MR, PET Imaging Calculates Chemotherapy’s Ability to Prolong Life of Breast Cancer Patients

For patients with advanced breast cancer, positron emission tomography (PET) and magnetic resonance (MR) imaging can improve quality of life and survival by providing physicians with information on the effectiveness of chemotherapy before surgery.

The investigators who presented their data June 2013 at the annual meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) held in Vancouver (BC, Canada), merged separate imaging systems, PET, MR, and computed tomography (CT), to map the course of chemotherapy prior to surgery, known as neoadjuvant chemotherapy. These different imaging systems provide complementary data, both structural and physiologic, about how chemotherapy will be distributed in the body to destroy breast cancer and metastatic tumors. Investigators, in this research, used a specialized molecular imaging agent called F-18 fluorodeoxyglucose (FDG) that acts as a biomarker for cellular metabolism with PET to target regions of cancer metastasis.

“Previous studies have shown that, separately, FDG PET and dynamic enhanced MR imaging can provide a prediction of how patients will respond to neoadjuvant treatment, but we have improved upon this concept by combining the two techniques side by side,” said Sang Moo Lim, MD, current director of the department of nuclear medicine, and until 2006, director of the National Radiation Emergency Medical Center of the Korea Institute of Radiological and Medical Sciences (Seoul, Republic of Korea). “Using both FDG PET and MR imaging to predict cancer progression-free survival allows us to apply more aggressive therapies that could potentially halt patients’ cancers and extend their lives.”

This study, which assessed survival after chemotherapy included a patient population of 44 women with advanced breast cancer. All underwent three cycles of neoadjuvant chemotherapy and sequential whole-body FDG PET/CT, breast MR, and delayed breast PET/CT a total of four times—once before the first course of chemotherapy, again after the first course, after the second course, and once more prior to surgery to predict and validate disease-free survival. The findings indicated that patient survival with no recurrence of cancer after neoadjuvant chemotherapy was from just under three months to about three years for a median of 661 days.

“Additionally, this study demonstrates the collective potential of these imaging systems, which provides evidence that fused PET/MR utilizing both metabolic and vascular perfusion imaging can benefit patients,” said Dr. Lim. “Together, these techniques can help clinicians classify patients and provide risk stratification to not only predict cancer recurrence after treatment but also avoid chemotherapy for those who probably would benefit more from an alternative treatment.”

This research using combined, sequential PET and MR imaging provides additional proof of the potential benefit of simultaneous PET/MR imaging, an emerging molecular imaging technology. “This extends beyond just breast cancer,” Dr. Lim added. “We could potentially apply these technologies to other malignancies and develop some brilliant methods to improve clinical outcomes. Considering the results of our research, we now need to further develop the technology—not just imaging systems, but tracers and biomarkers—to advance our field. Research and development in nuclear medicine and molecular imaging can satisfy these demands for the future.”

Related Links:
National Radiation Emergency Medical Center of the Korea Institute of Radiological and Medical Sciences