Jamali Faek R, Darwiche Sophie S, El-Kinge Nizar, Tawil Ayman, Soweid Assaad M
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Oncologist. 2007 Apr;12(4):438-42. doi: 10.1634/theoncologist.12-4-438.
Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal neoplasms of the GI tract. The optimal management of GISTs has been evolving rapidly over the past 5 years and depends on proper histopathologic and radiologic diagnosis as well as appropriate multidisciplinary medical and surgical treatments. Complete surgical resection of primary localized GIST with negative margins remains the best therapeutic option today. In the setting of locally advanced or metastatic disease, imatinib mesylate has emerged as the initial treatment of choice, administered either as cytoreductive or as definitive treatment. Surgery or ablative modalities in this setting are becoming increasingly employed, particularly when all disease becomes amenable to gross resection or destruction, or to manage complications arising from the disease following imatinib failure. We report on the surgical management of an unusual and clinically significant complication following progression of disease secondary to imatinib resistance. The role of surgical therapy in the management of GIST complications following resistance to imatinib and the integration of surgical and molecular therapy of locally advanced or metastatic GISTs are discussed.
胃肠道间质瘤（GISTs）是胃肠道最常见的间叶性肿瘤。在过去5年中，GISTs的最佳治疗方案一直在迅速发展，这取决于正确的组织病理学和放射学诊断以及适当的多学科药物和手术治疗。对原发性局限性GIST进行切缘阴性的完整手术切除仍是目前最佳的治疗选择。在局部晚期或转移性疾病的情况下，甲磺酸伊马替尼已成为首选的初始治疗药物，可作为减瘤治疗或确定性治疗。在这种情况下，手术或消融方式的应用越来越多，特别是当所有病灶都适合进行大体切除或破坏，或用于处理伊马替尼治疗失败后疾病引发的并发症时。我们报告了一例因伊马替尼耐药导致疾病进展后出现的罕见且具有临床意义的并发症的手术治疗情况。本文还讨论了手术治疗在伊马替尼耐药后GIST并发症管理中的作用，以及局部晚期或转移性GIST手术与分子治疗的整合。
