内容紹介
Summary
We hereby report a case of long-term survival of metastatic and recurrent duodenal gastrointestinal stromal tumor(GIST)treated with multimodality managements. A 59-year-old man was diagnosed with duodenal GIST and underwent surgical resection of a primary lesion of the duodenum. Since the pathological findings on mitotic rate indicated its high risk of recurrence, the systemic treatment by imatinib mesylate was given shortly after the surgery. Six months later, metastatic lesions being considered to be imatinib-resistant were observed in the remnant liver. Since there were no other drugs available for GISTs in clinic at that time, surgery of central bisegmentectomy with partial resection of the liver was performed to eliminate all metastatic lesions. However, recurrences had been repeatedly diagnosed afterward. In response to them, four more surgery for recurrent liver or peritoneal tumors, two transcatheter arterial chemoembolizations(TACE)and one radiofrequency ablation(RFA)were performed on the basis of its resectability. Sunitinib malate had been given since it was approved for imatinib-resistant GISTs in clinic. Eventually, as long as 99 months had passed since we observed the first evidence of the resistance to imatinib mesylate when he died from the GIST.
要旨
症例は59歳,男性。腹痛の精査の結果,十二指腸水平部に4.5 cm大のGISTを認め外科切除を行った。病理所見より高リスク症例であったため術後補助化学療法としてイマチニブが投与されたが,術後6か月目に多発肝転移を来した。当時,臨床使用できる他の分子標的薬が存在せず,全病巣切除が可能であったため肝切除を行い,術後はイマチニブ投与を継続した。その後の再発に対しては切除可能であれば外科切除を第一選択とし,再発巣の局在や残肝機能の制約により切除不能な場合は肝動脈化学塞栓療法やラジオ波焼灼術を行い,転移巣に対する局所療法を継続した。スニチニブが保険収載されてからは同薬への変更も試み,全身療法も継続した。これらの治療によりイマチニブ耐性出現後99か月の長期生存を得ることができ,転移・再発十二指腸GISTに対する外科切除,肝動脈化学療法,ラジオ波焼灼術の有用性が示唆された。
目次
We hereby report a case of long-term survival of metastatic and recurrent duodenal gastrointestinal stromal tumor(GIST)treated with multimodality managements. A 59-year-old man was diagnosed with duodenal GIST and underwent surgical resection of a primary lesion of the duodenum. Since the pathological findings on mitotic rate indicated its high risk of recurrence, the systemic treatment by imatinib mesylate was given shortly after the surgery. Six months later, metastatic lesions being considered to be imatinib-resistant were observed in the remnant liver. Since there were no other drugs available for GISTs in clinic at that time, surgery of central bisegmentectomy with partial resection of the liver was performed to eliminate all metastatic lesions. However, recurrences had been repeatedly diagnosed afterward. In response to them, four more surgery for recurrent liver or peritoneal tumors, two transcatheter arterial chemoembolizations(TACE)and one radiofrequency ablation(RFA)were performed on the basis of its resectability. Sunitinib malate had been given since it was approved for imatinib-resistant GISTs in clinic. Eventually, as long as 99 months had passed since we observed the first evidence of the resistance to imatinib mesylate when he died from the GIST.
要旨
症例は59歳,男性。腹痛の精査の結果,十二指腸水平部に4.5 cm大のGISTを認め外科切除を行った。病理所見より高リスク症例であったため術後補助化学療法としてイマチニブが投与されたが,術後6か月目に多発肝転移を来した。当時,臨床使用できる他の分子標的薬が存在せず,全病巣切除が可能であったため肝切除を行い,術後はイマチニブ投与を継続した。その後の再発に対しては切除可能であれば外科切除を第一選択とし,再発巣の局在や残肝機能の制約により切除不能な場合は肝動脈化学塞栓療法やラジオ波焼灼術を行い,転移巣に対する局所療法を継続した。スニチニブが保険収載されてからは同薬への変更も試み,全身療法も継続した。これらの治療によりイマチニブ耐性出現後99か月の長期生存を得ることができ,転移・再発十二指腸GISTに対する外科切除,肝動脈化学療法,ラジオ波焼灼術の有用性が示唆された。