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RSNA News - February 2005R&E Foundation Grant Leads to Innovative Treatment for Liver Cancer
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| Jean-François Geschwind, M.D. |
| Johns Hopkins School of Medicine |
Patients with advanced liver cancer have reason for renewed hope thanks to a 2000 RSNA Research & Education Foundation Research Seed Grant and the groundbreaking work of its recipient, Jean-François Geschwind, M.D., an associate professor of radiology, oncology and surgery at the Johns Hopkins School of Medicine and director of Interventional Radiology at Johns Hopkins Hospital.
What began as a burning question about a medical oddity led this interventional radiologist on a path of discovery that is buying precious time for patients waiting for life-saving liver transplants.
Originally from Paris, France, Dr. Geschwind pursued his undergraduate studies at the University of Paris and at the University of Pennsylvania before receiving his medical degree in 1991 from the Boston University School of Medicine. He completed residency training at the University of California in San Francisco (UCSF) and fellowship at Johns Hopkins where he joined the staff in 1998. He was promoted to associate professor in 2002 and named director of cardiovascular and interventional radiology the same year.
During his radiology residency at UCSF, Dr. Geschwind conducted MR imaging research under the mentorship of Charles Higgins, M.D. This research experience gave him the foundation to explore the role of MR imaging in patients with advanced liver cancer. Then, as a fellow in interventional radiology at Johns Hopkins, he discovered something curious in patients with liver cancer receiving loco-regional therapy.
"We found early on that despite the fact that these patients were doing better and surviving, their tumors were not changing in size. If anything they were growing," said Dr. Geschwind. "I thought that a more sophisticated MR imaging technique such as diffusion would allow us to get the answer."
Dr. Geschwind's initial research, which employed animal liver tumor models, won him the Gary J. Becker Young Investigator's Award from the Society of Cardiovascular and Interventional Radiology, now the Society of Interventional Radiology (SIR).
Then in 2001, the RSNA Research Seed Grant allowed him to carry his work into the clinical setting and assess tumor response using diffusion MR imaging on patients who had undergone chemoembolization, a therapy in which chemotherapeutic drugs are injected directly via the artery into tumors. His research was presented at several RSNA annual meetings and was published in the American Journal of Roentgenology in September 2003.
Diffusion MR imaging is the first imaging method available that can adequately determine the extent of necrotic versus viable liver tumor following embolotherapy or chemoembolotherapy, said Dr. Geschwind. It has been extremely valuable in determining prognosis for patients and for influencing decisions regarding their subsequent therapy.
"His research is innovative, clinically important and addresses an area of high priority," said Elias A. Zerhouni, M.D., director of the National Institutes of Health and former chairman of the Radiology Department at Johns Hopkins who recommended Dr. Geschwind for the RSNA grant.
The RSNA Research Seed Grant was a first for Dr. Geschwind, who credits the experience with teaching him the true rigors of research. "It's one thing to write a grant. It's another to make sure the research gets done," said Dr. Geschwind. "It has given me the necessary confidence to pursue this kind of work, which can be overwhelming and somewhat intimidating for a clinician."
"Dr. Geschwind is a remarkable investigator," said Jonathan Lewin, M.D., current chair of the Radiology Department at Johns Hopkins. "He is one of a very few interventional radiologists that is approaching not only the treatment of disease but also looking to understand the biological and pathological underpinnings of disease."
Leadership in Imaging Research
Dr. Geschwind views leadership in research as particularly important as the landscape of radiology continues to expand beyond diagnostics to include image-based treatments.
"It is critically important that those of us in interventional radiology strive to be outstanding clinicians and researchers because it's a way to establish our turf," said Dr. Geschwind. "If we are lagging behind in imaging research, radiologists will not be credible. As a result, patients and physicians will not look at us with the same degree of respect."
There has been explosive growth and interest in minimally invasive image-guided therapeutic techniques, and oncology seems to be emerging as a primary area within interventional radiology, according to Dr. Geschwind, who cites tremendous research potential in three areas: new drugs, new drug delivery systems and imaging technology.
"This is really our expertise. With needles and catheters we can reach virtually any part of the body so we can deliver drugs more effectively and with great accuracy directly to the tumor target," said Dr. Geschwind. "There have been huge recent technological advances in the field of MR imaging with faster systems and even better sequences. With the advent of flat-panel detectors in angiography, new valuable tools are suddenly available allowing us to expand our capabilities in the field."
With a new grant from NIH nearly in hand, Dr. Geschwind is looking forward to devoting more time to research and the mentoring of other physician researchers.
Dr. Geschwind has authored more than 140 published manuscripts and has received numerous national and international awards and grants for his research in the field of cardiac MR imaging and liver cancer. He continues to lecture throughout the world and is active in numerous national organizations including RSNA, SIR, American Roentgen Ray Society, American Association for Cancer Research, and American Society of Clinical Oncology.
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