Zusammenfassung
Gastrointestinale Stromatumoren (GIST) sind aufgrund ihres unsicheren biologischen Verhaltens und der durch Imatinib gegebenen Therapieoption von aktuellem Interesse. In der folgenden Studie soll untersucht werden, welche Form der Nachsorge zur Erkennung eines Rezidives geeignet und ökonomisch vertretbar ist. Patienten und Methode: Wir behandelten im Zeitraum von 07/97 bis 02/04 43 GIST-Patienten. Bei Vorliegen eines hohen (HR) oder intermediären Risikos (IR) bzw. nachgewiesener Malignität (OM) wurde ein regelmäßiges Follow-up durchgeführt. Anfang 2004 untersuchten wir alle Patienten unabhängig von der Risikokonstellation nach. Neben einer Abdomensonographie führten wir bei zugänglichem Ursprungsorgan eine Endoskopie und eine Endosonographie durch. Eine weiterführende Diagnostik erfolgte befundabhängig. Ergebnisse: Bei 33 Patienten unter Risiko traten fünf Rezidive auf. Die Konstellation hinsichtlich malignen Verhaltens der rezidivierten Tumoren laut Einteilung des NIH war: 2 × OM, 1 × HR, 2 × IR. Das Intervall zwischen Erstbehandlung und Auftreten eines Rezidives lag bei 4,5 bis 33 Monaten. Vier der rezidivierten Patienten wurden mit Imatinib therapiert, der fünfte Patient wurde vor der Imatinib-Ära palliativ behandelt. Schlussfolgerung: Nach unserer Erfahrung sollte eine strukturierte Nachsorge nur bei Patienten mit OM, HR und IR GIST in den ersten zwei Jahren alle 6 Monate, dann jährlich für weitere drei Jahre durchgeführt werden.
Abstract
Gastrointestinal stromal tumours are topical because of their uncertain biological behaviour and the potential of treatment with imatinib. In the following study we have examined which pattern of follow-up is both appropriate for detecting recurrences and cost-effective. Patients and methods: Between July 1997 and February 2004 we treated 43 patients diagnosed with a GIST. Patients with high risk (HR), intermediate risk (IR), or overtly malignant (OM) tumours were followed-up regularly. In 2004 we screened all patients independent of their risk of malignant disease with an ultrasound scan and endoscopy followed by endosonography. Further diagnostic procedures were carried out if necessary. Results: Overall, we diagnosed recurrences in five out of 33 patients at risk (two in patients with OM, one in a patient with HR, and 2 in patients with IR according to the NIH criteria). The time period between resection of the primary tumour and recurrence ranged from 4.5 to 33 months. One of the patients with a recurrence was seen before the imatinib era, the other four were treated with imatinib mesylate. Conclusion: In our experience, regular follow-up should be restricted to patients with OM, HR, and IR GIST. We suggest that patients are initially seen in six months intervals for two years and annually for another three years thereafter.
Schlüsselwörter
GIST - Nachsorge - Rezidiv - Imatinib
Key words
GIST - follow-up - recurrence - imatinib mesylate
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Dr. med. S. Stelzner
Krankenhaus Dresden-Friedrichstadt · Städtisches Klinikum · Klinik für Allgemein- und Abdominalchirurgie
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Email: Stelzner-Si@khdf.de