Recommendations for diagnostics and therapy of gastrointestinal stromal tumors (GIST) in 2010 [Zasady postȩpowania diagnostyczno-terapeutycznego u chorych na nowotwory podścieliskowe przewodu pokarmowego (GIST)]
Rutkowski P.,Klinika Nowotworow Tkanek Miekkich I Kosci |
Kulig J.,I Katedra Chirurgii Ogolnej I Klinika Chirurgii Gastroenterologicznej |
Krzakowski M.,Klinika Nowotworow Pluca I Klatki Piersiowej |
Osuch C.,I Katedra Chirurgii Ogolnej I Klinika Chirurgii Gastroenterologicznej |
And 17 more authors.
Nowotwory | Year: 2011
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Over the last years advances in the understanding of the molecular mechanisms of GIST pathogenesis have resulted in the emerging of GIST as a distinct sarcoma entity. This paper presents the guidelines for diagnostics and therapy of these tumors based on scientific research and experts' experience, These guidelines are commonly accepted and worthy of recommendation. Overexpression of the KIT receptor, as a consequence of mutation of the KITprotooncogene is highly specific for GIST and enables immunohistochemilcal detection staining (CD117) in tumor specimens. It is the most important criterion in microscopic diagnostics and for indicating treatment with small-molecule tyrosine kinase inhibitors. Sending material for molecular analysis is strongly recommended (for KIT and PDGFRA genotyping). Radical surgery is still the mainstay treatment for primary, localized, resectable GISTs, although although a significant ratio of patients after potentially curative operations develop recurrent or metastatic disease. In inoperable/metastatic lesions the treatment of choice is a tyrosine kinase inhibitor - imatynib mesylate - the first effective systemic therapy in advanced CD117(+) GIST. The recommended initial dose should be 400 mg daily (800 mg for exon 9 KIT mutants). Tretament monitoring should be based on serial computed tomography imaging of the abdominal cavity with the assessment of changes of tumor size and density. In case of disease progression the increase of imatynib dose to 800 mg daily is recommended and - if progression maintains - sunitinib in the initial dose of 50 mg daily should be introduced. Clinical trials evaluating the role of surgery combined with imatynib and the efficacy of other molecular targeted drugs in resistant cases are ongoing. Existing data indicate the beneficial role of adjuvant imatynib therapy in terms of relapse-free survival, especially in the group of patients with a significant risk of relapse. The presented recommendations for the diagnostics and therapy of GIST should be practically implemented by physicians involved in the management of GIST patients in Poland. Entering all GIST cases in the National Clinical Registry (http:// gist.coi.waw.pl) and standardising patient treatment in multidisciplinary teams with expertise in GIST therapy, as well as enrollment of new cases into prospective clinical trials, are recommended.
Bocian A.,Dzial Chirurgii Onkologicznej |
Szkudlarek J.,Medical University of Lódz |
Bartkowiak J.,Medical University of Lódz
Nowotwory | Year: 2013
Introduction: Breast carcinoma is one of the most common malignancies in women, and its carcinogenesis etiology is still unknown. Loss of MMR function prevents the correction of replicative errors leading to instability of the genome, and can be detected by polymorphisms in micro satellites (1-6 nucleotide repeat sequences). This is known as microsatellite instability (MSI), and is a hallmark of MMR dysfunction and can thus be used as a marker of MMR dysfunction in colorectal and other malignancies. Material and methods: We studied the presence of MSI in 81 invasive breast cancers and evaluated its relationship with patient age, tumor size, tumor type, lymph node metastasis, liver metastasis, brain metastasis, local recurrence, and other. Microsatellite analysis was performed using 10 markers selected for sensitive detection of microsatellite instability in breast cancer. Results: MSI was detected in 40 of 81 cases (49.4%), where MSI-H was in 15 cases (18.5%) and MSI-L was in 25 cases (30.9%). A statistically significant correlation was observed between MSI and liver metastasis and brain metastasis. We also found a correlation (not statistically significant) between MSI-H and lobular carcinoma. Conclusion: The analyzes performed showed that the presence of MSI in breast cancer was associated with shorter survival and was more aggressive when metastases to the liver and brain were present. © Polskie Towarzystwo Onkologiczne.
Trepka S.,Dzial Chirurgii Onkologicznej |
Rutkowski P.,Centrum Onkologii Instytut im. Marii Sklodowskiej Curie |
Nowecki Z.I.,Centrum Onkologii Instytut im. Marii Sklodowskiej Curie |
Sluszniak J.,Dzial Chirurgii Onkologicznej
Nowotwory | Year: 2010
Surgery is still the most important treatment modality to guarantee the highest survival ratio of melanoma patients. The adequacy of the surgical approach is a crucial aspect in face of the initial clinical appearances of the disease. Best results are obtained with the correct treatment of primary melanomas and lymph node metastases. To reach a general consensus on the surgical indications in terms of extension and timing, a large number of randomized trials have been conducted in the last 3-4 decades. The rationale behind these trials, even if proposed by different institutions on different continents, has been to find the most conservative surgical approach able to guarantee the same results as those achieved with more aggressive treatment. This lay behind the design of trials designed to determine the correct excision margin around primary melanomas in the most important studies. A similar approach has been followed in the preparation of several trials dedicated to the definition of the importance of performing immediate dissection of the locoregional nodes in view of the absence of clinical evidence of metastases. Ever since the sentinel node technique has become the standard treatment in a majority of institutions, the guidelines for the treatment of locoregional nodes have undergone a kind of revolution. In fact the policy of "wait and see" introduced by the aforementioned trials has been overriden by a more specific and selective even if a more invasive approach to obtain precise information regarding the status of clinically non-invaded locoregional nodes. The sentinel node biopsy technique makes use of a majority of scientific surgical tools, is the most conservative (when compared to elective node dissection), extremely precise and sophisticated and provides crucial data necessary to make decisions regarding the necessity to perform radical surgery, i.e. therapeutic node dissection. Radical lymph node dissection is recommended in case of confirmed regional lymph node metastases. However still little is known of the role of surgery in the treatment of patients with distant metastases and with extracutaneous melanoma.