A Study on Recurrent Gastrointestinal Stromal Tumor

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  • Takeyoshi Izumi
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Ogawa Hiroomi
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Igarashi Takamichi
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Tsukagoshi Hiroshi
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Hirai Keitaro
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Takahashi Norifumi
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Yamazaki Hotaka
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Tanaka Kazumi
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Takahashi Kengo
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Yoshinari Daisuke
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Sunose Yutaka
    Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
  • Iwazaki Shigeru
    Department of Surgery, Tatebayashi Kosei Hospital
  • Arai Tsuyoshi
    Division of Surgery, Keiaido Hospital

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Other Title
  • GIST再発症例の検討
  • GIST サイハツ ショウレイ ノ ケントウ

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Background and Purpose : Although the first choice of medical treatment for a primary gastrointestinal stromal tumor (GIST) is surgical excision, active treatment against recurrence leads to improved treatment outcomes among patients with a GIST. Since the establishment of GIST treatment guidelines in 2008, the principle treatment of recurrence has been imatinib administration. Patients with recurrent GIST in our department underwent clinicopathological examination and treatment evaluation. Results : Seven patients (3 men and 4 women) with a mean age of 61.9 years were analyzed. The primary tumor sites were the stomach (n=1), duodenum (n=1), small intestine (n=4), and rectum (n=1). Risk classification results were middle (n=2), middle to high (n=2), and high (n=3). All patients with a first recurrence also had hepatic metastases, and the period to the first recurrence ranged from 14 to 77 months. Three patients underwent excision of the recurrent lesions, and four patients underwent imatinib administration. Five of the seven patients had re-recurrence/resistance ; this included three of the four patients who had received imatinib. One patient was changed to sunitinib treatment, and two patients underwent excision of local resistant sites and continued imatinib treatment. Two patients died, and five patients have been alive for a long time period. Conclusions : Imatinib administration is the first treatment choice for GIST recurrence. However, if the disease becomes resistant, sunitinib may be effective in systemic cases and excision followed by the continuation of imatinib may be effective in localized cases.

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