Abstract
The first-line treatment for recurrent or metastatic gastrointestinal stromal tumors (GISTs) is imatinib, but the benefit of surgical intervention has not been determined. Surgery combined with long-term imatinib treatment (> 10 years) has rarely been reported. Patients with recurrent or metastatic GISTs who received surgery combined with long-term imatinib treatment (> 10 years) were included in this study. The demographic, surgical, and clinicopathologic data were retrospectively collected and analyzed. Five patients (three men and two women) with a median age of 47 (range 37–72) years were included. The primary tumor was located in the stomach and small intestine in three and two patients, respectively. Four patients who received complete resection (R0) had a single recurrent tumor. The remaining patient had more than two recurrent lesions, and the operation was done with gross residual disease (R2 resection, > 90% of the tumor bulk removed). All patients received more than 10 (median 13.50, range 12.30–13.67) years of imatinib treatment after resection of recurrent tumors. Two patients received a reduced dose of imatinib, and the remaining received 400 mg/day. The median follow-up was 17.0 (range 14.58–20.17) years since the primary tumor was resected. Two patients developed a tumor recurrence after 11.58 and 12.0 years of imatinib treatment, respectively. Surgical intervention may be beneficial when combined with long-term imatinib treatment for selected patients with recurrent or metastatic GISTs but should be further investigated.
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Joensuu H, Vehtari A, Riihimaki J et al (2012) Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 13(3):265–274
Li J, Ye Y, Wang J, Zhang B, Qin S, Shi Y, He Y, Liang X, Liu X, Zhou Y, Wu X, Zhang X, Wang M, Gao Z, Lin T, Cao H, Shen L, Expert Committee on GIST CSCO, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China, Peking University People’s Hospital, Department of Gastrointestinal Surgery, Beijing 100044, China, Fudan University Zhongshan Hospital, Department of Pathology, Shanghai 200032, China, Sichuang University Huaxi Hospital, Department of Gastrointestinal Surgery, Chengdu 610041, China, People’s Liberation Army Cancer Center, 81st Hospital of People’s Liberation Army, Department of Medical Oncology, Nanjing 210002, China, Fudan University Cancer Hospital, Department of Gastric Surgery, Shanghai 200032, China, The First Affiliated Hospital, Sun Yat-sen University, Department of Gastrointestinal Surgery, Guangzhou 510080, China, Shanxi Provincial Cancer Hospital, Department of Gastrointestinal Surgery, Shanxi 030013, China, Chinese PLA General Hospital, Department of General Surgery, Beijing 100853, China, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Department of General Surgery, Shanghai 200127, China (2017) Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor. Chin J Cancer Res 29(4):281–293
Verweij J, Casali PG, Zalcberg J, LeCesne A, Reichardt P, Blay JY, Issels R, van Oosterom A, Hogendoorn PCW, van Glabbeke M, Bertulli R, Judson I (2004) Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 364(9440):1127–1134
Patrikidou A, Chabaud S, Ray-Coquard I, Bui BN, Adenis A, Rios M, Bertucci F, Duffaud F, Chevreau C, Cupissol D, Domont J, Pérol D, Blay JY, le Cesne A, French Sarcoma Group (2013) Influence of imatinib interruption and rechallenge on the residual disease in patients with advanced GIST: results of the BFR14 prospective French Sarcoma Group randomised, phase III trial. Ann Oncol 24(4):1087–1093
Keung EZ, Fairweather M, Raut CP (2016) The role of surgery in metastatic gastrointestinal stromal tumors. Curr Treat Options in Oncol 17(2):8
Van Glabbeke M, Verweij J, Casali PG et al (2005) Initial and late resistance to imatinib in advanced gastrointestinal stromal tumors are predicted by different prognostic factors: a European Organisation for Research and Treatment of Cancer-Italian Sarcoma Group-Australasian Gastrointestinal Trials Group study. J Clin Oncol 23(24):5795–5804
Rubio-Casadevall J, Martinez-Trufero J, Garcia-Albeniz X et al (2015) Role of surgery in patients with recurrent, metastatic, or unresectable locally advanced gastrointestinal stromal tumors sensitive to imatinib: a retrospective analysis of the Spanish Group for Research on Sarcoma (GEIS). Ann Surg Oncol 22(9):2948–2957
Tjhoi WEH, Li K, Shou CH, Yang WL, Yu JR (2019) Long-term adjuvant imatinib treatment for a patient who underwent complete resection of a localized recurrent gastrointestinal stromal tumor after preoperative imatinib treatment: a case report. Medicine (Baltimore) 98(6):e14477
Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M, Muhammad Tunio G, Matsuzawa Y, Kanakura Y, Shinomura Y, Kitamura Y (1998) Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279(5350):577–580
Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen CJ, Joseph N, Singer S, Griffith DJ, Haley A, Town A, Demetri GD, Fletcher CD, Fletcher JA (2003) PDGFRA activating mutations in gastrointestinal stromal tumors. Science 299(5607):708–710
Wardelmann E, Merkelbach-Bruse S, Pauls K, Thomas N, Schildhaus HU, Heinicke T, Speidel N, Pietsch T, Buettner R, Pink D, Reichardt P, Hohenberger P (2006) Polyclonal evolution of multiple secondary KIT mutations in gastrointestinal stromal tumors under treatment with imatinib mesylate. Clin Cancer Res 12(6):1743–1749
Lee JH, Kim Y, Choi JW, Kim YS (2013) Correlation of imatinib resistance with the mutational status of KIT and PDGFRA genes in gastrointestinal stromal tumors: a meta-analysis. J Gastrointestin Liver Dis 22(4):413–418
Patrikidou A, Le Cesne A (2017) Key messages from the BFR14 trial of the French Sarcoma Group. Future Oncol 13(3):273–284
Gastrointestinal Stromal Tumor Meta-Analysis G (2010) Comparison of two doses of imatinib for the treatment of unresectable or metastatic gastrointestinal stromal tumors: a meta-analysis of 1,640 patients. J Clin Oncol 28(7):1247–1253
Cai Z, Yin Y, Shen C, Tang S, Yin X, Chen Z, Zhang B (2018) Role of surgical resection for patients with recurrent or metastatic gastrointestinal stromal tumors: a systematic review and meta-analysis. Int J Surg 56:108–114
Zaydfudim V, Okuno SH, Que FG, Nagorney DM, Donohue JH (2012) Role of operative therapy in treatment of metastatic gastrointestinal stromal tumors. J Surg Res 177(2):248–254
Bauer S, Rutkowski P, Hohenberger P, Miceli R, Fumagalli E, Siedlecki JA, Nguyen BP, Kerst M, Fiore M, Nyckowski P, Hoiczyk M, Cats A, Casali PG, Treckmann J, van Coevorden F, Gronchi A (2014) Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib -- analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol 40(4):412–419
Sato S, Tsujinaka T, Masuzawa T, Yamamoto K, Takahashi T, Yamashita Y, Fujita J, Takagi M, Hirota S, Nishida T (2017) Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry. Surg Today 47(1):58–64
Bischof DA, Kim Y, Blazer DG 3rd et al (2014) Surgical management of advanced gastrointestinal stromal tumors: an international multi-institutional analysis of 158 patients. J Am Coll Surg 219(3):439–449
Wang D, Zhang Q, Blanke CD, Demetri GD, Heinrich MC, Watson JC, Hoffman JP, Okuno S, Kane JM, von Mehren M, Eisenberg BL (2012) Phase II trial of neoadjuvant/adjuvant imatinib mesylate for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumors: long-term follow-up results of Radiation Therapy Oncology Group 0132. Ann Surg Oncol 19(4):1074–1080
Yeh CN, Wang SY, Tsai CY, Chen YY, Liu CT, Chiang KC, Chen TW, Liu YY, Yeh TS (2017) Surgical management of patients with progressing metastatic gastrointestinal stromal tumors receiving sunitinib treatment: a prospective cohort study. Int J Surg 39:30–36
Mussi C, Ronellenfitsch U, Jakob J, Tamborini E, Reichardt P, Casali PG, Fiore M, Hohenberger P, Gronchi A (2010) Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients? Ann Oncol 21(2):403–408
Gold JS, van der Zwan SM, Gonen M et al (2007) Outcome of metastatic GIST in the era before tyrosine kinase inhibitors. Ann Surg Oncol 14(1):134–142
An HJ, Ryu MH, Ryoo BY, Sohn BS, Kim KH, Oh ST, Yu CS, Yook JH, Kim BS, Kang YK (2013) The effects of surgical cytoreduction prior to imatinib therapy on the prognosis of patients with advanced GIST. Ann Surg Oncol 20(13):4212–4218
Patel S (2013) Long-term efficacy of imatinib for treatment of metastatic GIST. Cancer Chemother Pharmacol 72(2):277–286
Kim JH, Ryu MH, Yoo C, Chae H, Na H, Beck M, Kim BS, Yoo MW, Yook JH, Kim BS, Kim KH, Kim CW, Kang YK (2019) Long-term survival outcome with tyrosine kinase inhibitors and surgical intervention in patients with metastatic or recurrent gastrointestinal stromal tumors: a 14-year, single-center experience. Cancer Med 8(3):1034–1043
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1. Concept and design of the study: Chunhui Shou, Jiren Yu.
2. Drafting the article or revising: Chunhui Shou, Qing Gao, Weili Yang, Qing Zhang, Jiren Yu.
3. Final approval of the version to be published: Chunhui Shou, Qing Gao, Weili Yang, Qing Zhang, Xiaosun Liu, Jiren Yu.
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This study is approved by the Research Ethics Committee of the First Affiliated Hospital, College of Medicine, Zhejiang University.
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Shou, C., Gao, Q., Yang, W. et al. Surgery Combined with Long-Term Imatinib Treatment for Patients with Recurrent or Metastatic Gastrointestinal Stromal Tumors. Indian J Surg 83, 38–42 (2021). https://doi.org/10.1007/s12262-020-02261-4
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DOI: https://doi.org/10.1007/s12262-020-02261-4