Kanda Tatsuo, Ishikawa Takashi, Ozaki Toshiro, Yajima Kazuhito, Kosugi Shinichi, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata City, Niigata, Japan.
Gan To Kagaku Ryoho. 2011 Aug;38(8):1266-70.
Gastrointestinalstromaltumors (GIST)are occasionally found as large abdominal tumors at presentation. However, the best treatment approach for such large and marginally resectable GISTs remains unclear. The survival of patients with clinically malignant GISTs or GISTs with incomplete resection was as short as 1-2 years. Imatinib, a KIT kinase inhibitor, shows promise as a preoperative treatment for marginally resectable GIST, because it exhibits potent antitumor activity for unresectable and metastatic GISTs. Data obtained from imatinib therapy for advanced GISTs indicate that preoperative treatment with 400 mg of imatinib daily for 6-12 months is recommended, although no standard regimen has been established so far. Positron emission tomography is useful for the early assessment of the efficacy of preoperative imatinib treatment, a critical step for the management of patients with marginally resectable GIST. Two case studies have shown the safety and strong antitumor activity of preoperative imatinib treatment and concluded that treatment contributed to reducing surgical morbidity. However, a multicenter phase II trial conducted in the United States has shown that complete resection was not sufficiently achieved in patients who underwent preoperative imatinib treatment: complete resection rates were 77% for primary cases and 58% for metastatic cases, whereas the treatment was not associated with severe postoperative complications. The clinical guidelines for GIST in Japan regard preoperative imatinib treatment for marginally resectable GIST as an experimental treatment. More clinical evidence is required before making preoperative imatinib treatment the standard treatment for marginally resectable GIST.
胃肠道间质瘤（GIST）在初诊时偶尔会被发现为较大的腹部肿瘤。然而，对于此类较大且勉强可切除的GIST的最佳治疗方法仍不明确。临床恶性GIST或切除不完全的GIST患者的生存期短至1 - 2年。伊马替尼，一种KIT激酶抑制剂，显示出有望作为勉强可切除GIST的术前治疗药物，因为它对不可切除和转移性GIST具有强大的抗肿瘤活性。从伊马替尼治疗晚期GIST获得的数据表明，尽管目前尚未确立标准方案，但推荐每日400 mg伊马替尼进行6 - 12个月的术前治疗。正电子发射断层扫描对于术前伊马替尼治疗疗效的早期评估很有用，这是管理勉强可切除GIST患者的关键步骤。两项病例研究显示了术前伊马替尼治疗的安全性和强大的抗肿瘤活性，并得出结论认为该治疗有助于降低手术并发症发生率。然而，在美国进行的一项多中心II期试验表明，接受术前伊马替尼治疗的患者未能充分实现完全切除：原发性病例的完全切除率为77%，转移性病例为58%，而该治疗与严重术后并发症无关。日本GIST临床指南将勉强可切除GIST的术前伊马替尼治疗视为一种试验性治疗。在将术前伊马替尼治疗作为勉强可切除GIST的标准治疗之前，还需要更多的临床证据。
