Phase I trial of valproic acid and lenalidomide in patients with advanced cancer.

PURPOSE: The objectives of this study were to evaluate the tolerability and efficacy of valproic acid (VPA) and lenalidomide. METHODS: In this 3+3 design study, VPA was administered daily on a 7-day-on, 7-day-off schedule, and lenalidomide was administered daily for 28 days. Because of the response noted during the dose-escalation phase, 12 additional patients with adenoid cystic carcinoma (ACC) received the maximum tolerated dose (MTD) in a dose-expansion phase. RESULTS: Twenty-six patients with advanced cancer (14 men/12 women), median age of 56 years (range 38-70 years), and a median number of two prior therapies (range 0-12) were enrolled. The most common toxicities were fatigue, rash, neutropenia, thrombocytopenia, and change in mental status. Dose-limiting toxic (DLT) effects were grade III confusion (n = 3), somnolence (n = 1), and gait disturbance (n = 1). The MTD was reached at VPA 30 mg/kg and lenalidomide 25 mg. Although only two of the 12 patients from the dose-expansion phase had DLT during the first cycle at the MTD, during subsequent cycles the majority of patients required dose reduction of VPA to 5-20 mg/kg because of fatigue and drowsiness. No significant tumor reductions were noticed in patients with ACC, but seven of these patients had stable disease over four cycles. Of non-ACC patients, one patient with melanoma and one patient with parathyroid carcinoma had stable disease for six cycles and eight cycles, respectively. CONCLUSIONS: Lenalidomide combined with VPA was well tolerated. We recommend starting VPA at 5 mg/kg and titrating upward to 20 mg/kg. No significant tumor reductions were noticed in patients with ACC.

BI-RADS-MRI: a primer.

OBJECTIVE: Variations in breast MRI techniques and descriptions of morphologic findings led to the development of a breast MRI lexicon. This lexicon, the American College of Radiology's BI-RADS-MRI, includes terminology for describing lesion architecture and enhancement characteristics. We show the use of these descriptors on breast MR images obtained at our institution. CONCLUSION: BI-RADS-MRI is a common language with which to report MRI findings of studies from different institutions.

Specimen radiography in confirmation of MRI-guided needle localization and surgical excision of breast lesions.

OBJECTIVE: Confirmation of lesion retrieval after MRI-guided needle localization and surgical excision of breast lesions are difficult because the targeted lesion is not enhanced ex vivo. The aim of this study was to determine the feasibility of using specimen radiography to verify lesion removal after MRI-guided needle localization and surgical excision. CONCLUSION: To our knowledge, our study was the first to examine the use of specimen radiography in the localization and excision of breast lesions. Specimen radiography is a reliable, cost-effective alternative to repeated dynamic contrast-enhanced MRI for confirming lesion removal after surgery. Specimen radiography has the additional advantage of facilitating immediate assessment of surgical margins.

Direct injection of paraffin into the breast: mammographic, sonographic, and MRI features of early complications.

OBJECTIVE: We present the mammographic, sonographic, and MRI features of the early complications of breast augmentation by direct injection of liquid paraffin. We also examined the imaging features in patients with paraffinoma, a later complication of these injections. CONCLUSION: Early complications of breast augmentation by direct injection of liquid paraffin differ in appearance from paraffinoma, which is a late complication of the same procedure. On mammography, early lesions appear as multiple circumscribed, noncalcified masses in the retroglandular and subpectoral regions. Sonography reveals multiple cystic masses within the breast parenchyma, retroglandular region, ipsilateral axilla, and pectoral muscle. MRI shows parenchymal and retroglandular fluid collections, which are hypointense on T1-weighted images and hyperintense on T2-weighted and fat-suppressed T2-weighted images, that do not enhance.