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Chirurgische Therapieaspekte gastrointestinaler Stromatumoren

Aspects of surgical treatment for gastro-intestinal stromal tumors

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Zusammenfassung

Gastrointestinale Stromatumoren (GIST) stellen die häufigste Subgruppe von Weichgewebesarkomen dar. Sie entstehen in der Muskularisschicht von Ösophagus, Magen, Dünndarm und Rektum. Charakteristisch und wichtig für die Einschätzung des Tumorausmaßes ist die Randvaskularisation von Primärtumoren und Metastasen. Die Indikation zur Resektion gilt für Tumoren ab 2 cm Größe. Lokal fortgeschrittene GIST können sehr vorteilhaft mit Imatinib/Sunitinib neoadjuvant vorbehandelt werden, und es ist oft möglich, bei der Tumorgröße und wenn keine hypervaskularisierten Randbereiche vorliegen, ein geringeres Resektionsausmaß zu wählen. Auch im metastasierten Stadium hat die chirurgische Therapie einen Platz zur Eliminierung resistenter Metastasen bzw. zur Entfernung von Residualtumorgewebe als Versuch, einer sekundären Tumorprogression zu begegnen. Dieser Behandlungseffekt wird derzeit in einer randomisierten Phase-III-Studie überprüft.

Abstract

Gastro-intestinal stromal tumors (GIST) form the commonest subgroup of soft tissue sarcomas. They arise in the muscular layer of the esophagus, stomach, small intestines and rectum. Characteristic and important for the assessment of the extent of tumors is the peripheral rim vascularization of primary tumors and metastases. Indications for resection are given for tumors larger than 2 cm in size. Locally advanced GISTs can be advantageously treated with imatinib/sunitinib as neoadjuvant and it is often possible to select a low level of resection for this size of tumor and when the rim area is not hypervascularized. Even in the metastizing stage surgical treatment can be used for elimination of resistant metastases or for removal of residual tumor tissue in an attempt to counteract secondary tumor progression. The effect of this treatment is currently being tested in a randomized phase III study.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Forschungsunterstützung + Advisory Board + Honorare: Novartis; Advisory Board: Pfizer.

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  1. Sektion Chirurgische Onkologie und Thoraxchirurgie, Chirurgische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68135, Mannheim, Deutschland

    P. Hohenberger

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Hohenberger, P. Chirurgische Therapieaspekte gastrointestinaler Stromatumoren. Radiologe 49, 1122–1127 (2009). https://doi.org/10.1007/s00117-009-1853-8

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