胃肠间质瘤的外科及靶向治疗策略

The strategy of surgical treatment and targeted therapy in gastrointestinal stromal tumors

众所周知,伊马替尼等靶向药物改变了胃肠间质瘤(GIST)病人的治疗策略。但目前伊马替尼等的应用已从单纯药物治疗模式向与外科治疗联合应用的模式转变。PET-CT显像结果与临床症状缓解相一致,可早期评价GIST病人的疗效。动态增强超声造影已成为GIST靶向药物治疗疗效评价新的功能成像方法。对于高危的GIST病人,术后应采用伊马替尼辅助治疗1～2年。新辅助治疗在GIST中的应用已被广泛接受。目前认为对于伊马替尼耐药的病例,应用舒尼替尼治疗是安全可接受的。

It is well known that imatinib, as a targeted drug, has converted the therapy strategy of GIST patients. However, currently, the usage of imatinib has changed from the mode of merely drug therapy to the style of combining drug therapy and surgical treatment. The results of PET-CT imaging are in accord with symptomatic relief of GIST patients, which suggests that PET-CT imaging can he used in assessing the healing efficacy at the early stage of treatment. Dynamic enhanced ultrasonic contrast has become a new function imaging for evaluating the effect of targeted therapy in GIST patients. As for high risk GIST patients, imatinib , as an adjuvant therapy, should be used for 1 to 2 years. Neoadjuvant therapy has been widely accepted. Currently, with regards to patients with imatinib resistence, sunitinib could be adopted for GIST patients.