A Case of Gastrointestinal Stromal Tumor (GIST) of the Rectum, Treated by Sphincter-Preserving Surgery after Neoadjuvant Treatment

概要

論文の詳細を見る
A 94-year-old man was referred to our hospital with a huge rectal GIST, which had been diagnosed seven years earlier by core needle biopsy. CT and PET-CT revealed a bulky mass, 8 cm in diameter, in the presacral space. He refused an abdominoperineal resection, which is essential for large rectal GIST, so we started neoadjuvant treatment with imatinib at 400 mg/day to avoid rectal amputation. Six weeks later, the size of the tumor markedly decreased (41% decrease in maximum diameter), but adverse effects (severe edema with pleural effusion and pancytopenia) appeared. Two weeks after ceasing imatinib, we conducted sphincter-preserving, transsacral tumor resection. Pathologically, most tumor cells appeared atrophic with fibrotic change throughout the tumor. The patient has remained recurrence-free in the 18 months since surgery. The present case suggests that imatinib is useful as a neoadjuvant treatment for marginally-resectable GIST of the rectum.