GIST肝転移のイマチニブ2次耐性例に術中RFAおよび肝切除術を施行した1例
症例は80歳，女性．残胃のgastrointestinal stromal tumor（以下，GIST）にて手術後，外来にて施行したCTにて多発性肝転移を認めたためイマチニブ投与を開始．奏効しPRが持続していたが，4カ所で肝転移の再燃を認めるようになったため肝部分切除および術中radiofrequency ablationを行い良好な結果を得た．再発GISTに対する治療はイマチニブが第1選択だが，2次耐性例に対しては治療法の選択に苦慮することが多いが，積極的な外科的介入の有用性が示唆された．...
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| Published in | 日本臨床外科学会雑誌 Vol. 69; no. 11; pp. 2952 - 2955 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2008
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.69.2952 |
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| Abstract | 症例は80歳，女性．残胃のgastrointestinal stromal tumor（以下，GIST）にて手術後，外来にて施行したCTにて多発性肝転移を認めたためイマチニブ投与を開始．奏効しPRが持続していたが，4カ所で肝転移の再燃を認めるようになったため肝部分切除および術中radiofrequency ablationを行い良好な結果を得た．再発GISTに対する治療はイマチニブが第1選択だが，2次耐性例に対しては治療法の選択に苦慮することが多いが，積極的な外科的介入の有用性が示唆された． |
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| AbstractList | 症例は80歳，女性．残胃のgastrointestinal stromal tumor（以下，GIST）にて手術後，外来にて施行したCTにて多発性肝転移を認めたためイマチニブ投与を開始．奏効しPRが持続していたが，4カ所で肝転移の再燃を認めるようになったため肝部分切除および術中radiofrequency ablationを行い良好な結果を得た．再発GISTに対する治療はイマチニブが第1選択だが，2次耐性例に対しては治療法の選択に苦慮することが多いが，積極的な外科的介入の有用性が示唆された． |
| Author | 坂元, 克考 馬場, 慎司 玉木, 一路 上原, 正弘 王子, 裕東 間中, 大 |
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| References | 8) Demetri GD, Benjamin RS, Blanke CD, et al : NCCN Task Force report : management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw (Suppl 2) : S1-29 ; quiz S30, 2007 3) 西田俊朗:【新しい癌の標的療法】GISTに対する分子標的治療法．Biother 18:519-526，2004 6) 神田達夫，大橋 学，松本 淳他:【GIST(gastrointestinal stromal tumor)】GISTに対するイマチニブ治療．臨消内科 20:1301-1308，2005 5) Verweij J, Casali P, Zalcberg J, et al : Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib : randomised trial. Lancet 364 : 1127-1134, 2004 7) Heinrich MC, Corless CL, Demetri GD, et al : Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol 21 : 4342-4349, 2003 2) Demetri G, von Mehren M, Blanke C, et al : Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347 : 472-480, 2002 12) Rutkowski P, Nowecki Z, Nyckowski P, et al : Surgical treatment of patients with initially inoperable and/or metastatic gastrointestinal stromal tumors (GIST) during therapy with imatinib mesylate. J Surg Oncol 93 : 304-311, 2006 11) Raut C, Posner M, Desai J, et al : Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors. J Clin Oncol 24 : 2325-2331, 2006 14) Hasegawa J, Kanda T, Hirota S, et al : Surgical interventions for focal progression of advanced gastrointestinal stromal tumors during imatinib therapy. Int J Clin Oncol 12 : 212-217, 2007 13) 佐藤龍一郎，及川昌也，片寄 友他:イマチニブ投与後に切除しえた胃原発gastrointestinal stromal tumor多発肝転移の1例．日消外会誌 40:427-432，2007 10) 神田達夫，廣田誠一，神谷欣志他:GIST診断と治療の問題点 転移・再発性GISTに対するイマチニブ治療―耐性発現とその対策．日消外会誌 38:986，2005 4) Heinrich M, Corless C, Blanke C, et al : Molecular correlates of imatinib resistance in gastrointestinal stromal tumors. J Clin Oncol 24 : 4764-4774, 2006 9) Gronchi A, Fiore M, Miselli F, et al : Surgery of residual disease following molecular-targeted therapy with imatinib mesylate in advanced/metastatic GIST. Ann Surg 245 : 341-346, 2007 1) DeMatteo R, Lewis JJ, Leung D, et al : Two hundred gastrointestinal stromal tumors : recurrence patterns and prognostic factors for survival. Ann Surg 231 : 51-58, 2000 |
| References_xml | – reference: 10) 神田達夫，廣田誠一，神谷欣志他:GIST診断と治療の問題点 転移・再発性GISTに対するイマチニブ治療―耐性発現とその対策．日消外会誌 38:986，2005 – reference: 14) Hasegawa J, Kanda T, Hirota S, et al : Surgical interventions for focal progression of advanced gastrointestinal stromal tumors during imatinib therapy. Int J Clin Oncol 12 : 212-217, 2007 – reference: 11) Raut C, Posner M, Desai J, et al : Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors. J Clin Oncol 24 : 2325-2331, 2006 – reference: 6) 神田達夫，大橋 学，松本 淳他:【GIST(gastrointestinal stromal tumor)】GISTに対するイマチニブ治療．臨消内科 20:1301-1308，2005 – reference: 9) Gronchi A, Fiore M, Miselli F, et al : Surgery of residual disease following molecular-targeted therapy with imatinib mesylate in advanced/metastatic GIST. Ann Surg 245 : 341-346, 2007 – reference: 3) 西田俊朗:【新しい癌の標的療法】GISTに対する分子標的治療法．Biother 18:519-526，2004 – reference: 1) DeMatteo R, Lewis JJ, Leung D, et al : Two hundred gastrointestinal stromal tumors : recurrence patterns and prognostic factors for survival. Ann Surg 231 : 51-58, 2000 – reference: 2) Demetri G, von Mehren M, Blanke C, et al : Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347 : 472-480, 2002 – reference: 7) Heinrich MC, Corless CL, Demetri GD, et al : Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol 21 : 4342-4349, 2003 – reference: 4) Heinrich M, Corless C, Blanke C, et al : Molecular correlates of imatinib resistance in gastrointestinal stromal tumors. J Clin Oncol 24 : 4764-4774, 2006 – reference: 12) Rutkowski P, Nowecki Z, Nyckowski P, et al : Surgical treatment of patients with initially inoperable and/or metastatic gastrointestinal stromal tumors (GIST) during therapy with imatinib mesylate. J Surg Oncol 93 : 304-311, 2006 – reference: 13) 佐藤龍一郎，及川昌也，片寄 友他:イマチニブ投与後に切除しえた胃原発gastrointestinal stromal tumor多発肝転移の1例．日消外会誌 40:427-432，2007 – reference: 5) Verweij J, Casali P, Zalcberg J, et al : Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib : randomised trial. Lancet 364 : 1127-1134, 2004 – reference: 8) Demetri GD, Benjamin RS, Blanke CD, et al : NCCN Task Force report : management of patients with gastrointestinal stromal tumor (GIST)—update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw (Suppl 2) : S1-29 ; quiz S30, 2007 |
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| Snippet | 症例は80歳，女性．残胃のgastrointestinal stromal tumor（以下，GIST）にて手術後，外来にて施行したCTにて多発性肝転移を認めたためイマチニブ投与を開始．奏効しPRが持続していたが，4カ所で肝転移の再燃を認めるようになったため肝部分切除および術中radiofrequency... |
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| SubjectTerms | 2次耐性 gastrointestinal stromal tumor イマチニブ |
| Title | GIST肝転移のイマチニブ2次耐性例に術中RFAおよび肝切除術を施行した1例 |
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