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Clinical Analysis and Therapeutic Application of Imatinib in Gastrointestinal Stromal Tumors

Author: ZhuQingShan
Tutor: LiuJiWei
School: Dalian Medical University
Course: Oncology
Keywords: Gastrointestinal stromal tumors (GIST) Imatinib Image features Prognosis
CLC: R735
Type: Master's thesis
Year: 2007
Downloads: 126
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Objective: previous gastrointestinal stromal tumor (gastrointestinal stromal tumor, GIST) is a rare tumor, clinical understanding of GIST rarely, almost little progress. The study found that in the late nineties kit gene plays a key role in the process of GIST occur, kit tyrosine kinase inhibitor mesylate imatinib (imatinib mesylate) then treatment of GIST success, caused a great medical profession interest has become a model for molecular targeted therapy, made a series of significant progress. Currently, gastrointestinal stromal tumors (GIST) is the most common non-epithelial tumors of the gastrointestinal surgery is the only means of incurable mesylate imatinib is the standard treatment of metastatic and non-surgical resection of GIST. The first part of this paper will analyze the the GIST clinical features and prognosis, the second part of the observed molecular targeted drug imatinib efficacy and adverse effects of treatment of GIST. Methods: The first part of the collection of First Affiliated Hospital of Dalian Medical University from September 2002 to October 2005 menstrual pathologically confirmed 65 cases of GIST medical records were retrospectively analyzed data from the clinical manifestations, imaging features, pathological features and prognosis . The second part of the observation of Dalian Medical University First Affiliated Hospital of Dalian City Tumor Hospital from February 2004 to March 2007 Application imatinib efficacy and safety of treatment of 26 cases of GIST. Results: The first part of the 65 patients, age of onset is 35 years old -84 years old (median age 60 years); 31/34 male / female; common occurrence sites were stomach (44.6%) and small intestine (44.6%); clinical nonspecific, more to the mass as the main performance, other bleeding, bloating, and can also be asymptomatic medical examination found or stumbled upon diagnosis and treatment of other disease processes; CT is a valuable means of checking, preoperative spiral CT in 60 cases, 27 cases (45%) reported tumor of the smooth muscle (meat) or source of mesenchymal tissue tumors, CT mainly lumps some necrosis, enhanced scan heterogeneous enhancement; pathology mainly main spindle cells, immunohistochemical of CD117-positive; 58 cases not associated with other parts of the cancer patients were followed up, follow-up data complete 45 cases, the median follow-up time of 14 cases of recurrence for 23 months (3 months -48 months) follow-up period, which is high in the low-risk group were 9,4,1 cases, different risk classification was statistically significant (P = 0.003) and recurrence. The second part of the show 26 cases of GIST patients according to RECIST (response evaluation criteria in solid tumor) standards can evaluate the efficacy of 21 cases of complete remission (CR) in 4 cases (19.0%), partial remission (PR), 12 cases of (57.1% ), stable disease (SD) 4 (19.0%), disease progress (PD) patients (4.8%), efficiency (RR = PR CR) was 76.2%, disease control rate (DCR = PR CR SD) 95.2 %; 26 cases can be carried out the evaluation of adverse reactions, the degree of adverse reactions are I-II level, can be tolerated or control; disease progression of the follow-up period, 12 patients (60%), the median TTP22.5 month (April -38 months), the 1-year survival rate was 100%. Statistical analysis showed that the time to tumor progression (TTP) with no significant correlation between efficacy (P = 0.90). Conclusion: GIST incidence no significant gender differences in different parts of the digestive tract can occur most commonly in the stomach and small intestine; 2 of GIST symptoms of non-specific preoperative diagnosis is low, CT examination can help diagnosis; GIST has has a good correlation between benign and malignant relative risk of relapse risk assessment of tumor size and mitotic grading standards of prognosis; mesylate imatinib treatment of GIST safe and efficient, and the disease control rate was 95.2% can extend progression-free survival and overall survival, major adverse reactions, including edema, nausea, fatigue, skin rashes, itchy skin, blood cells decline was well tolerated; 5. Evaluation Criteria of Solid Tumors (RECIST) is not well Prediction imatinib treatment of GIST time to disease progression.

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