臨牀消化器内科 Vol.26 No.4(4)


特集名 転移性肝癌 -- 多様化する治療
題名 GIST(gastrointestinal stromal tumor)肝転移の治療
発刊年月 2011年 04月
著者 田澤 賢一 新潟県厚生連糸魚川総合病院外科/富山大学医学薬学研究部消化器・腫瘍・総合外科
著者 杉山 敏郎 富山大学医学薬学研究部第3内科
著者 山岸 文範 新潟県厚生連糸魚川総合病院外科
著者 嶋田 裕 富山大学医学薬学研究部消化器・腫瘍・総合外科
著者 塚田 一博 富山大学医学薬学研究部消化器・腫瘍・総合外科
【 要旨 】 GIST(gastrointestinal stromal tumor)肝転移の治療の第1選択は,イマチニブ投与である.その高い再発率から,肝切除単独は,単発,数個の初回手術後2年以上経過症例などの症例に適応を限るべきである.しかし,イマチニブも単剤投与での完治は望めず,耐性獲得の予防に外科切除の重要性が見直されつつある.外科切除の介入のタイミングは,イマチニブ奏効中か,耐性獲得後かの選択は,今後の課題である.イマチニブ耐性獲得時における,イマチニブ増量,スニチニブ投与,臨床試験の導入,RFA(ラジオ波凝固療法),TAE(肝動脈塞栓療法)など,集学的治療の重要性が高まる.
Theme Chemoprevention of Colorectal Cancer by Tea Lobe Polyphenol
Title Treatment of Hepatic Metastases Resulting from Gastrointestinal Stromal Tumors (GISTs)
Author Kenichi Tazawa Department of Surgery, Itoigawa General Hospital / Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama
Author Toshiro Sugiyama Department of Gastroenterology and Hematology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama
Author Huminori Yamagishi Department of Surgery, Itoigawa General Hospital
Author Yutaka Shimada Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama
Author Kazuhiro Tsukada Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama
[ Summary ] Imatinib is acceptable as a first-line therapy for hepatic metastases arising from GISTs. Because of high recurrence rates, indications for hepatic resection should be limited to cases with only one or a minimal number of lesions in the liver which have metastasized along with long recurrencefree intervals. The primary effect of imatinib is not considered to be complete response. To enhance the resistance provided by imatinib, surgical resection of metastatic GISTs is required. The timing of resection for liver metastasis is currently a topic of discussion. The clinical importance of a multimodal approach has increased, including dose-up of imatinib, intaking of sunitinib, clinical research, transarterial embolization (TAE) and radio frequency ablation (RFA).
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