Clinical Applications of P.E.T. in Oncology

Dr Simon Sutcliffe, CEO and President of BC Cancer Agency:

Good morning. On behalf of the BCCA, a co-sponsor of the meeting, I would like to offer my thanks to all of you as participants, to the local faculty, and to the invited faculty for joining us today for what will be a very important part of the step towards PET becoming an available modality in BC. I would like just to give you a few comments about PET, more specifically so for our BC audience, to tell you where we are and where we need to get to. You probably will understand that PET has become an established technology for the diagnosis, staging, and restaging of a number of different cancer sites in the US, Europe and in Asia. There are of course other indications than cancer, including neurological sciences and cardiovascular, but today we are focusing on clinical oncology.

In the US, there has recently been an expansion of coverage for funding for PET studies, such that there are now six cancer sites that have well-covered indications. Those include lung, oesophagus, colorectal, lymphoma, melanoma, and head and neck cancer excluding brain and thyroid. This expansion of funding recognises the acceptance by the funding bodies that PET is a unique modality of imaging, and acts in a manner that characterizes the biology of the disease, rather than purely the spatial aspects of the disease characterized by other types of imaging modalities. In Canada, health system funded PET is only available in Quebec, to a very limited extent in Ontario, and possibly very recently also in Alberta. Health system funded PET to date has not been available in the Province of BC.

Our attention here in BC on PET, was focused in the early part of 1998 with an educational symposium. We were very fortunate in early ’99 to have the Institute of Clinical PET and the Society of Nuclear Medicine hold their annual meeting here in Vancouver, and offer us the opportunity to have an educational symposium. Later that year, we were given money through a philanthropic donation for the specific purpose of gaining some experience with PET. That initial experience was done through referral of patients to the University of Washington in Seattle. In February 2000, we submitted a business case statement to Government for the implementation of clinical PET capability in BC.

In October of 2000, the IPET Centre was opened, and we diverted our PET cases still using the philanthropic funding to the IPET Centre. We now have 8 months of experience, and at the rate of referral now, we would probably be annualizing at about 600 cases per year. Based upon our business case assessment of 17,000 new cases per year plus the prevalence factor that we would rise from that, we would estimate that we should be probably at least 10 times that figure—in a fully developed and mature and unrestrained system that could offer PET capability.

So our major task today is really two fold:

1. Number one is to raise awareness and become knowledgeable about the appropriate usage of PET in clinical oncology, and to do that using our own local in-house experience over the past 8 months, but placed into the context of international experience, as reflected by our invited international faculty.
2. Our second task, and we must all be held to this, is we need to derive those practice derived indications, with the evidence where possible, such that we can put a submission before government that identifies the indications with PET that we believe should be funded through the publicly funded health care system. To the degree possible, we will need to explore the evidence in this meeting for those indications. We need after this meeting to prepare that submission and put it responsibly before government and give them a mechanism for an accountable introduction of PET, with funding, that is appropriate for the introduction of a new modality—relative to existing technologies.

Today, we have a very full agenda, as you will see. It is essential that we deliver on this goal of getting the evidence of the indications out by the end of today, and to that extent you will find me somewhat a rigorous adjudicator of the time, and I would ask all speakers to observe that because we have a lot of content and I don’t want to keep you here any longer than the agenda has outlined. There are two minor additions to the schedule: Dr Nick Voss will be joining Joe Connors on the presentation with regard to lymphoma and PET, and secondly, Dr Dianne Miller will be presenting some experience on clinical PET in Gynaecological malignancies during the period of the session 11:25 to 12:00 noon.

So with those introductory comments, I’d now like to call upon Dr Edward Coleman. Dr Coleman is going to give a presentation entitled “Clinical PET: Current Practice, Future Potential.” Dr Coleman is Professor of Radiology and Clinical Pharmacy at Duke University Medical Centre in Durham, North Carolina.