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Background: It is unclear for whom new anti-human epidermal growth factor receptor 2 (anti-HER2) agents, such as pertuzumab and T-DM1, should be considered. We investigated prognostic factors before neoadjuvant chemotherapy (NAC) among HER2-positive invasive breast cancer patients and those after NAC among patients who did not achieve pathological complete response (pCR) using conventional adjuvant trastuzumab. Methods: HER2-positive primary breast cancer patients treated using NAC containing trastuzumab were enrolled between September 2006 and June 2017 at the Osaka Breast Clinic. Patients with distant metastasis or using NAC containing pertuzumab were excluded. The main outcome was disease-free survival (DFS). We investigated pre- and post-NAC prognostic factors using the log-rank test and Cox proportional hazards model. Results: In total, 157 patients were included. Among the pre-NAC prognostic factors, younger age (under 40 years old) and positive clinical nodal status were significantly poorer prognostic factors (hazard ratio [HR] 3.47, 95% CI 1.06–10.12, p = 0.041 and HR 3.32, 95% CI 1.03–14.78, p = 0.045) by multivariate analysis. Among the post-NAC prognostic factors, patients with non-pCR (3-year DFS; 85 vs. 96%, p = 0.022) had a poorer DFS than patients with pCR. DFS was assessed for non-pCR patients (n = 64). High post-NAC Ki-67 status (≥20%; HR 6.73, 95% CI 1.82–31.93, p = 0.004) was a significant and large post-NAC tumor size (≥2 cm; HR 3.65, 95% CI 0.97–14.71, p = 0.056) was a marginally significant prognostic factor by multivariate analysis. After having combined them, high post-NAC Ki-67 status or large post-NAC tumor size was also a significant prognostic factor (HR 5.75, 95% CI 1.32–16.12, p = 0.017). Conclusions: Positive clinical nodal status and young age were found to be prognostic factors before NAC in HER2-postive invasive breast cancer patients. A high post-NAC Ki-67 status and large post-NAC tumor size were significant and marginally significant prognostic factors, respectively, after NAC in patients who did not achieve pCR. New anti-HER2 agents, such as pertuzumab and T-DM1, should be considered for the patients with those prognostic factors.

Background: De-escalation therapy omitting anthracycline has been generally adopted for patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer in the adjuvant setting, but not in the neoadjuvant chemotherapy (NAC) setting. We investigated whether anthracycline can be omitted in HER2-positive early breast cancer patients receiving neoadjuvant taxane plus trastuzumab with clinical response. Methods: HER2-positive primary breast cancer patients treated using NAC containing trastuzumab were enrolled between September 2006 and July 2018 at Osaka Breast Clinic. The primary outcome was disease-free survival (DFS). The secondary outcome was overall survival (OS). We investigated survival with or without fluorouracil, epirubicin, and cyclophosphamide (FEC) using the log-rank test and propensity score matching (PSM). Results: In total, 142 patients were retrospectively included and median follow-up was 61 months. There was no significant difference in DFS (p = 0.93) and OS (p = 0.46) between the FEC-omitted group and the FEC-added group. The 5-year DFS was 91% and 88% and OS was 100% and 100%, respectively. After PSM, the FEC-omitted group and the FEC-added group had no significant differences in DFS (p = 0.459) and there were no death events in either group. The 5-year DFS was 90% and 88% and OS was 100% and 100%, respectively. Conclusions: Using PSM, the 5-year DFS of HER2-positive early breast cancer was not different with or without anthracycline. Response-guided omission of anthracycline may be an option for HER2-positive early breast cancer patients receiving neoadjuvant taxane and trastuzumab with good response in order to avoid overtreatment.

Treatment for cancer recurrence in elderly people over 90 years old is usually less advantageous in chemotherapy, and surgical resection is considered rather invasive if cure can be expected. We experienced a case of colon cancer in which recurrence of peritoneal dissemination was discovered and resected at the age of 90 years and at 92 years twice. Laparoscopic surgery for colon cancer at the age of 89 years was performed. At 13 months after primary surgery, CT revealed a nodule of 10mm in diameter in the abdominal cavity, and it was also positive in PET-CT. Because there was no other recurrent foci, radical resection was performed. After 14 months(2 years and 4 months after primary surgery), a 17mm large nodule was pointed out and radical resection was done again. Three years later(5 years and 6 months from primary surgery)have passed, she survives without recurrence at 95-years-old and 4 months without any decline in QOL. When recurrence of peritoneal dissemination can obtain radicality in resection, even for elderly persons, surgery should be considered if invasion is minor.

We here report the case of a 56-year-old female patient who underwent curative resection for right ovarian cancer with intraperitoneal dissemination and liver metastases. She received following adjuvant chemotherapy, and had been visited hospital for regular follow-up since then. One and half a year after surgery, blood examination showed increasing value of CA125. Contrast-enhanced CT scan revealed a tumor whose long diameter was 5 cm at front side of lower rectum. Following MRI and PET-CT examinations indicated the pelvic tumor as recurrence of ovarian cancer, so that laparotomy was carried out. As the tumor was palped through Douglas cavum, we performed low-anterior rectal resection for en bloc tumor extirpation. Tumor cells mainly developed at peri-rectal wall and proper muscle by HE staining of pathological findings, and ER(positive), vimentin(positive), CD56(positive), synaptophysin(negative)and chromogranin A(negative)by immunostaining indicated the tumor as metastasis of ovarian cancer. Though rectal metastasis from ovarian cancer is basically rare, it might be necessary to rule out possibility of metastatic colon tumor from ovarian cancer when treating patient with rectal tumor who had underwent surgery for ovarian cancer before.

A 67-year-old man was admitted to our hospital because of anemia and weight loss, and diagnosed with a type 3 tumor in the upper gastric body. Pathological examination suggested moderately differentiated adenocarcinoma with immunohistochemically negative staining for HER2. Abdominal CT revealed thickening of the gastric wall and multiple liver metastases. The clinical findings suggested Stage IV disease(T4aN0M1). Chemotherapy was administered with a combination of S-1 plus CDDP(SP). However, the level of CEA(ng/mL)increased from 49.2 to 634.6, and the treatment schedule was changed to a combination of S-1 plus oxaliplatin(SOX). After 3 courses of the SOX regimen, abdominal CT showed a reduction of liver metastases and the level of CEA decreased to 8.4 ng/mL. We performed total gastrectomy with D1 lymph node dissection in September 2016. Post-operative pathological findings were ypStage IV (T3N0M1)and chemotherapeutic effect was grade 2. CT scan revealed regrowth of the tumor in S2 3 months after the operation. The patient underwent transcatheter arterial chemoembolization(TACE)followed by a regimen of paclitaxel plus ramucirumab(PTX/RAM). At present, he is being treated with the PTX/RAM regimen in the outpatient department with no signs of tumor growth. Although the prognosis of gastric cancer with synchronous liver metastases is very poor, it is possible for survival to be prolonged with multimodality therapy.

A 61-years-old man was admitted to our hospital because of abdominal pain. Colonoscopy revealed a type 2 tumor in the rectum, which was diagnosed as low differentiated adenocarcinoma. At least 8 abdominal lymph adenopathies were enhanced on contrast-enhanced CT. We diagnosed stage cT3N2H0M0P0, cStage III b. Because of the risk of a poor prognosis, we tried neoadjuvant chemotherapy for the purpose of down staging. A CRT was prevented by Clostridium difficile enteritis, but we completed 80% of the regimen. Laparoscopic abdominoperineal resection was performed after 4 months of chemotherapy. The specimen contained no tumor lesion, and the pathology results were no residue of adenocarcinoma, status postchemoradiation therapy, Grade 3.

A 49-year-old woman presented to our hospital complaining of abdominal distension and right thigh edema 6 years and 7 months after undergoing total gastrectomy for early gastric cancer in December 2008. The histopathological type of the tumor was poorly differentiated adenocarcinoma. The pathological findings led to a diagnosis of T1aN2M0, Stage II A disease. In August 2015, abdominal CT and MRI revealed para-aortic lymph node swelling, ascites, and a tumor on the right femoral muscles. We performed a needle biopsy of the femoral muscle, and the final diagnosis was intramuscular metastasis from the primary gastric cancer. We initiated chemotherapy using TS-1 plus docetaxel. TS-1(80mg/m2/day)was orally administered for 2 weeks followed by a 1-week drug-free period, and 1 course of docetaxel(40mg/m2)was administered intravenously on day 1. After 2 courses of this regimen, the tumor on the right femoral muscles was reduced in size. However, diarrhea and leukopenia were observed, and the treatment schedule was changed to several other chemotherapy regimens. The patient died of progressive disease 6 months after the diagnosis of muscle metastasis. We report a rare case of late recurrence after curative resection in a patient treated for T1a early gastric cancer.

We herein report the case of a 75-year-old female patient who underwent 4 surgeries for bilateral breast cancer and its recurrence. When she presented at a clinic with an irritable colon, a fist-sized tumor was palpated in the right upper abdomen at her first medical examination. Abdominal CT scan at the clinic revealed a tumor with a maximum diameter of 10 cm on the right side of the transverse colon and multiple swollen mesenteric lymph nodes. Therefore, the patient was referred to our hospital for surgery. Colonoscopy revealed stenosis of the same lesion with an edematous mucosa and sclerosis. Using immunohistochemistry, a biopsy specimen from the lesion tested positive for CK AE1+AE3, and negative for CD20(-)and CD3 (-). As a result, the tumor was diagnosed as a poorly differentiated adenocarcinoma. We performed right hemicolectomy to avoid her intestinal obstruction. Tumor cells were mainly present at the subserosa, according to HEstaining. Using immunostaining, the cells were tested for the following markers: CDX2(-), GCDFP15(weakly positive), CK7(strongly positive), CD20(partially positive), E R(+), PgR(-), and HER2(1+), characterizing the tumor as metastasis of breast cancer. Although gastro-intestinal metastasis from breast cancer is rare, and colon metastasis is even rarer, it might be necessary to rule out the possibility of a metastatic colon tumor from breast cancer when treating patients with a colon tumor who have undergone surgery for breast cancer.

There are few reports that describe the efficacy of proton beam therapy for lymph node metastasis of recurrent rectal cancer, and carbon ion radiotherapy yields higher local tumor control rates. Proton beam therapy needs a longer treatment period but is less toxic to adjacent healthy organs compared to carbon ion radiotherapy. Here we report an 85-year-old man who underwent curative surgery for rectal and sigmoid cancer at the age of 76 years. After 4 years and 2 months, he had liver metastases at S3 and S8, both of which were resected. Eight years and 6 months after primary resection, CT imaging revealed a solitary lymph node metastasis of 28mm in the minor axis, adjacent to the portal vein and IVC. Because of the location and patient's age, proton beam therapy was selected as the treatment strategy, rather than surgery or chemotherapy. A total of 67.5 GyE/25 fx proton beam therapy was applied. CT imaging 4months after irradiation revealed a partial response(PR)and the tumor had shrunk to 8mm. PR continued for 2 years and 1 month. Although the tumor relapsed after 3 years of irradiation and had grown to 16 mm, the patient had no adverse events or symptoms throughout this period. Proton beam therapy may be one of the options for tumors at difficult locations in fragile patients because of its reduced toxicity.

A 61-year-old man underwent a curative operation for advanced esophageal cancer (CT-pT3N2M0, pStage Ⅲ), which had been downstaged with docetaxel, CDDP, 5-FU (DCF) neoadjuvant chemotherapy. Five months after the operation, we diagnosed the patient with recurrence of esophageal cancer with para-aortic lymph node (PALN) metastasis. Systemic chemotherapy was initiated using a regimen of weekly paclitaxel (PTX) administration. After 2 courses, abdominal computed tomography examination indicated regression of the PALN swelling. Eighteen months have passed since the curative operation, and the patient has been doing well with no signs of recurrence. In summary, we successfully treated a case of lymph node metastases from esophageal cancer with weekly PTX chemotherapy.

Here, we report the case of a 43-year-old man who was diagnosed with sigmoid colon cancer with synchronous multiple liver metastases following resection of a primary lesion. Subsequent mFOLFOX+BV therapy elicited a marked response in the liver metastases, which led to the patient undergoing hepatic (S7) radiofrequency ablation (RFA), hepatic resection (lateral segmentectomy and partial [S5] resection), and cholecystectomy. Six months later, transluminal RFA was repeated because liver (S7) metastasis recurred, and 8 courses of XELOX plus BV therapy were administered. As obstructive jaundice due to recurrence of the liver metastases developed after a 6 months hiatus in chemotherapy, we endoscopically inserted a biliary stent. Despite reducing IRIS plus BV therapy, obstructive jaundice developed again, and 3 intrahepatic biliary stents were inserted with percutaneous transhepatic biliary drainage. To date, the patient has been alive for 4 years since the initial resection of the primary lesion after undergoing consecutive systemic chemotherapy with different regimens. Some studies have shown that in cases of obstructive jaundice caused by advanced gastrointestinal cancer, longer survival could be expected by reducing the severity of jaundice, suggesting that resuming chemotherapy as well as improving the severity of jaundice could contribute to better outcomes. The patient in the present case was successfully treated twice with biliary drainage for occlusive jaundice and chemotherapy, suggesting that a combination of multidisciplinary therapy and adequate local therapy such as biliary drainage could be important for the treatment of metastatic liver cancer.

A 100-year-old man was admitted to our hospital because of bloody stool. Colonoscopy revealed a type-2 tumor in the rectum, which was diagnosed as moderately differentiated adenocarcinoma. There was no distant metastasis on CT. After meticulous preoperative evaluation of surgical risks considering his age, laparoscopic high anterior resection was performed. During surgery, the edge of the descending colon showed ischemia; therefore, we performed conversion to open surgery and transverse colon resection. However, the edge of the transverse colon showed ischemia; therefore, ascending colon resection and ascending colon-rectum anastomosis were performed. On day 5 after surgery, the patient developed aspiration pneumonia, for which respirator management was conducted. As his condition improved, he was discharged on postoperative day 32. The pathology results were tub2, pT3, ly0, v2, PM0, DM0, RM0, pN1, Stage Ⅲa. One year 6 months after the surgery, when the patient was 102 years old, CT revealed liver metastasis. RFA was performed for the liver lesion. In people aged 100 years or older, few reports are available on colectomy, and there is no report of treatment for metastasis.

A 66-year-old woman was admitted to our hospital because of epigastralgia, and she was diagnosed with a type 2 tumor at the antrum of the stomach. Pathological examination suggested a moderately differentiated adenocarcinoma with negative staining for HER2 on immunohistochemistry. Abdominal CT showed gastric wall thickening and enlarged lymph nodes. Although the clinical finding was Stage ⅢB(T4aN2M0), a liver metastasis (S2) was found during the operation. We performed distal gastrectomy with D2 lymph node dissection and partial hepatic resection in December 2010. A post-operative pathological diagnosis of gastric cancer, pT4aN2M1, pStage Ⅳ, was made. Although adjuvant chemotherapy of S-1 was administered, CT revealed a liver metastasis in S3 5 months after the operation, and the patient underwent transcatheter arterial chemoembolization (TACE) followed by a regimen of S-1 plus CPT-11. After 3 courses of this regimen, grade 2 anorexia was observed, and the treatment schedule was changed to a regimen of capecitabine plus cisplatin (XP). After 7 courses of this regimen, CT revealed multiple liver metastases in S2, S3, and S8, and the treatment schedule was changed to several other chemotherapy regimens. However, liver metastases continued to grow, and the patient died 51 months after surgery. Although the prognosis of gastric cancer with synchronous liver metastases is very poor, it is possible to prolong survival with multimodal therapy.

For accurate assessment of the response to primary chemotherapy (PCT) for locally advanced breast cancer, we measured reduction in total tumor volume (TTV) by using three-dimensional magnetic resonance imaging (3D MRI), and examined the relationship between this reduction and patient prognosis. Fifty-one patients with locally advanced breast cancer were treated with four cycles of docetaxel (60 mg/m(2)) before surgery. Tumor size was measured with calipers, ultrasonography (US) and conventional two-dimensional (2D) MRI before and after chemotherapy. TTV was measured with 3D MRI. These and other clinicopathological parameters were statistically analyzed to determine the prognosis for the patients. Median follow-up time was 46 months (1-64 months). Of the 51 patients, 25 developed distant recurrences. Patients whose TTV decreased by 75% or more after PCT showed significantly better prognosis than others, while tumor size measured with calipers, US and 2D MRI showed no significant relationship with patient prognosis. Of the clinicopathological parameters, only reduction in TTV and histological grade showed a significant association with distant recurrence-free survival (p = 0.03 and 0.02, log-rank test), while stepwise multivariate Cox's proportional hazards analysis identified TTV as the strongest independent prognostic factor. Reduction in TTV measured with 3D MRI can be a useful prognostic factor for patients with locally advanced breast cancer treated with PCT.

Epirubicin exerts its anti-tumor effect through binding to topoisomerase IIalpha (TOP2A) and inducing DNA double-strand breaks. BRCA1 is involved in the repair of these breaks. We investigated the relationship between TOP2A or BRCA1 immunohistochemical expression and pathological response in 108 primary breast cancers treated with epirubicin-based regimens. The pCR (pathological complete response) rate for TOP2A-positive (17%) was significantly (P < 0.005) higher than for TOP2A-negative (2%), while the pCR rate for BRCA1-negative (11%) was non-significantly higher than for BRCA1-positive (5%). The pCR rate of TOP2A-positive and BRCA1-negative (30%) was significantly higher than for TOP2A-negative and BRCA1-positive (3%; P < 0.05), or TOP2A-negative and BRCA1-negative (0%; P < 0.005). The TOP2A-positive and BRCA1-negative phenotype associates with a favorable response to epirubicin-based regimens.

Predictive factors for response to docetaxel in human breast cancers have yet to be identified. The aim of the present study was to investigate the relationship of various clinicopathological and biological parameters with pathological response to docetaxel in the neoadjuvant setting. The study population comprised 78 patients with primary breast cancers who were treated with docetaxel [60 mg/m2; four (median) cycles, range 3–6; q3w] as neoadjuvant therapy and subsequently treated with mastectomy or breast conserving surgery. Tumor samples obtained before chemotherapy were subjected to histological examination and immunohistochemistry of HER-2 and Ki-67. The pathological complete response (pCR) rate was significantly (P = 0.04) higher for tumors with low nuclear grade (NG-I or -II) (21%) than for tumors with high NG (NG-III) (5%). The pCR rate (20%) of small (≤5 cm) tumors was marginally significantly (P = 0.05) higher than that of large (>5 cm) tumors (5%). Combined analysis of NG and tumor size showed that low-NG small tumors have a higher response rate (30%) than high-NG small tumors (11%; P = 0.13), low-NG large tumors (11%; P = 0.15), and high-NG large tumors (0%; P = 0.009). No statistically significant association was observed between pCR rate and menopausal status, lymph node status, ER, PR, HER-2, or Ki-67. Low nuclear grade, but not cell proliferation determined by Ki-67, is associated with a good pathological response to docetaxel. Combination of low nuclear grade and small tumor size may be useful for the selection of breast tumors with a high pCR rate (30%).

A 66-year-old man underwent a curative operation for advanced gastric cancer (T4aN0M0, Stage IIB). A gastric cancer recurrence with paraaortic lymph node (PALN) metastasis was diagnosed fifteen months after the operation. Systemic chemotherapy was initiated, using a regimen of S-1/CDDP. After 7 courses, abdominal computed tomography (CT) examination indicated the regression of PALN swelling. However, peritoneal dissemination was detected in the neighborhood of the right kidney. S-1/docetaxel (S-1/DOC) was selected as the second-line chemotherapy. After 3 courses, the peritoneal dissemination could not be detected. Five years since the curative operation, the patient has been doing well, with no signs of recurrence. In summary, we successfully treated a case of peritoneal dissemination from gastric cancer with S-1/DOC chemo- therapy.

A 68-year-old man presenting with anorexia was admitted to our hospital; he was diagnosed with pyloric stenosis arising from a type 3 tumor in the antrum of the stomach. Pathological examination revealed a poorly differentiated adenocarcinoma; immunohistochemical staining tested positive for alpha fetoprotein(AFP), and negative for human epidermal growth factor receptor 2(HER2). Abdominal computed tomography (CT) showed a portal vein thrombus and enlarged lymph nodes. Since the clinical finding was Stage IV(T4aN3M1), curative surgery was ruled out. Following stent placement for food intake, TS-1 plus cisplatin (CDDP) neoadjuvant chemotherapy was initiated. TS-1(80 mg/m² / day) was administered orally for 2 weeks followed by a drug-free 1-week period, and CDDP (60 mg/m²) was administered intravenously on day-1 as 1 course. After 5 courses of this regimen, lymph nodes were reduced in size and the portal vein thrombus disappeared. However, grade 4 thrombocytopenia was observed, and the treatment schedule was modified to include several other chemotherapies. Two years after the initiation of chemotherapy, liver metastasis was detected via elevated AFP. The patient died 27 months after initial treatment. Although the prognosis for gastric cancer with portal vein thrombus is very poor, it is possible to prolong survival with multimodality therapy.

Purpose: The reason why chemotherapy induces resistance to subsequent hormonal therapy remains to be clarified in postmenopausal breast cancers. We hypothesized that chemotherapy might down-regulate the intratumoral biosynthesis of estrogens. Thus, we have studied the influence of chemotherapy (docetaxel) on intratumoral aromatase mRNA expression because aromatase is a key enzyme for intratumoral biosynthesis of estrogens. Experimental Design: The mRNA levels of aromatase and its inducers [tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and cyclooxygenase 2 (COX-2)] were determined by a real-time polymerase chain reaction assay in breast cancer tissues obtained before and after neoadjuvant chemotherapy with docetaxel (four cycles of 60 mg/m2 every 3 weeks) in 16 postmenopausal patients with estrogen receptor (ER)- and/or progesterone receptor (PR)-positive breast cancers. ER and PR levels in tumor tissues were also determined by enzyme immunoassay before and after chemotherapy. Results: The intratumoral aromatase mRNA levels decreased significantly (P < 0.05) after chemotherapy from 0.84 ± 0.28 (mean ± SE) to 0.47 ± 0.28. The intratumoral TNF-α mRNA levels also decreased significantly (P < 0.05) after chemotherapy from 2.40 ± 0.52 to 0.95 ± 0.25. On the contrary, the intratumoral IL-6 and COX-2 mRNA levels showed a marginally significant increase (P = 0.07) and a significant increase (P < 0.05), respectively, after chemotherapy. PR levels showed a marginally significant decrease (P = 0.08) after chemotherapy, whereas ER levels were almost constant before and after chemotherapy. Conclusions: Antitumor activity of docetaxel is mediated, at least in part, through a down-regulation of aromatase expression in tumor tissues, resulting in the suppression of intratumoral estradiol synthesis. Aromatase expression seems to be regulated mostly by TNF-α, but not IL-6 and COX-2.

Although the intra-tumoral estradiol (E2) level is thought to be more closely related to the E2-inducible events such as progesterone receptor (PR) induction and tumor growth than the serum E2 level, prognostic significance of the intra-tumoral E2 level in breast cancer patients has yet to be studied. E2 level in tumor tissues obtained from 90 primary breast cancer patients were measured by the high-pressure liquid chromatography-radioimmunoassay method. Relationship between the intra-tumoral E2 level and the various clinicopathological factors including the prognosis was investigated. E2-high tumors (n=45) were significantly more likely to be estrogen receptor (ER)-positive tumors and PR-positive tumors than E2-low tumors (n=45). A significant correlation was observed between the intra-tumoral E2 level and PR level by a simple curve fit test (r=0.39, P

The patient was an 85-year-old woman who was referred to a nearby clinic complaining of shortness of breath. Blood test showed anemia, and she was referred to our hospital for identification of the source of bleeding. Upper and lower endoscopy were performed and revealed no abnormalities. Computed tomography (CT) was performed and showed a7- cm thickening in the wall of her small intestine. The presence of small bowel cancer was suspected. Oral double-balloon endoscopy was performed and showed a near-circumferential ulcerative lesion in the jejunum that was causing small bowel stenosis. A biopsy yielded a diagnosis of signet-ring cell carcinoma. We performed a partial resection of the patient's jejunum. The histopathological diagnosis of the resected specimen (according to the Union for International Cancer Control [UICC]TNM Classification of Malignant Tumours, seventh edition) was poorly differentiated adenocarcinoma, signet-ring cell carcinoma, mucinous carcinoma, T2 (MP), N0, H0, P0, stage I. 7 months after surgery, the patient is alive without recurrence. The incidence of small intestinal cancer is generally reported to be 1% to 2% of all gastrointestinal malignancies. We report a rare case in which cancer of the small intestine was identified during investigation of anemia.

In November 2010, a 76-year-old man was diagnosed as having advanced gastric cancer with paraaortic lymph node (PALN) metastasis. Systemic chemotherapy was initiated using S-1/docetaxel( DTX) regimen. Regression of the PALN swelling was confirmed after 2 courses. Total gastrectomy with D2 lymph node dissection was performed as a reduction surgery, although intraoperative histopathological examination revealed PALN metastasis. Two months postoperatively, S-1 chemotherapy was initiated for the treatment of residual PALN metastasis. About 8 months postoperatively, abdominal computed tomography( CT) examination indicated complete regression of the PALN enlargement. This patient has been doing well for 30 months since the reduction surgery, with no sign of recurrence. In summary, we successfully treated a case of PALN metastasis with multimodal therapy including systemic chemotherapy and reduction surgery.

Herein, we report the case of 57-year-old woman who visited our hospital for abdominal distention, difficulty in walking, and edema of the legs in January 2012. She underwent gastroendoscopy, resulting in a diagnosis of advanced gastric cancer of the pyloric antrum. A diagnosis of unresectable advanced gastric cancer was made because computed tomography (CT) showed the presence of ascites (suspected to indicate peritoneal dissemination), para-aortic lymph node metastases, and brain metastases. Stenting was performed for pyloric stenosis and cell-free and concentrated ascites reinfusion therapy (CART) was administered to facilitate oral intake. We administered two courses of chemotherapy with weekly paclitaxel. However, CT showed the presence of ascites and growth of the main tumor in the first month after the initiation of chemotherapy. We performed CART, and treatment was changed to S-1/paclitaxe(l 5 courses). Ascites decreased markedly and activities of daily living improved. However, 11 months after the initiation of therapy, the patient died.

A 66-year-old man underwent distal gastrectomy with Roux-en-Y anastomosis and D2 dissection for the treatment of advanced gastric cancer (pT4a, N0, M0, stage IIB) in June 2009. He was treated with adjuvant postoperative chemotherapy consisting of S-1. However, in September 2010, computed tomography (CT) showed #16a2 lymph node recurrence, which was treated with combination chemotherapy of S-1 and cisplatin. After 7 courses of this combination chemotherapy, CT revealed a significant reduction in the size of the metastatic lesion as well as a new peritoneal dissemination recurrence around the right kidney. We therefore changed the regimen to combination chemotherapy of S-1 and docetaxel. After 3 courses of this treatment, the dissemination lesion was no longer evident by CT. After 6 more courses of treatment, the lymph node and peritoneal dissemination recurrence showed no regrowth. In response to the patient's wish, we changed the chemotherapy to S-1 alone beginning in June 2012. He survived without recurrence for approximately 2 years after gastrectomy. We suggest that the taxane drug was effective as second-line chemotherapy for the treatment of patients with peritoneal dissemination recurrence.

The purpose of this study was to examine the safety and validity of reduced-port surgery( RPS) in comparison with conventional laparoscopic surgery for colorectal cancer. We investigated 64 cases of colorectal cancer( CRC) resected by laparoscopic surgery at our hospital in 2012, including 22 cases resected by RPS using 1 or more port-less forceps( Endo Relief, Hope Electronics, Japan). With regard to safety, Endo Relief yielded satisfactory outcomes in terms of the limitations of other needlescopic devices, such as lack of strength and risk of tissue injury, while maintaining countertraction. In addition to the original reasons for introducing RPS, such as lessening wound pain and improving the cosmetic outcome after surgery, the advantages of RPS for CRC are high cost efficiency and the possibility of using additional forceps to maintain triangulation or countertraction during laparoscopic surgery. Because it involves a port-less system, RPS facilitates the frequent reuse of forceps, thereby contributing to its high cost efficiency. In the introduction of RPS for laparoscopic colorectal resection, the use of port-less forceps for countertraction could be safe and effective.

A 64-year-old man with obstructive jaundice underwent percutaneous transhepatic biliary drainage, and bile cytology diagnosed adenocarcinoma. The operation ended with exploratory laparotomy because of severe cirrhosis, and thus, S-1 therapy was started after radiation therapy (50 Gy) with an endoscopic retrograde biliary drainage (ERBD) tube. After 37 months, an abdominal computed tomography(CT) scan detected dilation of the intrahepatic biliary tract without recurrence, and we therefore detained a biliary expandable metallic stent instead of the causal obstruction of the ERBD tube. Subsequent CT scan and upper gastrointestinal endoscopy detected stenosis and a thickened wall of the duodenum because of recurrence, and thus, we detained a duodenal stent and started gemcitabine therapy. The patient is alive 70 months after the initial consultation. We report herein a long-term survival case of biliary tract cancer treated with multimodality therapy.

A female never-smoker in her 60s presented with persistent productive cough. Chest radiography and computed tomography revealed widespread consolidation in the basal area of her left lung lower lobe. She received antibiotics and steroid therapy. Nevertheless, consolidation extended over the left lower lobe, and multiple nodular shadows appeared in both the lungs until a histological diagnosis of adenocarcinoma was obtained with lung wedge resection biopsy. Left lower lobectomy was performed as a tumor reduction surgery to palliate dyspnea due to massive sputum. The duration of decreased sputum production was short, and the lesion spread rapidly over the residual lung, resulting in death due to respiratory failure 8 months after her first visit. The histological diagnosis was diffuse pneumonic type of invasive mucinous adenocarcinoma with lepidic, acinar, and solid growth patterns (formerly mucinous bronchioloalveolar cell carcinoma). Mucous sputum containing tumor cells tends to spread aerogenously to other lobes and both lungs, and thus, disease control is difficult. Although there are some case reports of successful treatment with oral epidermal growth factor receptor tyrosine kinase inhibitors or pemetrexed, an effective therapeutic strategy for this type of lung cancer has not been established.

A 75-year-old man visited our hospital in August 2011 due to general malaise and loss of appetite. Abdominal computed tomography scan showed a retroperitoneal tumor. Therefore, we performed resection of the retroperitoneal tumor, pancreas tail, and spleen. The pathological diagnosis was dedifferentiation-type liposarcoma with invasion of pancreas. Abdominal computed tomography scan 2 months after the operation showed peritoneal dissemination and multiple liver metastasis. The patient selected the best supportive care. An effective cure for dedifferentiation-type liposarcoma, besides surgical resection, is not yet established. Therefore, complete resection is important. Moreover, since the rate of recurrence is high, the development of an effective systemic chemotherapy is desired.

The FOLFOX regimen is approved as an adjuvant therapy for colon cancer in Japan. We report a case of pathological damage in the resected non-cancerous liver after 12 courses of mFOLFOX6 therapy as an adjuvant therapy for stage IIIb colon cancer. A 45-year-old man underwent laparoscopic right hemicolectomy for ascending colon cancer. After completing 12 courses of adjuvant mFOLFOX6 therapy, this patient exhibited liver metastasis. Lateral segment resection was performed, and pathological examination of the resected specimen revealed irregular sinusoidal dilatation and cell apoptosis in the non-tumorous part of the liver. This was probably due to the effects of mFOLFOX6. We stress that when resectable liver metastasis is found after 12 courses of FOLFOX as an adjuvant therapy for colon cancer, careful attention should be paid during surgery and during postsurgical management because there may be damage in the remnant liver.

We report 2 cases of complete response for cStage I(T1bN0M0) esophageal carcinoma treated with chemoradiation therapy. Case 1: A 70-year-old man was diagnosed with cStage I(T1bN0M0) thoracic esophageal carcinoma(Type 0- IIc, squamous cell carcinoma). efinitive chemoradiotherapy (5-FU 250 mg/m2, CDDP 5 mg/m2 days 1-5, 8-12, 15-19, 22-26, 29-33, and 36-40; radiation: 60 Gy/30 Fr) was administrated. After treatment, we confirmed that the esophageal lesion had disappeared by upper endoscopy. Case 2: A 78-year-old man was diagnosed with cStage I(T1bN0M0) thoracic esophageal carcinoma (Type 0-I+IIb, squamous cell carcinoma) and early stage gastric carcinoma. Considering his general condition, radical surgery for esophageal cancer and gastric cancer was difficult; hence, he was treated with definitive chemoradiotherapy. After treatment, the esophageal lesion disappeared and we performed fundusectomy. Chemoradiation therapy appears to be effective for patients with cStage I(T1bN0M0) esophageal carcinoma.

A 63-year-old woman underwent distal gastrectomy for gastric cancer (P+, CY+, Stage IV) in February 2011. About 3 months after surgery, abdominal computed tomography(CT) examination revealed solitary liver metastasis. Systemic chemotherapy was started using a regimen of S-1/cisplatin(CDDP). After 2 courses, an adverse reaction of grade 3 neutropenia occurred, although liver metastasis regression was confirmed. Weekly paclitaxel (PTX)was selected as the second -line chemotherapy. After 3 courses, imaging indicated complete regression of the liver metastasis. No adverse events occurred following 5 courses of weekly PTX. No recurrence was noted at a post-surgical follow-up of 15 months. We experienced a case of liver metastasis that was successfully treated with S-1/CDDP and weekly PTX chemotherapy.

The patient was an 85-year-old woman with a chief complaint of anemia and epigastralgia. She was diagnosed with type 4 gastric cancer(por) located in the upper-third of the stomach by gastrointestinal endoscopy in April 2011. Computed tomography scan revealed no distant metastases, but a tumor measuring about 4 cm in diameter was detected in the spleen. We performed total gastrectomy with D2 lymph node dissection and splenectomy in June 2011. The postoperative pathological finding of the gastric cancer was pT4aN3aM1P0CY1H0, p-Stage IV(Japanese Classification of Gastric Carcinoma, 14th Edition). Histological examination of the splenic tumor revealed a follicular-type malignant lymphoma. At present, our patient is being treated with S-1 monotherapy in the outpatient clinic and shows no signs of recurrence. However, it is important that the patient is followed-up carefully because peritoneal lavage cytology was positive and the relapse rate of follicular lymphoma is comparatively high.

The case was a 60-year-old man. The patient with a main complaint of husky voice was introduced by a nearby doctor to our otolaryngology department at the end of August 2009. Because of the wall thickening image of the upper part (Ut domain) esophagus, left infraclavicular lymph node and mediastium lymphadenopathy syndrome observed by head and neck CT, the patient was transferred to surgery department. Squamous cell carcinoma was diagnosed based on the upper part gastrointestinal tract endoscopy showing a type-3 advanced cancer of the upper thoracic esophagus sized 25-30 cm from nostril. The patient was in PD, fever and coughing, though we performed 2 FAP therapies. A chest CT revealed that there was a passage between the trachea and esophagus. Then, radiation therapy( a total of 60 Gy, 2 Gy at a time) was enforced. After the radio therapy, a covered type Ultraflex esophagus stent was inserted due to a fistula, though the tumor was reduced to 6 mm in size. The patient was passed away five months after the stent custody; a solid food intake was possible until just before he died.

A-62-year-old man with gastric cancer underwent gastrectomy 5 years ago, and an abdominal computed tomography scan detected a 15 mm early enhanced lesion located liver (S8) in 2008. Although primary or metastatic were unclear, we underwent partial hepatectomy( S8) as it was an isolated liver tumor. Pathological finding showed adenocarcinoma, and immunostaining was negative for cytokeratin (CK) 7 and positive for CK20 which was the same in primary gastric cancer, so it was diagnosed liver metastasis of gastric cancer. The patient was living at the time, but he passed away 24 months after hepatectomy. We report herein the case of resectable case of liver tumor 5 years after gastrectomy against gastric cancer.

A 75-year-old man underwent distal gastrectomy for gastric cancer (CY+, Stage IV) in June 2009. About 4 months after surgery, he had a strong pain in a right shoulder, and became writing difficulty. Some imaging examinations revealed multiple bone metastases, and it was diagnosed that the pain was caused by the tumor of cervical spine. Systemic chemotherapy was started using a regimen of S-1/CDDP, and radiotherapy (30 Gy) was performed for the cervical tumor at the same time. After two-course of the chemotherapy, the shoulder pain disappeared. About 12 months after surgery, he had a strong pain in a left leg, and became walking difficulty. Some imaging examinations revealed a progression of the tumor of lumbar spine. Radiotherapy (30 Gy) was demonstrated for the tumor. After the treatment, the leg pain disappeared. We experienced a case of multiple bone metastases successfully treated with chemo-radiotherapy.

A man in his sixties was pointed out a solitary anterior mediastinal tumor 3 cm in diameter by CT scan with a complaint of chest compression, which grew 7 cm in diameter involving right subclavian and common carotic arteries and left innominate vein and superior vena cava 2 months later. FDG-PET/CT showed a high abnormal uptake only in the mediastinal tumor. A histological diagnosis of mediastinal poorly differentiated carcinoma or mediastinal lymph node metastasis of unknown origin was made by medistinoscopic biopsy. After 4 courses of chemotherapy with carboplatin and paclitaxel, the tumor was markedly decreased but was judged as unresectable because of residual involvement of great vessels. Addition of 60 Gy of radiotherapy targeted for the tumor resulted in further decrease in diameter of the tumor in CT scan and disappearance of abnormal uptake of the tumor in FDG-PET/CT thus regarded as clinical complete response. Since then, a disease free status has been maintained for 16 months.

We report a case of Stage IV inoperable gastric cancer demonstrating a cCR treated with S-1/PTX. The patient was a 65-year-old female with advanced gastric cancer. CT scan suggested an invasion of tumor into a pancreatic body, jejunum and transverse colon. Staging laparoscopy showed it to be positive with peritoneal washing cytology and peritoneal dissemination. The surgical findings were T4a (SE) N2M1H0P1CY1, Stage IV. Chemotherapy was conducted with a combination of S-1/CDDP. After 2 courses of this regimen, the endoscopy findings did not show an improvement, so we decided to change the chemotherapy to S-1/PTX as second-line treatment. After 2 courses of this regimen, the endoscopy findings revealed a reduction of the primary tumor. After 19 courses, histopathological examination of biopsy specimen showed Group 1. Second-line chemotherapy was continued for 28 courses. The patient has had no recurrence without chemotherapy and been alive for 91 months after diagnosis.

The patient was an 80-year-old female with chief complaint of anemia. She was diagnosed as a type 3 gastric cancer (por/tub2) of the esophagogastric junction by gastrointestinal endoscopy in November 2010. CT scan revealed no distant metastasis and we diagnosed as c-stage II B (T4aN0M0). However, severe COPD was detected by the respiratory function test. Considering her age and respiratory function, we decided that total gastrectomy under general anesthesia was difficult. She was treated with radiation( 50.4 Gy/28 Fr) and the combination chemotherapy of S-1( 80 mg/m², day 1-21) plus low-dose CDDP (6 mg/m², day 1-5, 8-12, 15-19) during her hospitalization, and treated with S-1 mono-therapy as an outpatient. The tumor was reduced and the hemorrhage was not seen though the response was SD. Moreover, she did not experience any adverse event of grade 3 or more. The chemoradiation therapy appears to be effective for patients of adenocarcinoma of the esophagogastric junction.

We report a case of fifties man. He admitted to our hospital due to a hypochondralgia. Computed tomography revealed a tumor of right adrenal gland and a tumor of upper lobe of the right lung. Adrenal tumor had rapidly increased, so we performed adrenectomy. At first adrenal tumor was diagnosed as primary adrenal cancer because its histological findings did not coincide with those of common histologic types of lung cancer. As there were possibilities that one of adrenal or lung tumor was primary and the other was metastatic or both of the two were double primary, we performed right upper lobectomy. Lung tumor was diagnosed as primary pleomorphic carcinoma containing spindle-shaped tumor cells and adenocarcinoma, and then the diagnosis of adrenal tumor was corrected as metastasis of lung cancer. Two months after the lung operation, cervical lymph node swelling, metastasis of stomach and local recurrence of adrenal tumor appeared. After he underwent six courses of systemic chemotherapy of carboplatin and paclitaxel, a clinical complete response was obtained and no recurrence is observed for 4 years.

Neoadjuavnt chemotherapy for liver metastasis of colorectal cancer implies issues about timing for resection and management for adverse events due to chemotherapy.A 50-year-old male patient with synchronous liver metastasis from rectal cancer had a surgery for primary lesion followed by neo-adjuvant chemotherapy for liver resection. Chemotherapy of bevacizumab + mFOLFOX6 achieved a partial response for liver metastasis. When we planned a liver resection, platelet count decreased to 1.4 × 10(4)/µL. The patient was diagnosed as idiopathic thrombocytopenic purpura (ITP) by several examinations but medical control including steroids failed. Partial splenic artery embolization could recover platelet count successfully. However, during the period of therapy for ITP, liver metastasis became unresectable. The patient is currently treated by FOLFIRI and with stable disease for three months.NeoPyloriadjuvant chemotherapy for respectable liver metastasis should be considered carefully in terms of timing for resection and prompt management for adverse events.

We report two cases of lung cancer patients with postoperative solitary brain metastases obtaining long-term survival after gamma knife stereotactic radiosurgery. Both were seventies men and had good performance status without active extracranial disease. In one case, an asymptomatic metastatic brain tumor 1.8 cm in maximum diameter appeared one year and two months after the operation and was irradiated with gamma knife resulting in complete local control for seven years. He is alive with solitary lung metastasis in good performance status. In the other case, gamma knife was employed for a metastatic brain tumor 2.7 cm in maximum diameter that appeared nine months after the operation accompanying incomplete left hemiplegia. Six months later, the tumor was enlarged and gamma knife was repeated, but the tumor growth could not be suppressed. Following deterioration of hemiplegia and appearance of convulsion, he died of neurological disorder three years and two months after the onset of brain metastasis. Gamma knife stereotactic radiosurgery for metastatic brain tumors is less invasive and a repeatable technique, and is expected to provide a good local control and a survival benefit for appropriately selected patients.

The patient was a 55-year-old female. In 1997, she was diagnosed as type-I glycogen storage disease (von Gierke disease). In March 2002, abdominal ultrasound tomography revealed an early enhanced lesion at liver S2, which suspected to a well differentiated hepatocellular carcinoma (HCC) with super-paramagnetic iron oxide (SPIO) enhanced magnetic resonance imaging (MRI). From 2002 to 2006, she received three times trans-arterial chemo-embolization (TACE) at enhanced lesions. But abdominal computer tomography (CT) revealed a 3.6 cm-in diameter early enhanced lesion near this tumor at S2, which was suspected to a diagnosis of recurrent HCC in December 2008. Therefore, she received a partial hepatectomy at S2. This resected specimen was diagnosed as poorly differentiated HCC. This patient is still alive with no recurrence after 6 months from operation. In conclusion, it might be effective for an early detection of recurrent HCC to see the doctor for a long regular checkup, because the growth of HCC with glycogen storage disease would be very slow.

Intrapleural hypotonic cisplatin treatment, which was introduced by Ichinose and colleagues, was performed for 5 cases of primary lung cancer with carcinomatous pleuritis: one case intraoperatively, one case postoperatively and 3 unresected cases. Fifty microg/mL of cisplatin distilled water solution was administered into pleural cavity and drained 10 minutes later in the intraoperative case or 30 minutes later in the bedside cases. No adverse effect was observed. For 2 dissemination- dominant cases, 2 regimens of single cytotoxic agent followed by gefitinib were administered, and the two patients died in 26 and 69 months, respectively. For one case with dissemination and effusion, 5 regimens including combination chemotherapy were administered, and the patient died in 41 months. For 2 effusion-dominant cases, gefitinib was administered and one case is still in PR status for 21 months, and the other was alive for 19 months. Ipsilateral pleural effusion was controlled in all 5 cases. This therapy is helpful for systemic chemotherapy as a main therapeutic means in cases of lung cancer with carcinomatous pleuritis by controlling malignant pleural effusion and relieving dyspnea.

We report a case of superior sulcus tumor performed chemoradiation followed by operation obtaining a long-term survival without relapse. A case is a male of fifties, who visited our hospital with the complaint of numbness in the ulnar side of the left arm and scapular pain. Computed tomography revealed a mass, 4 cm in diameter in the apical portion of the left lung extending to superior sulcus and supraclavicular region. The tumor decreased in size by 2 cm after induction chemoradiotherapy under clinical diagnosis of T3N0M0 superior sulcus tumor and then the apex of the lung and the chest wall was resected with some superior mediastinal lymph nodes. No residual viable tumor cells were seen in the resected tissues. He was followed-up by CT without adjuvant therapy and is alive with no sign of relapse 6 years after the operation, so the effect of induction chemoradiotherapy is evaluated to be complete response. Multimodality therapy with induction chemoradiation and surgery for superior sulcus tumor without lymph node metastasis appears promising.

Predictive factors for anthracycline-based chemotherapy have yet to be incorporated into daily practice. Meta-analyses of studies using anthracycline-based treatment regimens have shown an improved prognosis for human epidermal growth factor receptor type 2 (HER2)-positive tumors, but not for HER2-negative tumors compared with results of non-anthracycline regimens. Currently it is believed that the positive association between HER2 status and anthracycline sensitivity is indirect, that is, their association may be mediated through topoisomerase II alpha (TOP2A), a target molecule of anthracyclines, since TOP2A is near HER-2 and co-amplification of the TOP2A gene frequently occurs in HER2-amplified tumors. This strongly suggests that TOP2A gene amplification is a predictive factor for anthracyline-based regimens. The Collaborative Study Group of Scientific Research of the Japanese Breast Cancer Society has demonstrated that TOP2A-positive and BRCA1-negative subsets evaluated by immunohistochemical staining show a significantly higher pathological complete response when treated with preoperative epirubicin-containing regimens. Combining these findings with the observation that triple-negative tumors and basal-like tumors respond to anthracycline treatment suggests that not only HER2-positive tumors but also a distinct subset of HER2-negative tumors may be sensitive to anthracycline-based regimens.

We conducted a retrospective study to assess the safety, cosmetic outcome, and patients' satisfaction after skin-sparing (SSM) and nipple-sparing mastectomy (NSM) for breast cancer with immediate reconstruction of the breast (SMIBR).The subjects were patients, who underwent SMIBR, breast-conserving surgery (BCS), and total mastectomy (MST) between 2000 and 2004 at Osaka University Hospital. Cosmetic outcome was estimated by 4 reviewers by scoring postoperative photographs of the patients. Patient satisfaction was evaluated with a questionnaire for assessment of quality of life for Japanese breast cancer patients.Of the 74 patients who had undergone SMIBR, 4 developed local recurrences (5%). The local recurrence rate for SMIBR patients was greater than that for BCS (4/178) and MST (3/178, P = .10). The distant recurrence rate was similar for all three types of patients (5% for SMIBR, 5% for BCS, and 9% for MST). The median averaged score by 4 reviewers for the estimated cosmetic outcomes was 7.8 for the SMIBR and 7.5 for the BCS group (P = .20), and for age-adjusted patients, the corresponding scores were 8.2 and 8.0 (P = .70). There was no difference in cosmetic outcome between the SSM and NSM subgroups (P = .09). Average scores for patient satisfaction (social activity, physical aspects, and general condition) were the same for the 3 groups. For body image, the BCS and SMIBR groups had higher scores than the MST group (p0.05). Average scores for questions relating to bodily pain and sexual aspects were higher for the BCS than the MST group, but were not different between SMIBR and BCS groups. Similar trends for the 3 groups were observed when patients were divided into subgroups by tumor size or axillary dissection.SMIBR is safe with a comparatively low local recurrence rate and the same distant recurrence rate as for BCS and MST. Moreover, it results in objective cosmetic outcome and patient satisfaction as good as those for BCS, and greater patient satisfaction with body image than that for MST.

Breast-conserving treatment has become the standard treatment for early breast cancer, not only in Western countries but also in Japan. Wide excision is perferred to quadrantectomy because the former results in better cosmesis than the latter. However, the margin status may be positive more frequently in the former than in the latter. The results of our study indicated that positive margins and the absence of radiotherapy or endocrine therapy proved to be independent risk factors for local recurrence. Because margin status influences local control, tumor margins after wide excision should be accurately determined, and higher doses of radiotherapy and adjuvant therapy are indicated for patients with positive margins.

The purpose of this study was to evaluate the usefulness of three-dimensional magnetic resonance imaging (3D MRI) for the preoperative assessment of residual tumor extent in breast cancer patients treated with neoadjuvant chemotherapy (NAC). Thirty-eight breast cancer patients treated with NAC containing taxane and/or anthracycline for 3-6 months were enrolled in this study. Tumor size was measured by means of calipers, ultrasonography, and dynamic MRI before and after NAC. Three-dimensional maximum intensity projection MRIs to measure the tumor size were created for every case. The tumor size determined by calipers, ultrasonography, and 3D MRI after NAC was compared with that determined by pathologic examination. The tumor size determined by 3D MRI showed a strong correlation with that determined by pathologic examination (r = 0.896). Moderate, but significant correlations were found between measurements obtained with calipers and pathology (r = 0.554), and between ultrasonography and pathology (r = 0.484). The response rates to NAC were estimated at 84.2% with calipers, 58.0% with ultrasonography, and 44.7% with 3D MRI. Calipers and ultrasonography thus tended to overestimate the response to NAC compared to 3D MRI (p < 0.001 and 0.240, respectively). Three-dimensional MRI can visualize residual tumor extent after NAC more accurately than calipers and ultrasonography, and seems to be more reliable than other modalities for estimating response to NAC. It should also help surgeons with decision making for breast-conserving surgery after NAC.