+ FES FDG FDG Example 2 • Newly Dx’d met breast CA • ER+ primary • FES-negative bone mets University of Washington (Linden, J Clin Onc, 2006)

  10. Surgery may be avoided or tailored based on tumor characteristics Divgi et al, Lancet Oncol. 2007; 8 : 304-10.

  11. Response evaluation by PET Changes in tumor characteristics precede structural change and predict overall therapeutic outcome

  12. Thank you.

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