合併斷層掃描腫瘤密度和RECIST標準，評估局部晚期胃腸道間質腫瘤輔助Imatinib治療

Combined Computed Tomography-Measured Tumor Density and RECIST for Evaluating Neoadjuvant Therapy in Locally Advanced Gastrointestinal Stromal Tumors

蘇偉智(Wei-Chih Su)

指導教授 ： 王照元

共同指導教授 ： 潘美仁(Mei-Ren Pan)

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2017年)

摘要

目的
由於缺乏一個完善的臨床評估方法，決定局部晚期胃腸道間質瘤（LAGISTs）手術切除的最合適時機一直是一項挑戰。在本研究中，我們將測量斷層掃描（CT） - 腫瘤密度和實體腫瘤的評估標準（RECIST）相結合，以評估11例LAGIST患者的臨床反應。我們的目標是提供替代方法，以增強LAGISTs的手術切除率評估。

研究對象與方法
本研究招募了11名診斷為LAGIST的患者，其主要在2010年12月至2015年9月在本研究機構接受新輔助Imatinib治療。追蹤至2017年2月。通過測量CT影像上的腫瘤密度合併應用RECIST，同時分析腫瘤反應。還評估了臨床病理特徵、臨床結果與KIT和PDGFR基因突變特徵。

結果
使用合併CT測量的腫瘤密度和RECIST方法分析腫瘤反應顯示，11例患者中有10例被認為具有部分反應（PR），因此可以切除。根據RECIST，六個可切除的胃腸道間質瘤（GIST）中的兩個是疾病穩定(SD)的，但是使用我們的合併評估方法被歸類為PR。就KIT和PDGFR基因突變分析，三名患有KIT點突變的患者使用我們的合併方法被認為PR，而根據RECIST一名患者顯示PR，兩名患者顯示出穩定的疾病（SD）。

結論
我們建議合併CT測量的腫瘤密度和RECIST方法有助於確定LAGISTs手術切除的最合適時機。

關鍵字

斷層掃描腫瘤密度 ； 輔助Imatinib治療 ； 局部晚期胃腸道間質腫瘤

並列摘要

Background
Deciding the most appropriate timing for surgical resection of locally advanced gastrointestinal stromal tumors (LAGISTs) has conventionally been challenging, because no well-established clinical guideline is available. In this study, we combined computed tomography (CT)-measured tumor density and Response Evaluation Criteria in Solid Tumors (RECIST) to evaluate the clinical responses in 11 patients with LAGISTs. We aimed to offer alternative approaches that can enhance the surgical resectability evaluation of LAGISTs.

Methods
This study recruited 11 consecutive patients diagnosed with LAGISTs who had received neoadjuvant imatinib therapy primarily at the study institution from December 2010 to September 2015. They were followed up until February 2017. Tumor responses were simultaneously analyzed by measuring tumor density on CT images and applying RECIST. Clinicopathological features, clinical outcomes, and KIT and PDGFR gene mutation profiles were also evaluated.

Results
Analysis of tumor responses using the combined CT-measured tumor density and RECIST method revealed that 10 of 11 patients were considered to have a partial response (PR) and were thus resectable. Two of six resectable gastrointestinal stromal tumors (GISTs) were stable according to RECIST but were categorized as PR using our combined approach. According to the KIT and PDGFR gene mutation analyses, three patients with KIT point mutations were considered to have PR, determined using our combined method, whereas one patient showed a PR and two patients showed stable disease (SD), according to RECIST.

Conclusion
We suggest that our combined CT-measured tumor density and RECIST method is beneficial for deciding the most appropriate timing for surgical resection of LAGISTs.

並列關鍵字

CT-measured tumor density ； Neoadjuvant therapy ； Locally advanced gastrointestinal stromal tumors

參考文獻

References

1. Cassier PA, Ducimetière F, Lurkin A, et al. A prospective epidemiological study of new incident GISTs during two consecutive years in Rhône Alpes region: incidence and molecular distribution of GIST in a European region. Br J Cancer. 2010; 103(2):165-170.

2. Casali PG, Jost L, Reichardt P, et al. ESMO Guidelines Working Group. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009; 20(Supplement 4):64-67

3. Wang D, Zhang Q, Blanke CD, et al. Phase II trial of neoadjuvant/adjuvant imatinib mesylate for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumors: long-term follow-up results of radiation therapy oncology group 0132. Ann Surg Oncol. 2012;19(4):1074–1080.

4. Joensuu H. Gastrointestinal stromal tumor (GIST). Annals of Oncology. 2006; (Supplement 10):x280–x286.