Prognostic Factors in Gastrointestinal Stromal Tumours.

Aqib, K Shaick (2008) Prognostic Factors in Gastrointestinal Stromal Tumours. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION : Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the digestive tract. Most gastrointestinal soft tissue neoplasms, previously classified as leiomyomas, schwannomas, leiomyoblastomas or leiomyosarcomas, are today classified as GIST on the basis of molecular and immunohistological features. They originate from gastrointestinal pacemaker cells and are characterised by overexpression of the tyrosine kinase receptor KIT. Overall 5-year survival after surgical resection of GIST is approximately 60%. However, these tumours span a wide clinical spectrum from benign to highly malignant. Prognostic factors have recently been identified for GIST and include tumour size, mitotic rate and other minor factors. At present, surgery is the standard treatment for primary resectable GIST. Benign GIST have an excellent prognosis after primary surgical treatment, with over 90% 5- year survival. While recurrent or malignant GIST, which are resistant to radiotherapy and chemotherapy, had until recently an extremely poor prognosis even after surgical resection, with median survival of 12 months. The development of a tyrosine kinase inhibitor has changed the management of unresectable malignant cases. This new tyrosine kinase inhibitor, imatinib mesylate, which inhibits the c-kit receptor, has proved highly effective against GIST and has improved survival in metastatic GIST. AIMS & OBJECTIVES : 1. To find out the actual number of Gastrointestinal stromal tumours treated in our institute based on c-kit positivity. 2. To identify the prognostic factors influencing recurrence and survival. 3. To identify subgroup of patients, who might benefit from adjuvant therapy. MATERIALS & METHODS : All the case records of patients who were diagnosed to have GIST (on the basis of c-kit positivity) were analysed individually. Case records of all the patients who were diagnosed to have intraabdominal sarcoma from the year 1999 to june 2007 were scrutinized. Paraffin blocks and slides of the above patients were retrieved from pathology dept. IHC study for c-kit were performed on the slides. All the c-kit positive cases were also included in the study. Of the 32 patients with GIST only 31 were available for analysis. CONCLUSION : Primary surgery remains the cornerstone in the treatment of localized and resectable GIST. Recurrent disease is still a great problem. Summarizing our results with the influence of high mitotic count, presence of tumour necrosis, large tumour size, incomplete surgical resection and primary site other than stomach on the DFS, which is reflected by a high rate of recurrences, we support the concept that all patients with these high risk features need to be assessed for adjuvant treatment with Imatinib. Considering the 100% chance of recurrence with an incomplete resection, neoadjuvant treatment with Imatinib followed by surgical resection and continuing of Imatinib administration is a reasonable option. This combination strategy may provide survival benefit. But it remains to be determined whether this multimodal approach may exceed the benefits associated with Imatinib monotherapy.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prognostic Factors in Gastrointestinal Stromal Tumours.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:34
Last Modified: 26 Jul 2017 02:34

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