Scientists at the University of Manchester have discovered a potential new method for predicting if patients with head or neck cancer will benefit from chemotherapy.
By assessing tumour blood flow with an MRI scan, it is possible to determine if induction chemotherapy will be helpful on a patient-by-patient basis.
The technique itself is nothing new to the world of medicine; MRI is frequently used to investigate the anatomy and physiology of the human body. However, its use in this area of cancer research has only just come to light.
Patients suffering from head and neck cancer commonly undergo pre-treatment induction chemotherapy before starting surgery or radiotherapy, to try and ensure that the disease doesn’t spread. If the blood flow in the tumour is poor, however, the effectiveness of this treatment is reduced significantly.
Professor Catharine West, who led the study, said: “It’s also important to identify those patients who are unlikely to respond to induction therapy so that we can skip ahead in the treatment pathway and offer them potentially more effective treatments and hopefully improve their outcome.”
CT scans are currently used to investigate tumour blood flow, although there is concern that this technique has the potential to contribute to radiation-induced cancer. This problem doesn’t exist for MRI, since no ionising radiation is used. Even though the cost of MRI has fallen, at present there are not many scenarios in the world of medical imaging in which it can readily replace CT scanning.
However, researchers at the Manchester Cancer Research Centre have shown that a scenario in which MRI can replace CT is in the study of tumour blood flow.
A variant of traditional MRI called dynamic contrast-enhanced MRI (DCE-MRI) was used. In this technique, a contrast agent tracer is injected into a vein of a patient whilst they are undergoing MRI scanning. Contrast agents are used to improve the visibility of internal body structures; in this case, tumours.
The MRI scans are therefore acquired dynamically, enabling scientists and doctors to investigate both the vessel structure and blood flow of the tumour in more precise detail.
The team found that the blood flow of the tumour prior to induction chemotherapy could be used to predict how successful the therapy would actually be. Their findings were published in the journal Oral Oncology, where they stated that patients with high tumour blood flow were more likely to respond to the treatment.
Jonathan Bernstein, a co-author on the paper, said: “Delivery and effectiveness of chemotherapy appears to be better in tumours with higher blood flow.
“However, amongst those patients with lower measured tumour blood flow, more work is needed to determine those who will and won’t respond.”
