title: [A case of Giant GIST of the stomach successfully treated with imatinib mesylate neoadjuvant therapy and followed postoperatively].
abstract: Since the advent of imatinib mesylate (IM), its clinical efficacy against gastrointestinal stromal tumor (GIST) has been widely acknowledged, and therapeutic strategies for this disease have undergone great changes. We recently experienced a case of giant GIST of the stomach that was successfully treated with IM neoadjuvant therapy prior to surgical resection, but liver metastasis recurred 1 year and 7 months after the operation. The patient was a 65-year-old male who presented at our department with the chief complaints of dizziness, malaise, and fever in April 2002. An abdominal CT revealed a mass with a maximum diameter of 17 cm, as well as a cystic septate mass, 12 cm in diameter, with a thick capsule in the left lobe of the liver. The patient was diagnosed with GIST of the stomach and liver metastasis. Since radical operation was considered difficult at that point, IM (400 mg/day) was started on May 9. The result of treatment was determined to be PR, and radical operation was considered feasible. On March 18, 2003, total gastrectomy and left hepatic lobectomy/S 6 partial lobectomy were performed in the surgery department of our hospital. The postoperative course was favorable and oral administration of IM was resumed soon after the operation. However, the drug was discontinued for financial reasons and a decreased white blood cell count (grade 3) 2 months after the operation. Recurrence in the liver and abdominal wall was found in October 2004, and oral administration of IM was resumed again. Currently, treatment with IM is ongoing. Case reports on the efficacy of IM neoadjuvant therapy are occasionally found in the literature, but there are few reports on its long-term prognosis. We report this case with a discussion of future therapeutic options.
authors.affiliation: Dept. of Gastroenterology and Rheumatology, Kushiro City General Hospital.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okuda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Masako
authors.initials: M
authors.lastname: Ueno
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shitani
authors.forename: Masanao
authors.initials: M
authors.lastname: Nasuno
authors.forename: Chikako
authors.initials: C
authors.lastname: Suzuki
authors.forename: Susumu
authors.initials: S
authors.lastname: Nishimura
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kimura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yonezawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Abe
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Makoto
authors.initials: M
authors.lastname: Kawabata
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D020360:Neoadjuvant Therapy; D010879:Piperazines / Q000627:therapeutic use*; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate