Entrar/Registro  
HOME SPANISH
 
Cirugía y Cirujanos
   
MENU

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board






>Journals >Cirugía y Cirujanos >Year 2012, Issue 1


Acín-Gándara D, Pereira-Pérez F, Ángel Castaño-Pascual Á, Durán-Poveda M, Antequera-Pérez A, Miliani-Molina C
Gastrointestinal stromal tumors: diagnosis and treatment
Cir Cir 2012; 80 (1)

Language: Español
References: 39
Page: 44-51
PDF: 394.13 Kb.


Full text




ABSTRACT

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the digestive tract. They originate from the interstitial cells of Cajal and are characterized by the overexpression of KIT protein (tyrosine kinase). Their prognosis has improved significantly with the discovery of imatinib mesylate for advanced GIST treatment.
Methods: We carried out a retrospective, descriptive study of GISTs diagnosed in our center during the past 5 years. We excluded patients with incidental diagnoses in the context of other pathologies because GIST did not affect outcome or prognosis. The variables studied were clinical characteristics, location, size, imaging techniques, resectability, neoadjuvant imatinib, surgical technique, histology, immunohistochemistry, prognostic classification of Fletcher, morbidity, monitoring, and disease-free and overall survival.
Results: Nineteen patients were diagnosed (14 males/5 females) with a mean age of 63 years (range: 30-84 years). Diagnosis was incidental in eight patients (42%). Tumor location of the remaining 11 patients (58%) was six tumors of the small intestine (55%), four gastric (36%) and one rectal (9%). Predominant gastrointestinal bleeding and anemia were diagnosed mainly by abdominal computed tomography (CT). At diagnosis, nine patients were considered resectable with radical intent (82%) and the other two patients (18%) received neoadjuvant treatment with a favorable response after 6 months. Three patients were treated with imatinib after surgery (33%). Median survival was 34 months (range: 5-58 months).
Conclusions: Diagnosis of GIST is often incidental. The predominant clinical symptom is usually gastrointestinal bleeding and anemia and the most widely used imaging test is CT. Treatment is surgical unless advanced GIST is diagnosed, which will be treated with imatinib mesylate neoadjuvant therapy. A multidisciplinary approach to this pathology is essential, a fact that affects prognosis and patient survival.


Key words: Gastrointestinal stromal tumors, imatinib, neoadjuvant, c-kit, treatment, prognosis, response criteria.


REFERENCIAS

  1. Nishida T, Hirota S. Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol Histopathol 2000;15:1293-1301.

  2. Rubin BP, Heinrich MC, Corless CL. Gastrointestinal stromal tumor. Lancet 2007;369:1731-1741.

  3. Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 2007;5(suppl 2):S1-29.

  4. Thomas RM, Sobin LH. Gastrointestinal cancer. Cancer 1995;75(suppl 1):154-170.

  5. Nishida T, Takahashi T, Miyazaki Y. Gastrointestinal stromal tumor: a bridge between bench and bedside. Gastric Cancer 2009;12:175-188.

  6. Robinson TL, Sircar K, Hewlett BR, Chorneyko K, Riddell RH, Huizinga JD. Gastrointestinal stromal tumors may originate from a subset of CD34-positive insterstitial cells of Cajal. Am J Pathol 2000;156:1157-1163.

  7. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259-1269.

  8. Corless CL, Fletcher JA, Heinrich MC. Biology of gastrointestinal stromal tumors. J Clin Oncol 2004;22:3813-3825.

  9. Tornillo L, Terracciano LM. An update on molecular genetics of gastrointestinal stromal tumours. J Clin Pathol 2006;59:557-563.

  10. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-fuction mutations of c-kit in human gastrointestinal stromal tumors. Science 1998;279:577-580.

  11. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459-465.

  12. Cormier JN, Patel SR, Pisters PW. Gastrointestinal stromal tumours: rationale for surgical adjuvant trials with imatinib. Curr Oncol Reports 2002;4:504-509.

  13. Demetri GD. Identification and treatment of chemoresistant inoperable or metastatic GIST: experience with a selective tyrosine kinase inhibitor imatinib mesylate. Eur J Cancer 2002;38:S52-59.

  14. Sanchez-Hidalgo JM, Muñoz-Casares FC, Rufian-Peña S, Naranjo- Torres A, Ciria-Bru R, Briceño-Delgado J, et al. Gastrointestinal stromal tumors (GIST): factors predictive of survival after R0-cytoreduction. Rev Esp Enferm Dig 2007;99:703-708.

  15. Martin-Lorenzo JG, Aguayo-Albasini JL, Torralba-Martinez JA, Liron-Ruiz R, Gimenez-Bascuñana A, Miquel-Perello J, et al. Gastrointestinal stromal tumors. Diagnosis, prognosis and current surgical treatment. Follow-up of 18 treated patients. Cir Esp 2006;79:22-27.

  16. Eizaguirre-Zarza B, Burgos-Bretones J. GIST tumors. A literature review. Rev Esp Patol 2006;39:209-218.

  17. Nowain A, Bhakta H, Pais S, Kanel G, Verma S. Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol 2005;20:818-824.

  18. Ha CY, Shan R, Chen J, Azar RR, Edmundowicz SA, Early DS. Diagnosis and management of GI stromal tumors by EUS-FNA: a survey of opinions and practices of endosonographers. Gastrointest Endosc 2009;69:1039-1044.

  19. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol 2005;16:566-578.

  20. Corless CL, Schroeder A, Griffith D, Town A, McGreevey L, Harrell P, et al. PDGFRA mutations in gastrointestinal stromal tumors: frequency, spectrum and in vitro sensitivity to imatinib. J Clin Oncol 2005;23:5357-5364.

  21. Antoch G, Kanja J, Bauer S, Kuehl H, Renzing-Koehler K, Schuette J, et al. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. J Nucl Med 2004;45:357-365.

  22. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205-216.

  23. Padhani AR, Ollivier L. The RECIST criteria: implications for diagnostic radiologists. Br J Radiol 2001;74:983-986.

  24. Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 2007;25:1753-1759.

  25. Singer S, Rubin B, Lux M, Chen CJ, Demetri GD, Fletcher CD, et al. Prognostic value of KIT mutation type, mitotic activity, and histologic subtype in gastrointestinal stromal tumors. J Clin Oncol 2002;20:3898-3905.

  26. Huang HY, Huang WW, Lin CN, Eng HL, Li SH, Li CF, et al. Immunohistochemical expression of p16INK4A, Ki-67, and Mcm2 proteins in gastrointestinal stromal tumors: prognostic implications and correlations with risk stratification of NIH consensus criteria. Ann Surg Oncol 2006;13:1633-1644.

  27. Nemoto Y, Mikami T, Hana K, Kikuchi S, Kobayashi N, Watanabe M, et al. Correlation of enhanced cell turnover with prognosis of gastrointestinal stromal tumors of the stomach: relevance of cellularity and p27kip1. Pathol Int 2006;56:724-731.

  28. Schmieder M, Wolf S, Danner B, Stoehr S, Juchems MS, Wuerl P, et al. p16 expression differentiates high-risk gastrointestinal stromal tumor and predicts poor outcome. Neoplasia 2008;10:1154-1162.

  29. Kang YN, Jung HR, Hwang I. Clinicopathological and immunohistochemical features of gastrointestinal stromal tumors. Cancer Res Treat 2010;42:135-143.

  30. Fernández JA, Sánchez-Cánovas ME, Parrilla P. Controversies in the surgical treatment of primary gastrointestinal stromal tumours (GIST). Cir Esp 2010;88:69-80.

  31. Joensuu H. Tyrosine kinase inhibitor as a target therapy for GIST tumors. Duodecim 2002;118:2305-2312.

  32. Gervaz P, Huber O, Morel P. Surgical management of gastrointestinal stromal tumours. Br J Surg 2009;96:567-578.

  33. Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden. Cancer 2005;103:821-829.

  34. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51-58.

  35. Tabrizian P, Nguyen SQ, Divino CM. Laparoscopic management and long-term outcomes of gastrointestinal stromal tumors. J Am Coll Surg 2009;208:80-86.

  36. Rutkowski P, Nowecki ZI, Michej W, Debiec-Rychter M, Woźniak A, Limon J, et al. Risk criteria and prognostic factors for predicting recurrences after resection of primary gastrointestinal stromal tumor. Ann Surg Oncol 2007;14:2018-2027.

  37. Artigas-Raventós V, López-Pousa A. Tumores de la estroma gastrointestinal: nuevos conceptos y estrategias terapéuticas multidisciplinares médico-quirúrgicas. Cir Esp 2006;79:1-2.

  38. Fernández JA, Parrilla P. Surgical treatment of an advanced GIST: the age of imatinib. Cir Esp 2009;86:3-12.

  39. Deshaies I, Cherenfant J, Gusani NJ, Jiang Y, Harvey HA, Kimchi ET, et al. Gastrointestinal stromal tumor (GIST) recurrence following surgery: review of the clinical utility of imatinib treatment. Ther Clin Risk Manag 2010;6:453-458.






>Journals >Cirugía y Cirujanos >Year 2012, Issue 1
 

· Journal Index 
· Links 






       
Copyright 2019