[Compliance with FOLFOX4 for Stage III colon cancer in the adjuvant setting].

AIMS: The usefulness of oxaliplatin(L-OHP)as adjuvant chemotherapy for Stage III colon cancer has been shown in clinical trials, such as the MOSAIC trial. The Leucovorin, fluorouracil, and oxaliplatin(FOLFOX)regimen has been recommended as adjuvant chemotherapy for colorectal cancer in Japan. In the MOSAIC trial, 74.7% of patients completed all planned treatment cycles. Neurological toxicity caused byL -OHP is one of the factors for discontinuing treatment. Therefore, we planned to administer FOLFOX4 as postoperative adjuvant chemotherapy and evaluated the safety and feasibility of this regimen. METHODS: From November 2009, 13 patients with Stage III colon cancer who had undergone complete resection of a primary tumor were enrolled. Patients received 4 cycles of FOLFOX4, followed by 4 cycles of the simplified fluorouracil and Leucovorin (LV5FU2)regimen and 4 additional cycles of FOLFOX4(12 cycles in total). RESULTS: Thirteen patients were treated with our FOLFOX4 regimen. In total, 11 patients(84.6%)completed all 12 planned treatment cycles. The median L-OHP dose per patient was 560mg/m / 2(compared with the per-protocol 12-cycle dose of 680 mg/m2). Grade 1 neurological toxicity during treatment was reported in 10 patients(76.9%). Neurological toxicity was reduced during the 4 cycles without L-OHP. CONCLUSION: Our FOLFOX4 regimen showed reduced neurological toxicity compared to other trials and can be used safely.

The clinical significance of breast MRI in the management of ductal carcinoma in situ diagnosed on needle biopsy.

OBJECTIVE: To identify the factors associated with invasive disease in ductal carcinoma in situ diagnosed on needle biopsy by analyzing breast magnetic resonance imaging findings with the histopathological factors of biopsy specimens. METHODS: This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. Seventy-five ductal carcinoma in situ patients diagnosed by needle biopsy who underwent preoperative magnetic resonance imaging were retrospectively reviewed. The magnetic resonance imaging and histopathological variables were assessed between pure ductal carcinoma in situ and invasive breast cancer diagnosed on surgical specimens. Multivariable analyses were performed to determine the independent factors for invasion using a logistic-regression model. RESULTS: The median age of patients was 55 (34-76) years. On dynamic magnetic resonance imaging, 60 cases out of 75 (80%) were classified as non-mass-like enhancement type and 15/75 (20%) were Mass type. In non-mass-like enhancement, 11/60 (18%) were ultimately diagnosed as invasive breast cancer. Lesion size (P = 0.027), signal intensity ratios (calculated as the signal intensity of detected lesions divided by the signal intensity of surrounding normal breast tissue; P = 0.032) on magnetic resonance imaging and the number of biopsy-cores containing cancer nests (P = 0.012) were each independently associated with invasion. Furthermore, each signal intensity ratio of invasive and non-invasive components of invasive breast cancer represented a value significantly higher than that of 49 pure ductal carcinoma in situ classified as non-mass-like enhancement (P = 0.001 and P = 0.034, respectively). Conversely, there were no significant magnetic resonance imaging findings to distinguish seven invasive breast cancer from among Mass type. CONCLUSIONS: Needle-biopsy-proven ductal carcinoma in situ cases with non-mass-like enhancement type might be sufficiently managed using breast magnetic resonance imaging features such as enhanced lesion size and signal intensity, incorporating the number of cancer-cores at needle biopsy specimen in the clinical setting.

MRI accurately depicts underlying DCIS in a patient with Paget's disease of the breast without palpable mass and mammography findings.

Breast-conserving therapy must be carefully indicated among patients with Paget's disease of the breast, because the disease is often associated with an underlying in situ or invasive carcinoma, even when there are no palpable mass or mammography findings. We report a 52-year-old woman who complained of skin color change of her right nipple for 11 months. No mass was palpable in her breasts, and mammography did not show any density or calcification. Nipple biopsy revealed Paget's disease of the breast with ductal carcinoma in situ (DCIS) in the breast epithelium just beneath the nipple. Magnetic resonance imaging (MRI) of the breast demonstrated diffuse segmental enhancement in two different quadrants. According to the pattern of enhancement, the lesions depicted by MRI were diagnosed as an extensively spreading type of DCIS. Based on informed consent, the patient received a total mastectomy. The histopathological examination demonstrated non-invasive ductal carcinoma with comedo-necrosis. The histological mapping with subserial sectioning demonstrated an extent of the lesions that corresponded accurately to the lesions defined by MRI. We conclude that MRI may play an important role in selecting candidates for breast-conserving therapy out of those patients with mammary Paget's disease with no clinical evidence of an underlying breast carcinoma.