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Preoperative imatinib facilitates complete resection of locally advanced primary GIST by a less invasive procedure

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Abstract

Complete resection is the most effective therapy for gastrointestinal stromal tumors (GISTs). Complete resection of locally advanced primary GIST by less invasive procedure is usually difficult at initial diagnosis. Imatinib has been successful in treating locally advanced and metastatic GIST and this report shares the experiences in preoperative use of imatinib for patients with locally advanced primary GISTs. The procedure of treatment and completeness of resection were retrospectively accessed for locally advanced primary GIST. Disease-free survival (DFS) and overall survival (OS) after resection were analyzed. Thirteen patients were treated with imatinib preoperatively. All patients received surgical resection after a median imatinib treatment of 7 months when most tumors shrunk. All patients achieved R0 resection without tumor rupture. Two patients received an en-bloc multivisceral resection for the invasion of surrounding organs and 3 patients underwent Mile’s operation for a low rectal tumor. Eleven patients were disease-free. Median DFS or OS had not been reached, while 1- and 3-year DFS were estimated to be 92.3 and 76.9 %, respectively. 1- and 3-year OS were both estimated to be 100 %. Preoperative use of imatinib is useful in locally advanced primary GIST by downsizing the tumor in most patients and facilitating complete resection through less invasive procedures without tumor rupture.

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References

  1. Fletcher CDM, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459–65.

    Article  PubMed  Google Scholar 

  2. Hirota S, et al. Gain-of-function mutations of platelet-derived growth factor receptor alpha gene in gastrointestinal stromal tumors. Gastroenterology. 2003;125(3):660–7.

    Article  PubMed  CAS  Google Scholar 

  3. Hirota S. Gain-of-Function Mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279(5350):577–80.

    Article  PubMed  CAS  Google Scholar 

  4. Heinrich MC, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 2003;299(5607):708–10.

    Article  PubMed  CAS  Google Scholar 

  5. DeMatteo RP, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231(1):51–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Dematteo RP, et al. Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol. 2002;33(5):466–77.

    Article  PubMed  CAS  Google Scholar 

  7. Langer C, et al. Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg. 2003;90(3):332–9.

    Article  PubMed  CAS  Google Scholar 

  8. Hohenberger P, et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg. 2010;97(12):1854–9.

    Article  PubMed  CAS  Google Scholar 

  9. Joensuu H, et al. Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med. 2001;344(14):1052–6.

    Article  PubMed  CAS  Google Scholar 

  10. Demetri GD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347(7):472–80.

    Article  PubMed  CAS  Google Scholar 

  11. van Oosterom AT, et al. Safety and efficacy of imatinib (STI571) in metastatic gastrointestinal stromal tumours: a phase I study. Lancet. 2001;358(9291):1421–3.

    Article  PubMed  Google Scholar 

  12. Verweij J, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet. 2004;364(9440):1127–34.

    Article  PubMed  CAS  Google Scholar 

  13. Antonescu CR, et al. Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation. Clin Cancer Res. 2005;11(11):4182–90.

    Article  PubMed  CAS  Google Scholar 

  14. Eisenberg BL, et al. Phase II trial of neoadjuvant/adjuvant imatinib mesylate (IM) for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ACRIN 6665. J Surg Oncol. 2009;99(1):42–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Fiore M, et al. Preoperative imatinib mesylate for unresectable or locally advanced primary gastrointestinal stromal tumors (GIST). Eur J Surg Oncol. 2009;35(7):739–45.

    Article  PubMed  CAS  Google Scholar 

  16. Andtbacka RH, et al. Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol. 2007;14(1):14–24.

    Article  PubMed  Google Scholar 

  17. Raut CP, et al. Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors. J Clin Oncol. 2006;24(15):2325–31.

    Article  PubMed  CAS  Google Scholar 

  18. Blesius A, et al. Neoadjuvant imatinib in patients with locally advanced non metastatic GIST in the prospective BFR14 trial. BMC Cancer. 2011;11:72.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Choi H. Response evaluation of gastrointestinal stromal tumors. Oncologist. 2008;13(Suppl 2):4–7.

    Article  PubMed  Google Scholar 

  20. Doyon C, et al. Prolonged Therapy with Imatinib Mesylate before Surgery for Advanced Gastrointestinal Stromal Tumor Results of a Phase II Trial. Int J Surg Oncol. 2012;2012:761576.

    PubMed  CAS  PubMed Central  Google Scholar 

  21. Peter Hohenberger, C.L., Clemens Martin Wendtner, Werner Hohenberger, Annette Pustowka, Eva Wardelmann, Elisabeth Andre, Thomas Licht, Neoadjuvant treatment of locally advanced GIST: Results of APOLLON, a prospective, open label phase II study in KIT- or PDGFRA-positive tumors. J Clin Oncol 2012. 30 (suppl; abstr 10031).

  22. Roberts PJ, Eisenberg B. Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer. 2002;38(Suppl 5):S37–8.

    Article  PubMed  Google Scholar 

  23. Dematteo RP, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373(9669):1097–104.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  24. Choi H, et al. CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol. 2004;183(6):1619–28.

    Article  PubMed  Google Scholar 

  25. Benjamin RS, et al. We should desist using RECIST, at least in GIST. J Clin Oncol. 2007;25(13):1760–4.

    Article  PubMed  Google Scholar 

  26. Van den Abbeele AD. The lessons of GIST–PET and PET/CT: a new paradigm for imaging. Oncologist. 2008;13(Suppl 2):8–13.

    Article  PubMed  Google Scholar 

  27. Joensuu H, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA. 2012;307(12):1265–72.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310009, China

    Weili Yang, Jiren Yu, Yuan Gao, Qianyun Shen, Qing Zhang, Xiaosun Liu, Zhicheng Zhao, Xiaoxiao Shi, Kankai Zhu & Yingchun Ma

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  1. Weili Yang
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  2. Jiren Yu
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  3. Yuan Gao
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  4. Qianyun Shen
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  5. Qing Zhang
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  6. Xiaosun Liu
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  7. Zhicheng Zhao
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  8. Xiaoxiao Shi
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  9. Kankai Zhu
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  10. Yingchun Ma
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Correspondence to Jiren Yu.

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Yang, W., Yu, J., Gao, Y. et al. Preoperative imatinib facilitates complete resection of locally advanced primary GIST by a less invasive procedure. Med Oncol 31, 133 (2014). https://doi.org/10.1007/s12032-014-0133-2

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  • DOI: https://doi.org/10.1007/s12032-014-0133-2

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