A REVISIT TO MANAGEMENT OF GASTROINTESTINAL STROMAL TUMOUR (GIST) Joint Hospital Surgical Grand Round 17 Jan 2015 Grace Liu Pamela Youde Nethersole Eastern Hospital
16
Embed
A REVISIT TO MANAGEMENT OF GASTROINTESTINAL STROMAL TUMOUR (GIST) Joint Hospital Surgical Grand Round 17 Jan 2015 Grace Liu Pamela Youde Nethersole Eastern.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Slide 1
A REVISIT TO MANAGEMENT OF GASTROINTESTINAL STROMAL TUMOUR
(GIST) Joint Hospital Surgical Grand Round 17 Jan 2015 Grace Liu
Pamela Youde Nethersole Eastern Hospital
Slide 2
INTRODUCTION Surgical management is indicated whenever possible
because it is the only potentially curative option High risk GISTs
36 months adjuvant target therapy (imatinib)
Slide 3
HOW TO DEAL WITH SMALL GISTS? When we saw a small submucosal
mass, what should we do?
Slide 4
Small GIST
LAPAROSCOPIC RESECTION for small tumours 90% Studies have shown
laparoscopic resections of tumours up to 6cm with low recurrence
rates and margin negativity Koh, Y.X. et al. Annals of Surgical
Oncology, 20, 3549-3560.
Slide 9
Overall survivalDisease free survival Size >5-10cm DA
Bischof et al
Slide 10
High risk GIST after resection should receive adjuvant imatinib
for 36 months
Slide 11
A TUMOUR TOO LARGE
Slide 12
NEOADJUVANT THERAPY Aim: reduce tumor size to facilitate R0
resection and increase the likelihood of organ preservation may
decrease the risk of bleeding, postoperative complications, or
tumour rupture unresectable or borderline resectable primary tumour
potentially resectable tumour that requires extensive surgery local
recurrence of locally advanced disease NCCN Clinical Practice
Guideline in Oncology. ESMO Clinical Practice
Slide 13
Imatinib is given 2-6 months before surgery Interval assessment
of response by PET scan Before SUV=17.3 3 weeks after SUV=5.8
Slide 14
P Rutkowski et al Retrospective analysis of 10 EORTC centres,
161 patients with locally advanced, non-metastatic GIST Only 2
patients have disease progression during pre- operative phase R0
resection 83%, 5 yr DSS 95%
Slide 15
CONCLUSION Surgery for resectable GISTs, laparoscopic resection
for tumours