재발된 위장 GIST에 대한 Imatinib Mesylate의 효과
Effect of Imatinib Mesylate in Recurrent Gastric GIST
이중선, 오성태, 김용진, 최원용, 육정환, 김병식, 김정선, 김태원,
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이중선 ( Lee Jung-Sun )
울산대학교 의과대학 서울아산병원 외과학교실
오성태 ( Oh Sung-Tae )
울산대학교 의과대학 서울아산병원 외과학교실
김용진 ( Kim Yong-Jin )
울산대학교 의과대학 서울아산병원 외과학교실
최원용 ( Choi Won-Yong )
울산대학교 의과대학 서울아산병원 외과학교실
육정환 ( Yook Jeong-Hwan )
울산대학교 의과대학 서울아산병원 외과학교실
김병식 ( Kim Byung-Sik )
울산대학교 의과대학 서울아산병원 외과학교실
김정선 ( Kim Jung-Sun )
울산대학교 의과대학 서울아산병원 진단병리학교실
김태원 ( Kim Tae-Won )
울산대학교 의과대학 서울아산병원 혈액종양내과
KMID : 0371320040660030183
Abstract
Purpose: Gastrointestinal stromal tumor (GIST) is the designation for c-kit signal driven mesenchymal tumor. A great majority of these tumors occur in the stomach and small intestine, and rarely in the colon, rectum and esophagus. Metastatic or recurrent GIST must be resected surgically because it is resistant to conventional cytotoxic chemotherapy. Following recent evidence for the dramatic effect of Imatinib mesylate (Glivec), Glivec has become available in our country since June 2001 without insurance coverage. Although some doubt remained, we applied Glivec to recurrent GIST patients with great expectation.
Methods: A retrospective analysis was made for 16 GIST patients who were resected during 2001. Follow up duration was 19 to 29 months. All pathologic slides were reexamined immunohistochemically by an experienced pathologist. Clinicopathologic comparison between the recurred and non-recurred groups was summarized into the tables. The therapeutic and side effects of Glivec were surveyed. CT scan files were reviewed to decided tumor regression or progression.
Results: Fifteen GISTs were resected in 2001. Seven cases recurred during 19 to 29 months of follow up. The recurred group was characterized by huge tumor size (mean 14 cm), serosal invasion and more than 10 mitosis in 50 HPF. A daily dose of 400 mg of Glivec was prescribed to every recurred GIST patients and CT scan was followed serially. The therapeutic effect of Glivec effect was drastic but variable; complete tumo remission (n=3), rebounded tumor growth at the same location after remission (n=1), and recurrence at another location after complete remission (n=2).
Conclusion: Glivec drastically reduced the size of recurrent gastric GIST initially. However, it is not clear how long Glivec should be taken at a great expense in fear of rebounded growth after abstaining. It appears that reoperation is necessary without delay when tumor remission slows down.
키워드
위장관간질종양;글리백;Gastric GIST;Imatinib msylate;Glivec
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