内容紹介
Summary
Neoadjuvant imatinib may prevent tumor rupture and the need for extended surgery by reducing the tumor size by approximately 35%, especially for large gastric gastrointestinal stromal tumors(GISTs), as shown in a previous phaseⅡ study(Kurokawa et al. BJC 2017); however, the use of neoadjuvant imatinib is not prevalent in clinical practice. Herein, we report a large gastric GIST that was successfully treated with neoadjuvant imatinib. A 74-year-old woman complained of abdominal pain, and abdominal computed tomography(CT)revealed a 14 cm oval tumor in the left upper abdominal cavity. Gastric biopsy revealed that the tumor was a GIST. The patient also had a small lung tumor that was diagnosed as a primary lung carcinoma in the right upper lobe. We performed neoadjuvant imatinib for 6 months as the primary treatment. After 7 months of imatinib administration, CT revealed that the GIST decreased in size but the lung cancer was slightly enlarged. Therefore, we performed right upper lung lobectomy and continued imatinib therapy for an additional 3 months. After a total of 9 months of neoadjuvant imatinib treatment, we performed partial gastrectomy combined with splenectomy without tumor rupture. The patient is scheduled to continue imatinib therapy for a total of 3 years.
要旨
症例は74歳,女性。上腹部痛を主訴に腹部CTを撮影したところ胃体上部に12×9 cm大の巨大腫瘍を認め,当院紹介となった。上部内視鏡検査による生検でgastrointestinal stromal tumor(GIST)と診断され,術前化学療法としてイマチニブ400 mg/日の投与を開始した。計9か月の投与後の腹部CTで腫瘍の縮小を認めPRと判定し,脾合併胃部分切除を施行した。3年間のイマチニブ内服を行っていく予定であり,術後7か月経過した現在再発を認めていない。
目次
Neoadjuvant imatinib may prevent tumor rupture and the need for extended surgery by reducing the tumor size by approximately 35%, especially for large gastric gastrointestinal stromal tumors(GISTs), as shown in a previous phaseⅡ study(Kurokawa et al. BJC 2017); however, the use of neoadjuvant imatinib is not prevalent in clinical practice. Herein, we report a large gastric GIST that was successfully treated with neoadjuvant imatinib. A 74-year-old woman complained of abdominal pain, and abdominal computed tomography(CT)revealed a 14 cm oval tumor in the left upper abdominal cavity. Gastric biopsy revealed that the tumor was a GIST. The patient also had a small lung tumor that was diagnosed as a primary lung carcinoma in the right upper lobe. We performed neoadjuvant imatinib for 6 months as the primary treatment. After 7 months of imatinib administration, CT revealed that the GIST decreased in size but the lung cancer was slightly enlarged. Therefore, we performed right upper lung lobectomy and continued imatinib therapy for an additional 3 months. After a total of 9 months of neoadjuvant imatinib treatment, we performed partial gastrectomy combined with splenectomy without tumor rupture. The patient is scheduled to continue imatinib therapy for a total of 3 years.
要旨
症例は74歳,女性。上腹部痛を主訴に腹部CTを撮影したところ胃体上部に12×9 cm大の巨大腫瘍を認め,当院紹介となった。上部内視鏡検査による生検でgastrointestinal stromal tumor(GIST)と診断され,術前化学療法としてイマチニブ400 mg/日の投与を開始した。計9か月の投与後の腹部CTで腫瘍の縮小を認めPRと判定し,脾合併胃部分切除を施行した。3年間のイマチニブ内服を行っていく予定であり,術後7か月経過した現在再発を認めていない。