The Academy: July/August 2007

By Prachi Petal-Predd
Published: Thursday, Jul 08, 2010

    Mayo Clinic, Jacksonville, FL

    MRI Detects What Mammograms Missed

Based on MRI and mammography use at the Mayo Clinic in Jacksonville, FL, oncologists at the clinic have found that MRI can find additional tumors in a breast in which cancer has already been diagnosed using mammography. They have also found that MRI is better than mammography in detecting new tumors in a patient’s healthy breast. The researchers, led by Laura Vallow, MD, a radiation oncologist at the Multidisciplinary Breast Clinic in Jacksonville presented their results at the ASCO annual meeting.

Dr. Vallow and her colleagues compared results from both mammograms and MRI scans of hundreds of women screened at the clinic. In a study comparing the two screening methods for ipsilateral tumors, they found that MRI detected tumors missed by mammograms, ultrasound and physical examinations in 16% of 390 women. Women with MRI-detected ipsilateral tumors tended to be younger, the researchers found, or they had a primary breast tumor that was at least 1 centimeter in size. In addition, the newly diagnosed tumors were different from the primary tumors in 29% of women. “Patients who may benefit from preoperative bilateral breast MRI are younger women with newly diagnosed breast cancer who are considering breast conservation,” Dr. Vallow told Oncology & Biotech News.

In a second study, comparing screening for contralateral breast cancer, the oncologists found that MRI detected tumors missed by mammograms in 3.2% of 401 women. Patients whose contralateral tumors were detected by MRI were typically postmenopausal and had an ER-positive tumor. Detecting contralateral tumors before a newly diagnosed patient is treated is important because the patient could then undergo treatment for both tumors simultaneously rather than going through the trauma of another tumor detection after several years, according to the researchers.

According to Dr. Vallow, many doctors feel that there is a learning curve to breast MRI interpretation and that it is not a standardized evaluation at this time. “We feel our data support our continued routine use of MRI in women with newly diagnosed breast cancer,” she said. “As breast MRI becomes more standardized and more centers obtain the ability of MRI-guided biopsy the use of breast MRI will increase.” She does caution, however, that these results are based entirely on the experience at the Mayo Clinic in Jacksonville. “Other centers will evaluate for themselves whether this data is enough to support the use of MRI in their patient population.”


     Fox Chase Cancer Center, Philadelphia, PA

    Counting Circulating Tumor Cells Could Tell Doctors When or If to Change Colorectal Cancer Treatment

Results of an international study presented at ASCO on June 3 have shown that counting circulating tumor cells before and after the start of metastatic colorectal cancer treatment could help doctors in deciding when or if a patient’s treatment should be changed.

Researchers led by Neal Meropol, MD, director of the gastrointestinal cancer program at Fox Chase Cancer Center in Philadelphia, PA, studied the association between the number of circulating tumor cells (CTC) and progression-free and overall survival in 430 metastatic colorectal cancer patients. They measured CTC count at baseline, one month and at other points after the patients had started treatment. From an initial analysis, the researchers defined 3 or more CTCs per 7.5 milliliters (mL) of blood as unfavorable, and less than 3 CTCs per 7.5 mL as favorable.

At baseline, the researchers found that 53% of patients had no detectable CTC numbers. These patients had much better median survival times compared with those patients who had detectable CTCs.

Further, patients with a favorable CTC count had better progression-free survival and overall survival than those with an unfavorable count. Those with a favorable CTC number had a median overall survival almost double that of those with an unfavorable number. The median progression- free survival was 7.9 months for patients with a favorable CTC number compared to 4.5 months for those who had an unfavorable number.

The predictive value of CTC numbers could become a valuable tool in the clinic, Dr. Meropol said. “If we had a way to know early on that a tumor isn’t responding to a particular drug, we could switch to a different treatment before growth of the cancer if seen on a CAT scan,” he said. “If we could determine that the tumor was destined to grow after a few weeks of treatment, we’d be able to alter course even before the first scan.”


    Barbara Ann Karmanos Cancer Institute, Detroit, MI

    Combining Capecitabine and Docetaxel Improves Prostate Cancer Remission and Survival

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