利用基于 CT 的放射学标准监测新辅助治疗对 GIST 患者的手术治疗效果

IF 1.4 Q3 SURGERY Surgery open science Pub Date : 2024-07-14 DOI:10.1016/j.sopen.2024.07.002
Ylva A. Weeda , Gijsbert M. Kalisvaart , Henk H. Hartgrink , Aart J. van der Molen , Hans Gelderblom , Judith V.M.G. Bovée , Lioe-Fee de Geus-Oei , Willem Grootjans , Jos A. van der Hage
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引用次数: 0

摘要

目的这项单中心回顾性研究旨在确定接受新辅助酪氨酸激酶抑制剂(TKI)治疗的非转移性胃肠道间质瘤(GIST)患者因治疗引起的手术获益的发生率,并评估是否可以通过放射学反应标准来预测。方法39例非转移性GIST患者接受了新辅助TKI治疗,随后进行了治愈性手术,并使用造影剂增强计算机断层扫描(CE-CT)进行监测。手术获益由两名肿瘤外科专家独立评估,其定义是手术策略降级或手术复杂性降低。基线与最后一次术前扫描之间的放射学反应根据 RECIST 1.1、Choi 和容积标准确定。22/39例患者从手术中获益。在将放射学标准与手术获益结果进行比较时,计算了RECIST 1.1(90%、100.0%和82%)、Choi(64%、24%和96%)和容积测量(95%、100.0%和91%)的准确性、敏感性和特异性。对 30/39 例患者的肿瘤大小在治疗过程中的时间变化进行了评估。与非获益组相比,手术获益组的肿瘤体积在三个月内明显缩小(72 % vs. 25 %,p < 0.01)。14/19例手术获益患者的初始体积缩小率超过66%,之后体积略有缩小,中位缩小率为3.1%(IQR,2.1-7.8%)。在治疗诱导手术获益的患者中,几乎所有治疗诱导的体积缩小都是在三个月内实现的。
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Monitoring neoadjuvant treatment-induced surgical benefit in GIST patients using CT-based radiological criteria

Objective

This single-centre retrospective study aims to determine the incidence of therapy-induced surgical benefit in patients with non-metastatic gastrointestinal stromal tumour (GIST) treated with neoadjuvant tyrosine kinase inhibitors (TKI) and evaluate whether this can be predicted by radiological response criteria.

Methods

Thirty-nine non-metastatic GIST patients were treated with neoadjuvant TKI treatment, followed by curative-intended surgery, and monitored using contrast-enhanced computed tomography (CE-CT). Surgical benefit was independently assessed by two surgical oncologists and was defined by de-escalation of surgical strategy or reduced surgical complexity. Radiological response between baseline and the last preoperative scan was determined through RECIST 1.1, Choi and volumetric criteria.

Results

In this patient cohort, median neoadjuvant treatment interval was 8.3 (IQR, 3.9–10.6) months. Surgical benefit was gained in 22/39 patients. When comparing radiological criteria to findings on surgical benefit, accuracy, sensitivity, and specificity for RECIST 1.1 (90 %, 100.0 % and 82 %), Choi (64 %, 24 %, and 96 %) and volumetry (95 %, 100.0 %, and 91 %) were calculated. In 30/39 patients, temporal changes in tumour size over the course of treatment was assessed. Tumour volume reduced significantly in the surgical-benefit group compared to the non-benefit group (72 % vs. 25 %, p < 0.01) within three months. 14/19 surgical-benefit patients had an initial volume reduction above 66 %, after which volume reduced slightly with a median 3.1 % (IQR, 2.1–7.8 %) reduction.

Conclusion

Surgical benefit after neoadjuvant treatment was achieved in 56 % of patients and was most accurately reflected by size-based response criteria. In patients with therapy-induced surgical benefit, nearly all treatment-induced volume reductions were achieved within three months.

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CiteScore
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66 days
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