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(' h', great progress has been made in the pathology and basic research of gastrointestinal stromal tumors in the past ten years, especially the targeted drug Gleevec or India
Gleevec (' h', application and clinical treatment, Significantly improved the survival period of patients with gastrointestinal stromal tumors. Today, we will introduce the treatment methods and prognosis of gastrointestinal stromal tumors in detail, so that everyone can have a deeper understanding of gastrointestinal stromal tumors. Understanding.
' h', Surgical treatment
' h', >1. Principles of surgical treatment
' h', >Due to the potential malignancy of gastrointestinal stromal tumors, patients with clinically suspected gastrointestinal stromal tumors should Intestinal stromal tumors should be performed according to the principles of malignant tumor surgery. Since gastrointestinal stromal tumors are often brittle in texture, have rich blood supply, and metastasize through the blood and peritoneum, special attention should be paid to avoiding tumor rupture and extrusion during surgery. For intestinal gastrointestinal stromal tumors, the supply and return blood vessels should be ligated first. Biopsies should not be taken in suspicious cases during surgery, unless the tumor cannot be cured.
'h', >2. Surgical treatment plan
' h', > The diameter of the stomach is suitable for local resection or wedge resection, and the resection margin is at least 100 feet away from the tumor. Those with a stomach diameter of at least
' h', > should be operated within the scope of gastric cancer dissection.
' h', > The reported lymph node metastasis rate of the small intestine is ~%, so it is recommended to perform routine lymph node dissection. Resection should be performed at least as far away from the tumor as possible.
' h', >The rectum, especially the lower section, is sometimes very difficult to operate surgically. Since it is difficult to judge the degree of malignancy before surgery, the diameter can be considered to preserve the anus as much as possible
' h' , > For patients with rectal diameter m or postoperative recurrence, the decision should be made between anus-preserving and enlarging surgery after fully soliciting the patient's wishes before surgery.
' h', > For patients with local infiltration or distant metastasis Combined organ resection should be performed on the premise that it can be cured.
' h', >3. Surgical prognosis
' h', >Patients with high-risk gastrointestinal stromal tumors have a high rate of postoperative recurrence and metastasis. It can reach %~%, % have local recurrence within ~ years after surgery, and half of them also have liver metastasis at the same time. Although it is possible to re-resection, it is difficult to improve the survival rate.
' h', > Complete resection of the primary tumor Annual survival rate of patients without metastasis % (%~%),
' h', > Annual overall survival rate of patients who cannot be completely resected or metastases %,
' h', > Overall survival rate of those who cannot be resected ~month.
' h', >Special reminder
Surgical treatment is still the best treatment method for clinical cure of gastrointestinal stromal tumors, and patients should give priority to surgical treatment during treatment.
' h', Chemotherapy
' h', >Traditional chemotherapy for gastrointestinal stromal tumors is treated as leiomyosarcoma. The commonly used regimen is doxorubicin + cisplatin (D regimen), with a clinical response rate of %. Poor efficacy.
' h', Targeted drug Gleevec
' h', > Gleevec (imatinib) as a selective/receptor tyrosine kinase inhibitor, used Revolutionary progress has been made in the treatment of surgically unresectable and metastatic cases as well as postoperative preventive chemotherapy in some highly invasive risk cases.
' h', Gleevec administration method and clinical data for gastrointestinal stromal tumors
' h', > Gleevec administration method is ~ m/day for ~ months. The clinical data statistics are as follows
' h', >According to the phase II clinical study, R reaches %, and D reaches
' h', >The phase III clinical study lacks long-term follow-up reports, but it is reported that the number of months exceeds %.
' h', the prognosis of gastrointestinal stromal tumors taking Gleevec
' h', > (D) Patients with positive gastrointestinal stromal tumors who underwent resection took Gleevec after surgery The recurrence-free survival rate and overall survival rate of those who took it for only one year were significantly improved compared with those who only took it for one year.
'h', >MuH, President of Novartis Oncology Division, said that in the past nine years, Gleevec has provided the first drug treatment option for metastatic treatment and adjuvant treatment of positive patients. Now, they are seeing exciting new data showing that extending post-operative Gleevec treatment to three years in positive patients has a significant impact on overall survival.
' h', Definition of Gleevec resistance in gastrointestinal stromal tumors
' h', > According to statistics, the incidence of resistance to Gleevec (imatinib) can be as high as % , % of gastrointestinal stromal tumors exhibit primary drug resistance. Primary drug resistance is defined as tumor progression after several months of treatment. This progression is often multifocal. These drug-resistant tumors express wild-type or exon mutations or D mutations. Secondary drug resistance is defined as drug resistance that occurs again after several months of drug use.
'h', Gleevec resistance mechanism in gastrointestinal stromal tumors
'h', >Mutation stabilizes the structure of the kinase and prevents binding to imatinib.
'h', >The mutation interferes with the binding of imatinib. Secondary drug-resistant gastrointestinal stromal tumors often show primary mutations in exons, followed by exons, and the most recent ones. Studies have shown that primary exons and exon mutations are related to secondary resistance,
' h', choose sunitinib after Gleevec resistance
' h', >Sutent (Sunitinib) is an orally administered effective drug that can inhibit the activity of multiple receptor tyrosine kinases. The therapeutic targets of Sutent (Sunitinib) include: R, D and D, spectrum of action It is broad and has a higher inhibitory effect on R and R than other drugs, and can inhibit the mutation types that are resistant to Gleevec (imatinib). Many current clinical research results show that Sutent can be used as a first-line alternative drug for Gleevec resistance. .
' h', Recurrence/
Treatment of gastrointestinal stromal tumors with metastasis
' h', >Recurrence after surgical resection manifests as new lesions at the site of primary surgical resection, the primary The appearance of metastases outside the lesion, an increase in the size of the existing tumor, and the appearance of nodular hyperdensity in the lesion in patients treated with Gleevec.
'h', >The surgical prognosis of patients with recurrence or metastasis is related to tumor stage, tumor risk assessment and disease-free survival time after the first operation. Studies by DM and others have shown that in patients with postoperative recurrence
'h', >The median survival rate of patients with complete resection of recurrent metastases is months, while the median survival rate drops to months for patients with incomplete resection of metastases or residual concomitant disease.
'h', >Those who cannot be surgically resected should be treated with imatinib for one month first. Surgery will be performed as soon as possible after reaching the maximum efficacy of the drug. Imatinib drug treatment will be continued after surgery.
' h', > It can be seen that the comprehensive treatment method of surgery combined with the targeted molecular drug Gleevec has significantly improved the prognosis of patients with gastrointestinal stromal tumors. This is currently the best clinical treatment for gastrointestinal stromal tumors. Strategies for tract stromal tumors.