臨床外科69巻12号

2014年11月発行

特集 外科切除適応の境界領域—Borderline resectable cancerへの対応

がん種別の治療指針

GIST

著者： 岩槻政晃¹² 蔵重淳二¹ 岩上志朗¹ 吉田直矢¹ 髙森啓史² 馬場秀夫¹

所属機関： ¹熊本大学大学院消化器外科学 ²済生会熊本病院外科

ページ範囲：P.1371 - P.1375

文献概要

【ポイント】

◆Marginally resectable GISTとは，併存症や拡大手術により高率に術後合併症が予想される局所進行GISTと定義される．

◆Marginally resectable GISTに対する術前補助療法の安全性や治療効果のエビデンスはなく，ガイドラインでは「臨床試験段階の治療」としての位置づけである．

◆術前補助療法において，投与薬剤，用量・期間，効果判定のタイミング，術後補助化学療法の必要性などの問題点がある．

参考文献

1）日本癌治療学会，日本胃癌学会，GIST研究会（編）：GIST診療ガイドライン，第3版．金原出版．2014

2）Eisenberg BL, Harris J, Blanke CD, et al：Phase Ⅱ trial of neoadjuvant/adjuvant imatinib mesylate（IM）for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumor（GIST）：early results of RTOG 0132/ACRIN 6665. J Surg Oncol 99：42-47, 2009

3）Wang D, Zhang Q, Blanke CD, et al：Phase Ⅱ trial of neoadjuvant/adjuvant imatinib mesylate for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumors：long-term follow-up results of Radiation Therapy Oncology Group 0132. Ann Surg Oncol 19：1074-1080, 2012

4）Rutkowski P, Gronchi A, Hohenberger P, et al：Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors（GIST）：the EORTC STBSG experience. Ann Surg Oncol 20：2937-2943, 2013

5）Gervaz P, Huber O, Morel P：Surgical management of gastrointestinal stromal tumours. Br J Surg 96：567-578, 2009

6）Jakob J, Mussi C, Ronellenfitsch U, et al：Gastrointestinal stromal tumor of the rectum：results of surgical and multimodality therapy in the era of imatinib. Ann Surg Oncol 20：586-592, 2013

7）Machlenkin S, Pinsk I, Tulchinsky H, et al：The effect of neoadjuvant Imatinib therapy on outcome and survival after rectal gastrointestinal stromal tumour. Colorectal Dis 13：1110-1115, 2011

8）Tielen R, Verhoef C, van Coevorden F, et al：Surgical management of rectal gastrointestinal stromal tumors. J Surg Oncol 107：320-323, 2013

9）Svetlichnaya J, Huyck TK, Wayne JD, et al：Neoadjuvant use of sunitinib in locally advanced GIST with intolerance to imatinib. Chemotherapy 58：30-33, 2012

10）ESMO/European Sarcoma Network Working Group：Gastrointestinal stromal tumors：ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23（Suppl 7）：ⅶ49-55, 2012

11）Nishida T, Shirao K, Sawaki A, et al：Efficacy and safety profile of imatinib mesylate（ST1571）in Japanese patients with advanced gastrointestinal stromal tumors：a phase Ⅱ study（STI571B1202）. Int J Clin Oncol 13：244-251, 2008

12）Bonvalot S, Eldweny H, Pechoux CL, et al：Impact of surgery on advanced gastrointestinal stromal tumors（GIST）in the imatinib era. Ann Surg Oncol 13：1596-1603, 2006

13）Haller F, Detken S, Schulten HJ, et al：Surgical management after neoadjuvant imatinib therapy in gastrointestinal stromal tumours（GISTs）with respect to imatinib resistance caused by secondary KIT mutations. Ann Surg Oncol 14：526-532, 2007

14）Le Cesne A, Van Glabbeke M, Verweij J, et al：Absence of progression as assessed by response evaluation criteria in solid tumors predicts survival in advanced GI stromal tumors treated with imatinib mesylate：the intergroup EORTC-ISG-AGITG phase Ⅲ trial. J Clin Oncol 27：3969-3974, 2009

15）Choi H, Charnsangavej C, Faria SC, et al：Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate：proposal of new computed tomography response criteria. J Clin Oncol 25：1753-1759, 2007

16）Joensuu H, Eriksson M, Sundby Hall K, et al：One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor：a randomized trial. JAMA 307：1265-1272, 2012

17）von Mehren M, Randall RL, Benjamin RS, et al：Gastrointestinal stromal tumors, version 2.2014. J Natl Compr Canc Netw 12：853-862, 2014