Resection of residual disease in patients with metastatic gastrointestinal stromal tumors responding to treatment with imatinib
Resection of residual disease in patients with metastatic gastrointestinal stromal tumors responding to treatment with imatinib
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DOI：
10.1002/ijc.21164
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发表时间：
2005-11-01
影响因子：
6.4
通讯作者：
Schütte, J
中科院分区：
文献类型：
--
作者：
Bauer, S;Hartmann, JT;Schütte, J
胃肠道间质瘤（GIST）是最常见的胃肠道间质肿瘤。转移性疾病患者的长期生存仅在完全切除疾病的患者中观察到。最近，酪氨酸激酶抑制剂伊马替尼已被发现对大多数转移性GIST患者产生应答，这表明应答患者的可切除性得到改善。晚期转移性疾病患者在伊马替尼治疗后进行包括切除手术在内的联合治疗方法很少被探索。我们报告了一系列90例转移性GIST患者，其中伊马替尼治疗使12例大多数复发和广泛疾病的患者考虑切除残余疾病。其中11例患者可以实现完全切除。除一个切除标本外，在所有切除标本中均发现活的肿瘤细胞，这表明尽管有良好的放射学或临床反应，伊马替尼不太可能诱导病理完全反应。在前瞻性试验获得更成熟的数据之前，这些数据表明，对于所有转移性GIST患者，应考虑早期积极的手术治疗。进一步研究伊马替尼联合手术和术前/术后治疗晚期转移性GIST患者的试验是必要的。(c) 2005 Wiley-Liss, Inc。
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Long-term survival of patients with metastatic disease has only been observed in patients with completely resected disease. Recently, the tyrosine kinase inhibitor imatinib has been found to yield responses in the majority of patients with metastatic GIST suggesting improved resectability in responding patients. Combined treatment approaches including resective surgery after imatinib treatment in patients with advanced metastatic disease have rarely been explored. We report a series of 90 patients with metastatic GIST in whom treatment with imatinib enabled 12 patients with mostly recurrent and extensive disease to be considered for resection of residual disease. In 11 of these patients, complete resection could be achieved. Viable tumor cells were found in all but one resected specimens suggesting that despite favorable radiological or clinical responses, imatinib is unlikely to induce pathological complete responses. Until more mature data from prospective trials are available, these data suggest that an early aggressive surgical approach should be considered for all patients with metastatic GIST. Further trials investigating a combined surgical and pre/ postoperative treatment with imatinib in patients with advanced metastatic GIST are warranted. (c) 2005 Wiley-Liss, Inc.