Excision of a Large Gastrointestinal Stromal Tumour Following 16 Months of Neoadjuvant Therapy with Imatinib (Case Report)

Abstract

Introduction: Although the standard treatment for stromal tumours is surgery, in locally advanced forms, it is often necessary to achieve tumour downstaging to improve surgical outcomes. Neoadjuvant treatment in gastrointestinal stromal tumours (GISTs) with tyrosine kinase inhibitors, including imatinib, has been shown to be effective in several studies, but the duration of this treatment is still a subject of debate. Case report: We report a case of a large GIST of the stomach in a 51-year-old patient with atypical presentation that was initially unresectable. Neoadjuvant treatment with imatinib for 16 months resulted in a good response, allowing secondary surgical excision. Conclusion: Imatinib in neoadjuvant therapy should be continued as long as there is a good response and tolerance to the medication to obtain tumour downsizing compatible with carcinologic excision.

The Role of Neoadjuvant Therapy in a Giant Gastric Gastrointestinal Stromal Tumour: A Case Report and Review of the Literature

“…These two factors, i.e., tumour rupture and the presence of a residual tumour, are significantly associated with recurrence and poor prognosis [12]. Hence, studies recommend neoadjuvant therapy for large GISTs to cause tumour shrinkage, thereby reducing the risks of tumour rupture and incomplete resection [13], and improving R2 resection rates associated with favourable survival [14]. GIST is categorized as small (<5 cm), medium (5-10 cm), and large (>10 cm), with an average size of 8.78 cm (ranging from 0.6 cm to 25.5 cm) [15,16].…”

“…Recent data seem to confirm the presence of an interindividual difference in the treatment response. While KIT exon 11 and 13 mutations are associated with a good response, KIT exon nine mutations and PDGFRA gene mutations are linked to a poor response [13].…”