scholarly journals Virškinimo trakto stromos navikų chirurginio gydymo principai

2006 ◽  
Vol 4 (2) ◽  
pp. 0-0
Author(s):  
Raimundas Lunevičius ◽  
Michitaka Fujiwara ◽  
Juozas Stanaitis
Keyword(s):  
Imatinib Mesylate ◽  
Surgical Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Indications For Surgery ◽  
Stromal Tumors ◽  
Regional Lymphadenectomy ◽  
Active Research ◽  
Vilnius University ◽  
Key Words Gastrointestinal

Raimundas Lunevičius1, Michitaka Fujiwara2, Juozas Stanaitis11 Vilniaus universiteto Bendrosios ir plastinės chirurgijosortopedijos ir traumatologijos klinika,Šiltnamių g. 29, LT-041302 Nagojos universitetas, 2-asis chirurgijos skyrius, Endoskopinės chirurgijos centras,65 Tsurumai-cho, Showa-ku, Nagoya 466, JaponijaEl. paštas: [email protected] Įvadas / tikslas Chirurginis gydymas yra pagrindinis siekiant išgydyti virškinimo trakto stromos navikais sergančius ligonius. Straipsnio tikslas – apibūdinti šios ligos chirurginio gydymo indikacijas, principus ir vėlyvus rezultatus. Apžvalga Kertiniai klausimai, į kuriuos turi atsakyti klinicistas siekdamas nustatyti GIST chirurginio gydymo indikacijas, yra tokie: (i) ar tai pirminis lokalus chirurgiškai radikaliai pašalinamas GIST; jei taip – tai yra indikacija operuoti visais atvejais; (ii) ar tai yra lokaliai ar atokiai išplitęs GIST (kai naviko radikalaus pašalinimo galimybės yra labai ribotos arba jų nėra); jei taip – tai yra indikacija skirti neoadjuvantinę terapiją imatinibo mezilatu. Tokiu atveju chirurginio gydymo galimybės iš naujo vertinamos praėjus 3, 6, 9 mėn. ir daugiau nuo nepertraukiamo gydymo vaistais pradžios. Tai lemia naviko atsakas į gydymą vaistais. Virškinimo trakto stromos naviko operacijos tikslas – visiškas naviko pašalinimas apimant nepažeistus audinius. Atstumas nuo naviko kraštų turi būti ne mažesnis kaip 1–2 cm. Sisteminė sritinė limfadenektomija nedaroma arba daroma labai retai, tai yra tais atvejais, kai yra metastazių sritiniuose limfmazgiuose. Nustačius recidyvinį ar metastazavusį virškinimo trakto stromos naviką, klinicistui keliami tokie uždaviniai: pirma, išsiaiškinti chirurginės rezekcijos galimybes; antra, pagrįsti imatinibo mezilato skyrimo būtinumą. GIST dvinaris skirstymas į mažo piktybiškumo ir didelio piktybiškumo navikus klinicistui yra priimtinas. Išvada Siekiant pagerinti GIST gydymo rezultatus, būtini tolesni aktyvūs GIST diagnostikos ir gydymo tyrimai. Reikšminiai žodžiai: virškinimo trakto stromos navikai (GIST), chirurginis gydymas, imatinibo mezilatas Principles of surgical treatment of gastrointestinal stromal tumors Raimundas Lunevičius1, Michitaka Fujiwara2, Juozas Stanaitis11 Vilnius University, Clinic of General and Plastic Surgery, Orthopedics and Trauma SurgeryŠiltnamių str. 29 LT-04130 Vilnius, Lithuania2 Nagoya University, 2nd Department of Surgery, Section of Endoscopic Surgery,65 Tsurumai-cho, Showa-ku, Nagoya 466, JapanE-mails: [email protected] Background / objective Surgical resection is the main choice of reliable recovery for GIST patients. The purpose of the article is as follows: to define indications for surgery, the principles of operations due to GIST, and late follow-up results. Review Most important points in defining indications for surgery are the following: (i) is it a primary localized resectable GIST? If yes, it is an absolute indication for surgery; (ii) is it a locally or distantly outspread GIST when the possibilities of surgical resection are very restricted or there are no them; if yes, it is an indication for neoadjuvant imatinib mesylate therapy. There is a need for re-consideration of indications for surgery after 3, 6, 9 and more months after permanent neoadjuvant therapy, depending on response of the tumor to medication. An operation should be aimed to performe complete en block removal of the tumor and the surrounding 1–2 cm length of tissue. A systematic regional lymphadenectomy is not recommended routinely. It is warranted only for evident regional nodal involvement. In case of a recurrent or metastatic disease, there is a necessity to determine the following: first, are threre still any possibilities for surgical resection; second, to motivate the necessity for imatinib mesylate therapy. Binary categorization of GIST into low and high malignant potential tumors is acceptable to clinicians. Conclusion To optimize results of GIST management, a further active research and consensus are needed. Key words: gastrointestinal stromal tumors (GIST), surgery, imatinib mesylate

Imatinib mesylate therapy in advanced gastrointestinal stromal tumors—A Regional cancer centre experience

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 19505-19505
Author(s):  
K. M. Patel ◽  
P. M. Shah ◽  
S. N. Shukla ◽  
B. J. Parikh ◽  
A. S. Anand ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Imatinib Mesylate ◽  
Metastatic Disease ◽  
Gastrointestinal Stromal Tumors ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Free Survival ◽  
Stromal Tumors ◽  
Post Surgery

19505 Background: The treatment of gastrointestinal stromal tumors has been revolutionised by the advent of Imatinib, a specific tyrosine kinase inhibitor. Post operative local and metastatic recurrences of this tumor have been effectively managed by Imatinib. Here we present our experience of Imatinib in recurrent locally advanced/metastatic gastrointestinal stromal tumors (GIST). Methods: From Nov 2001 to Sep 2005, 33 patients with metastatic and / or locally advanced inoperable CD-117 positive GIST were offered imatinib mesylate therapy at 400 mg/day p.o. A total of 21 patients were evaluable for tumor response. Follow up period ranged from 4 months to 38 months with median follow up period being 18 months. Median age is 58 yrs, M:F ratio is 6:4. ECOG performance status was 0–1 in 70% (23 patients) and 2 in 30% (10 patients). 70% patients had post surgery recurrence. 2 patients (6%) had received adjuvant chemotherapy prior to recurrence. 30% (10 patients) had local recurrence, 40% (13 patients) had metastatic disease while 30% (10 patients) had local recurrence as well as metastatic disease. Results: Response evaluation was done by RECIST criteria. 15% (5 patient) showed CR while PR rates were 30% (10 patients). The overall major response (CR+PR) was 45%. The overall progression free survival was as high as 80%. All the patients who had a progression free survival also had a significant improvement in quality of life. Conclusions: Imatinib mesylate therapy shows significant survival benefits in locally advanced inoperable/metatstatic gastrointestinal stromal tumors. It will be a very long time before PET scan for evaluation and follow up becomes feasible in developing country setting. No significant financial relationships to disclose.

scholarly journals Recurrent Gastrointestinal Stromal Tumors in the Imatinib Mesylate Era: Treatment Strategies for an Incurable Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Rebecca M. Platoff ◽  
William F. Morano ◽  
Luiz Marconcini ◽  
Nicholas DeLeo ◽  
Beth L. Mapow ◽  
...  
Keyword(s):  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitor ◽  
Imatinib Mesylate ◽  
Surgical Resection ◽  
Dose Escalation ◽  
Gastrointestinal Stromal Tumors ◽  
Kinase Inhibitor ◽  
Inhibitor Therapy ◽  
Stromal Tumors ◽  
Tyrosine Kinase Inhibitor Therapy

Introduction. Recurrence of gastrointestinal stromal tumors (GISTs) after surgical resection and imatinib mesylate (IM) adjuvant therapy poses a significant treatment challenge. We present the case of a patient who underwent surgical resection after recurrence and review the current literature regarding treatment. Case Presentation. A 58-year-old man with a large intra-abdominal jejunal GIST was treated with complete surgical resection followed by IM. The patient experienced disease recurrence 3.5 years later and underwent IM dose escalation and reresection. Conclusion. Current strategies to treat recurrent GIST include dose escalation, modifying adjuvant tyrosine kinase inhibitor therapy, and surgery. High-level evidence will be required to better define the combinatory roles of tyrosine kinase inhibitor therapy, guided by molecular profiling, and surgery in the management of recurrent GIST.

scholarly journals Efficacy of Long-Term Adjuvant Therapy With Imatinib Mesylate After Extensive Surgical Treatment for Ruptured Gastrointestinal Stromal Tumors of the Small Intestine With Peritoneal Metastases: A Case Report

2020 ◽  
Vol 8 ◽  
pp. 232470962097073 ◽  
Author(s):  
Toshihisa Kimura ◽  
Tamotsu Togawa ◽  
Kenji Onishi ◽  
Atsushi Iida ◽  
Yasunori Sato ◽  
...  
Keyword(s):  
Small Intestine ◽  
Adjuvant Therapy ◽  
Imatinib Mesylate ◽  
Surgical Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Peritoneal Metastases ◽  
Metastatic Recurrence ◽  
Stromal Tumors ◽  
Dose Change

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Although most patients with advanced GISTs benefit from imatinib mesylate (IM) as standard targeted therapy, the optimal duration of adjuvant IM for GIST patients with high risk of recurrence who underwent surgical resection remains unknown. In this article, we present a case of a ruptured GIST of the small intestine accompanied by peritoneal metastases, which was effectively treated by surgical procedure followed by long-term adjuvant therapy with IM. Surgical resection was performed for the ruptured small intestinal GIST, and multitude of peritoneal metastases were cauterized. The patient received adjuvant therapy with IM (400 mg/day) for 12 years without an interruption or a dose change. Peritoneal metastatic recurrence was observed by the follow-up computed tomography scan obtained 12 years after surgery, and surgical resection of the recurrent GIST was performed. The molecular examination indicated a KIT exon 11 deletion mutation in both the primary GIST and recurrent GIST. An additional point mutation was observed in the recurrent GIST in exon 17 that caused resistance to IM. The present case might indicate that extensive removal of the tumor cells through surgery and long-term administration of IM without an interruption or a dose change were important for achieving improved recurrence-free survival in patients with ruptured GISTs of the small intestine with peritoneal metastases.

Multivisceral resections of gastrointestinal stromal tumors

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20523-20523
Author(s):  
Y. Zhou ◽  
C. Du ◽  
H. Fu ◽  
G. Zhao ◽  
Y. Shi
Keyword(s):  
Lymph Node ◽  
Imatinib Mesylate ◽  
Gastrointestinal Stromal Tumors ◽  
Abdominal Cavity ◽  
Tumor Diameter ◽  
Gross Margin ◽  
En Bloc ◽  
Primary Tumors ◽  
Stromal Tumors

20523 Background: Gastrointestinal stromal tumors (GISTs) with positive kit staining, although rare, are the most common mesenchymal neoplasms affecting the gastrointestinal tract. We present our experience in the treatment of disease involving adjacent organs with multivisceral resections. Methods: The clinicopathologic records of twenty-two patients with multivisceral resection, among 170 patients suffered from GISTs treated in our hospital from 1994 to 2005, were retrospectively reviewed. Nine primary tumors originated from the stomach, 4 from the small intestine, 6 from the colorectum, 1 from abdominal cavity, and 2 from the retroperitoneal area. Meanwhile complete follow-up records were available in 15 patients with median 5-year follow-up. Results: The patients included 9 men and 13 women, from 36 to 77 year old. The largest tumor diameter ranged from 2 to 20 cm. The types of multivisceral operation comprised splenectomy (n=8), coloectomy (n=6), nephrectomy (n=5), partial hepatectomy (n=1), duodenectomy (n=1), oophorectomy (n=1), pancreatectomy (n=1), and adrenalectomy (n=1). None of lymph node metastatsis was found in 7 patients with lymph node dissection with gastric GISTs (n=5) or small intestinal GISTs (n=2). The involved organs confirmed by the pathologic diagnosis included kidney (n=2), spleen (n=2), pancreas (n=2), mesentery (n=1), and omentum (n=1). There was no perioperative mortality in this series. Among follow up patients, 9 were alive and 5 were died from the tumor recurrence or metastasis. Among them, one person with gastrectomy, pancreatectomy, adrenalectomy is still alive under 2 year follow-up by imatinib mesylate therapy postoperatively. Conclusions: Complete surgical resection with a negative gross margin by en bloc resection of the involved organs remains the standard treatment for non-metastatic GISTs. Imatinib mesylate represents a major breakthrough in the treatment of advanced GISTs and is the first effective systemic therapy for the disease. No significant financial relationships to disclose.

Long-Term Follow-Up Outcome of Imatinib Mesylate Treatment for Recurrent and Unresectable Gastrointestinal Stromal Tumors

Digestion ◽  
2013 ◽  
Vol 87 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Seiko Saito ◽  
Katsunori Nakata ◽  
Shinya Kajiura ◽  
Takamaso Ando ◽  
Ayumu Hosokawa ◽  
...  
Keyword(s):  
Imatinib Mesylate ◽  
Gastrointestinal Stromal Tumors ◽  
Stromal Tumors ◽  
Long Term Follow Up

Multislice imaging of gastrointestinal stromal tumors

2018 ◽  
pp. 3-14
Keyword(s):  
Computed Tomography ◽  
Key Words ◽  
Gold Standard ◽  
Gastrointestinal Stromal Tumors ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Preferential Localization ◽  
Multislice Imaging ◽  
Computed Tomography Diagnosis

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract (1%). These tumors express the CD 117 in 95% of cases. The stomach is the preferential localization (70%). Diagnosis is difficult and sometimes late. Progress of imaging has greatly improved the management and the prognosis. Computed tomography (CT) is the gold standard for diagnosis, staging, and treatment follow-up. The increasing recognition of GIST’s histopathology and the prolonged survival revealed some suggestive imaging aspects. Key words: gastro-intestinal stromal tumors; computed tomography; diagnosis

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