内容紹介
Summary
The standard treatment for unresectable or recurrent gastrointestinal stromal tumor(GIST)is tyrosine kinase inhibitor(TKI). It is reported that resection of metastatic lesions after TKI administration prolongs progression free survival, but its influence on overall survival is not clarified. We experienced a case of GIST with peritoneal dissemination for which TKI administration and 2 local resections were effective. The patient was a man in his 70's. We started chemotherapy with imatinib for GIST with peritoneal dissemination. However, it was discontinued due to the occurrence of interstitial pneumonia. Dissemination was evaluated as radically resectable on the images. After the interstitial pneumonia was alleviated, surgery was performed. Although sunitinib was introduced at 2 months postoperatively, recurrent peritoneal dissemination was detected at 32 months postoperatively, and treatment was then changed to regorafenib. Regorafenib treatment reduced the tumor size; however, Grade 3 albuminuria was detected 16 months after treatment initiation and, thus, this treatment was discontinued. Subsequently, the tumor enlarged again. Because there was only 1 recurrent lesion, we performed radical resection. Postoperatively, a reduced dose of regorafenib was re-administered. At present, 9 months after the re-surgery, the patient is alive without recurrence.
要旨
切除不能・再発GISTに対してはTKIによる治療が標準である。TKI使用後の転移病巣の切除はPFSの延長が報告されているが,OSへの影響は明らかではない。TKIに加え二度の局所切除が有効であった腹膜播種を伴う胃GISTを経験したので報告する。症例は70歳台,男性。腹膜播種を伴う胃GISTに対しイマチニブによる化学療法を開始したが,間質性肺炎を発症したためイマチニブを中止した。播種は単発で画像上根治切除可能と判断し,間質性肺炎改善後に手術を施行した。術後2か月からスニチニブを導入したが,術後32か月目に腹膜播種再発を認め,レゴラフェニブに変更した。レゴラフェニブにより腫瘍は縮小したが,導入後16か月にGrade 3の蛋白尿を認めたため中止を余儀なくされると腫瘍も再増大を来した。再発病変は1病変のみで根治切除可能と判断し,切除を行った。術後はレゴラフェニブを減量し再開しており,再手術後9か月現在,無再発生存中である。
目次
The standard treatment for unresectable or recurrent gastrointestinal stromal tumor(GIST)is tyrosine kinase inhibitor(TKI). It is reported that resection of metastatic lesions after TKI administration prolongs progression free survival, but its influence on overall survival is not clarified. We experienced a case of GIST with peritoneal dissemination for which TKI administration and 2 local resections were effective. The patient was a man in his 70's. We started chemotherapy with imatinib for GIST with peritoneal dissemination. However, it was discontinued due to the occurrence of interstitial pneumonia. Dissemination was evaluated as radically resectable on the images. After the interstitial pneumonia was alleviated, surgery was performed. Although sunitinib was introduced at 2 months postoperatively, recurrent peritoneal dissemination was detected at 32 months postoperatively, and treatment was then changed to regorafenib. Regorafenib treatment reduced the tumor size; however, Grade 3 albuminuria was detected 16 months after treatment initiation and, thus, this treatment was discontinued. Subsequently, the tumor enlarged again. Because there was only 1 recurrent lesion, we performed radical resection. Postoperatively, a reduced dose of regorafenib was re-administered. At present, 9 months after the re-surgery, the patient is alive without recurrence.
要旨
切除不能・再発GISTに対してはTKIによる治療が標準である。TKI使用後の転移病巣の切除はPFSの延長が報告されているが,OSへの影響は明らかではない。TKIに加え二度の局所切除が有効であった腹膜播種を伴う胃GISTを経験したので報告する。症例は70歳台,男性。腹膜播種を伴う胃GISTに対しイマチニブによる化学療法を開始したが,間質性肺炎を発症したためイマチニブを中止した。播種は単発で画像上根治切除可能と判断し,間質性肺炎改善後に手術を施行した。術後2か月からスニチニブを導入したが,術後32か月目に腹膜播種再発を認め,レゴラフェニブに変更した。レゴラフェニブにより腫瘍は縮小したが,導入後16か月にGrade 3の蛋白尿を認めたため中止を余儀なくされると腫瘍も再増大を来した。再発病変は1病変のみで根治切除可能と判断し,切除を行った。術後はレゴラフェニブを減量し再開しており,再手術後9か月現在,無再発生存中である。