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TumorDiagnostik & Therapie 2014; 35(04): 212-216
DOI: 10.1055/s-0034-1366474
Thieme Onkologie aktuell
© Georg Thieme Verlag KG Stuttgart · New York

Gastrointestinale Stromatumore größer als 20 cm: Erfahrungen mit Imatinib in neoadjuvanter Intention

Gastrointestinal Stromal Tumours Bigger than 20 cm: Experience with Imatinib Chemotherapy in Neoadjuvant Intention
P. Girotti
1   Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen
,
J. Rolinger
1   Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen
,
H.-G. Kopp
2   Medizinische Klinik II, Hämatoonkologie, Universitätsklinikum Tübingen
,
A. Königsrainer
1   Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen
,
R. Ladurner
1   Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen
› Author Affiliations
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Publication History

Publication Date:
25 June 2014 (online)

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Zusammenfassung

Beim Gastrointestinalen Stromatumor (GIST) ist die Größe des Primärtumors einer der Hauptrisikofaktoren für eine Metastasierung bzw. das Auftreten von Lokalrezidiven. Bisher gibt es keine prospektiven Daten, die den Wert einer neoadjuvanten Therapie mit Imatinib belegen. Zwischen 2009 und 2012 wurden an unserer Klinik 7 Patienten mit einer GIST-Größe > 20 cm in neoadjuvanter Intention mit Imatinib behandelt, radikal operiert, adjuvant nachbehandelt und in Hinblick auf die peri-/postoperative Morbidität und das tumorfreie Überleben nachkontrolliert. Zwei Patienten waren primär als nicht resektabel eingestuft und ein Patient hatte zum Diagnosezeitpunkt Lebermetastasen. Bei 2/7 war die Tumorerkrankung präoperativ stabil, 3/7 wiesen ein partielles Ansprechen auf und 2/7 hatten ein klares Down-Staging (resektabler Tumor). Durch die Lokalisation des Primärtumors (Magen 6, Rektum 1) erfolgte 6-mal eine Gastrektomie, eine davon en bloc mit einer Pankreaslinksresektion und Resektion von Lebermetastasen und 1-mal eine Rektumexstirpation. Der Patient mit simultanen Lebermetastasen war im Verlauf progredient, alle anderen Patienten sind 2 Jahre postoperativ tumorfrei. Durch die neoadjuvante Therapie ist bei einem GIST > 20 cm eine wesentliche Reduktion der Tumormasse zu erzielen (30 %). Unsere Kasuistik mit GIST > 20 cm belegt die positiven Ergebnisse der neoadjuvanten Therapie mit Imatinib in Hinblick auf eine hohe Rate (100 %) an R0-Resektionen ohne wesentlich erhöhte Morbidität vor allem in Fällen mit allein durch die Tumorgröße ≥ 10 cm und/oder Lokalisation deutlich erhöhtem Risiko für eine R1-/R2-Resektion. Die perioperative Morbidität ist trotz der Tumormasse gering und das tumorfreie Überleben nach 2 Jahren beträgt 85 %.

Abstract

The size of the primary tumour is considered the most important risk factor for the development of metastasis or local recurrence in case of gastrointestinal stromal tumour (GIST). Until now no prospective data are available in the literature about the role of neadjuvant therapy with Imatinib. Between 2009 and 2012 seven patients with a giant GIST > 20 cm underwent a neadjuvant treatment with Imatinib, a radical operation, followed by an adjuvant therapy. These patients were controlled with regard to peri- and postoperative morbidity and disease-free survival. Two patients were considered not resectable and one patient showed liver metastasis at the time of diagnosis. RECIST responses to the neoadjuvant Imatinib were: 2/7 patients with stable disease, 3/7 partial response, 2/7 partial response with down-staging (resectable disease). Because of the following tumour localisations (6 gastric and 1 rectal), six gastrectomies (one en-bloc with left pancreas) and one Holm operation were performed. The patient with simultaneous liver metastasis developed a tumour progression during the follow-up but the others are still tumour free after 2 years. We detected a significant tumour volume regression due to the neadjuvant chemotherapy in cases of GIST > 20 cm (30 %). Our series showed good results for a neadjuvant therapy in cases of giant GIST with the achievement of 100 % R0 resection without a high morbidity rate (in the literature a tumor size > 10 cm and poor localisation is associated to a high risk of R1 – 2 and high morbidity). Peri- and postoperative morbidity are acceptable and the tumour free survival at 2 years is 85 %.

Schlüsselwörter

gastrointestinaler Stromatumor (GIST) - Tumor - Sarcoma

Key words

gastrointestinal stromal tumour (GIST) - tumours - sarcomas
 

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