Resection combined with imatinib therapy for liver metastases of gastrointestinal stromal tumors
- 276 Downloads
To evaluate the effectiveness of resecting liver metastases of gastrointestinal stromal tumors (GISTs), when performed in conjunction with imatinib treatment.
Forty-one patients with pathologically diagnosed GIST and liver metastases were randomly assigned to an operation group (neoadjuvant therapy + resection + adjuvant therapy with imatinib) or a nonoperation group (imatinib alone). Patients were monitored for up to 36 months, and survival was analyzed.
We monitored 39 patients throughout the 36-month follow-up period, recording 1- and 3-year survival rates of 100% and 89.5% in the operation group and 85% and 60% in the nonoperation group, respectively. There was a significant difference in overall survival between the operation and nonoperation groups (P = 0.03). Furthermore, resection improved the survival of patients who responded poorly to 6 months of preoperative imatinib treatment, compared with that of their counterparts in the nonoperation group (P = 0.04).
These findings suggest that surgical intervention in combination with imatinib treatment is more effective than imatinib alone against GIST liver metastases, with minimal complications and side effects.
Key wordsGastrointestinal stromal tumor Surgery Neoadjuvant therapy Tyrosine kinase inhibitor Imatinib
Unable to display preview. Download preview PDF.
- 4.Goss GA, Merriam P, Manola J, Singer S, Fletcher CD, Demetri GD. Clinical and pathological characteristics of gastrointestinal stromal tumors (GIST). Prog Proc Am Soc Clin Oncol 2000;19:599.Google Scholar
- 9.Choi H, Charnsangavej C, Macapinlac H, Burgess M, Patel S, Chen L, et al. Correlation of computerized tomography (CT) and positron emission tomography (PET) in patients with metastatic GIST treated at a single institution with imatinib mesylate (abstract 3290). Proc Am Soc Clin Oncol 2003;22:819.Google Scholar
- 10.DeMatteo RP, Owzar K, Antonescu CR, Maki R, Demetri GD, McCarter M, et al. Efficacy of adjuvant imatinib mesylate following complete resection of localized, primary gastrointestinal stromal tumor (GIST) at high risk of recurrence: The U.S. Intergroup phase II trial ACOSOG Z9000. American Society of Clinical Oncology 2008 Gastrointestinal Cancers Symposium, 25–27 January 2008, Orlando, FL, 2008. A–8.Google Scholar
- 11.Zhan WH, China Gastrointestinal Cooperative Group. Efficacy and safety of adjuvant post-surgical therapy with imatinib in patients with high risk of relapsing GIST (abstract 10045). J Clin Oncol 2007;25:556.Google Scholar
- 13.Eisenberg BL, Harris J, Blanke CD, Demetri GD, Heinrich MC, Watson JC, 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;99:42–47.CrossRefPubMedGoogle Scholar
- 15.Haller F, Detken S, Schulten HJ, Happel N, Gunawan B, Kuhlgatz J, et al. Surgical management after neoadjuvant imatinib therapy in gastrointestinal stromal tumours (GISTs) with respect to imatinib resistance caused by secondary KIT mutations. Ann Surg Oncol 2007;14:526–532.CrossRefPubMedGoogle Scholar
- 17.Blanke CD, Demetri GD, Von MM, Heinrich MC, Eisenberg B, Fletcher JA, et al. Long-term results from a randomized phase II trial of standard-versus higher-dose imatinib mesylate for patients with unresectable or metastatic gastrointestinal stromal tumors expressing KIT. J Clin Oncol 2008;26:620–625.CrossRefPubMedGoogle Scholar
- 18.Blanke CD, Rankin C, Demetri GD, Ryan CW, von Mehren M, Benjamin RS, et al. Phase III randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol 2008;26:626–632.CrossRefPubMedGoogle Scholar
- 20.Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205–216.CrossRefPubMedGoogle Scholar
- 21.Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 2007;25:1753–1759.CrossRefPubMedGoogle Scholar