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URMC Study: PET Scans Are Better for Staging Hodgkin's Disease

3-D Images Detect Tumors that Standard Scanning Techniques Miss

Tuesday, December 10, 2002

PET scans are rapidly becoming the norm for staging and detecting recurrence of disease

When a person is diagnosed with Hodgkin's disease, accurately determining the extent of the disease is critical to making treatment decisions that will improve the probability of a cure and also minimize the side effects, including secondary cancers. Traditionally, oncologists have relied upon gallium scans to help detect the spread of the disease, but researchers at the University of Rochester Medical Center have found that PET scans may be superior for staging the disease.

The study was presented Dec. 9 at the American Society of Hematology's 44th annual meeting in Philadelphia. "Three-dimensional images of tumors are superior for us to see where the cancer is and how extensive it has spread. This is critical in treating patients with Hodgkin's disease, which is readily curable," said Jonathan Friedberg, M.D., assistant professor at the Wilmot Cancer Center, and principal investigator on the study. "Because we see such success with this disease, we want to accurately stage the disease and treat it effectively while minimizing side effects."

The key to PET scan technology is that it tracks sugar-based radioisotopes through the body. Cancer cells use glucose rapidly and the radioactive element is clearly visible on the scans. This lets oncologists see tumors of all sizes, many that are missed by gallium scans and other forms of imaging. Gallium scans follow the absorption of gallium in the body, usually most readily seen in cells in tumors and other areas of inflammation.

The Medical Center and Wilmot Cancer Center provide PET scans, in partnership with PET Scans of America, to many cancer patients. Vaseem Chengazi, M.D., Ph.D., director of nuclear medicine in the Department of Radiology, says the use of PET scan technology has grown dramatically in recent years. "PET scans are rapidly becoming the norm for staging and detecting recurrence of disease," Chengazi says.

Friedberg's study comparing the standard imaging with the new technology for lymphoma illustrates the benefits of the PET scans. The blinded study focused on 36 patients with Hodgkin's disease that underwent both scans upon diagnosis and during treatment regimens. The scans were reviewed independently by nuclear medicine physicians. Baseline PET scans detected more lymphatic tumors than the gallium scans and specifically, five patients were found to have tumors in the spleen, which were not detected by the gallium scans. Three other patients were upstaged as a result of the PET scans. "PET scans also detect tumors in the spleen, which is another plus for our patients as we can better treat them knowing that the cancer has spread," Friedberg says.

PET scan technology emerged in the mid-1980s and is evolving to become a standard tool for detecting disease and recurring and metastatic disease, breast, lung, colorectal, head and neck cancers, as well as lymphomas. The digital images can be combined with CT scans, MRIs and gallium scans to show a number of different angles of tumors and clearly chart disease progression.

The Medical Center is one of a handful of sites in the nation to have a state-of-the-art computer system to review the layered scans, Chengazi says. The key to maximizing the benefits of this technology is having highly skilled specialists to interpret the images, Friedberg says. Chengazi has more than 15 years experience interpreting scans and earned a doctorate in nuclear medicine from the University of London. He is considered the foremost expert in this field in Western New York.

Friedberg's study is the first in a series of clinical and scientific research initiatives underway by the Wilmot Cancer Center's new lymphoma program. In the past six months, three faculty members have joined the program, providing expertise in lymphoma treatment, research and blood and marrow transplantation. Under the leadership of Richard I. Fisher, M.D., director of the Wilmot Cancer Center, the lymphoma program is expected to gain national prominence and become one of the best in the Northeast. ##

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