Gastrointestinal Stromal Tumors: Case Series of 29 Patients Defining the Role of Imatinib Prior to Surgery

Shrikhande, Shailesh V.; Marda, Sachin S.; Suradkar, Kunal; Arya, Supreeta; Shetty, Guruprasad; Bal, Munita; Shukla, Parul J.; Goel, Mahesh; Mohandas, K. M.

doi:10.1007/s00268-012-1440-4

Cited by 21 publications

(18 citation statements)

References 30 publications

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“…The EFS and OS seen in this study are consistent with previously conducted studies [4,8,15], although the high rate of progression/unresectability on neoadjuvant IM (20 %) seen with this study is previously not reported. Potential reasons for this include the slightly lower prevalence of stomach GIST and exon 11 mutants in our study compared to previous studies and higher % of the KIT/PDGFRA wild patients ('WT' category).…”

Section: Discussionsupporting

confidence: 94%

“…However, patients with GIST may be locally advanced/ unresectable at presentation or present in locations that entail morbid curative resections like rectum, duodenum or oesophagus. This category of patients has been the focus of recent studies elaborating the role of neoadjuvant or preoperative IM followed by evaluation for surgery [4][5][6]. While the phase II RTOG 0132 trial evaluated IM (600 mg/day) prospectively [7], the largest experience for neoadjuvant IM comes from the EORTC-STBSG analysis of 161 patients with locally advanced GIST [8].…”

Section: Introductionmentioning

confidence: 99%

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Neoadjuvant Imatinib in Locally Advanced Gastrointestinal stromal Tumours, Will Kit Mutation Analysis Be a Pathfinder?

Ramaswamy¹,

Ostwal²,

Shetty³

et al. 2016

J Gastrointest Canc

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One hundred twenty-five patients with LA or LR GIST were treated with NA IM. Forty-five patients (36 %) had undergone c-kit mutation testing. Exon 11 was seen in 25 patients (55.5 %), 3 with exon 9 (6.7 %) and 2 with exon 13 (4.4 %). Twelve were wild type (26.6 %) and 3 (6.7 %) were declared uninterpretable. Response rate (RR) for the exon 11 mutants was higher than the non-exon 11 mutant group (84 vs. 40 %, p = 0.01). Disease stabilization rate (DSR) rates were also higher in the exon 11 subgroup than non-exon 11 group (92 vs. 75 %). Eighty-four per cent exon 11 and 75 % non-exon 11 mutants were surgical candidates. Patients undergoing surgery had significantly improved event free survival (EFS) (p < 0.001) compared to patients not undergoing surgery, with the same trend seen in OS (p = 0.021). Patients with a SD on response to NA IM had a lower EFS (p = 0.076) and OS compared to patients achieving CR/PR. There were no differences between the various exon variants in terms of outcomes and responses CONCLUSION: Upfront evaluation of kit mutation status may help us in delineating separate treatment strategies for potentially biologically different tumours and assessing the correct timing of surgery for this subset of GIST.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal stromal Tumours, Will Kit Mutation Analysis Be a Pathfinder?

Ramaswamy¹,

Ostwal²,

Shetty³

et al. 2016

J Gastrointest Canc

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“…Our results differ from the RTOG 0132 phase 2 trial in which 83% of patients had SD amongst the 31 patients with primary GIST and lesser PR rates. This is possibly due to the shorter duration of neoadjuvant IM given in this trial (8)(9)(10)(11)(12) weeks) compared to our study (12).…”

Section: Discussionmentioning

confidence: 43%

“…Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib spillage of tumor cells (8)(9)(10). There is growing evidence for neoadjuvant IM therapy in terms of disease free survival (DFS) and overall survival (OS), with major evidence of benefit shown in the EORTC-STBSG retrospective analysis (11)(12)(13)(14)(15).…”

Section: Original Articlementioning

confidence: 99%

Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib

Ramaswamy¹,

Jain²,

Sahu³

et al. 2016

J. Gastrointest. Oncol.

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Background: Multimodality treatment of gastrointestinal stromal tumor (GIST) with surgery and adjuvant imatinib mesylate (IM), along with an emerging role for neoadjuvant IM prior to evaluation for resectability has resulted in high survival rates. Methods: We conducted a retrospective analysis of prospectively collected data of patients who underwent surgery for GIST, prior to or followed by IM therapy. A total of 112 patients underwent surgery between January 2009 and March 2015 at our centre. This included 27 patients with upfront resectable disease, 76 patients with locally advanced GIST who received neoadjuvant IM followed by surgery and 9 patients with metastatic disease who had excellent response to IM and were taken for surgery. Results: The primary tumor in the non metastatic patients was in the stomach (53%), duodenum (16%), rectum (12%), jejunum (11%), ileum (7%), and others (2%). Median duration of neoadjuvant IM was 5 months with 4 patients showing disease progression during neoadjuvant IM. Ninety-three percent of all patients had R0 resections, while 7% had R+ resections. The estimated 3-and 5-year DFS in non-metastatic patients was 86.1% and 67% respectively with a 3-and 5-year median OS of 95.4% and 91.7% respectively.Five-year PFS and OS for the metastatic patients was 88.8% and 100% respectively. Lack of adjuvant IM was the only factor related to inferior PFS and OS. Conclusions: Longer duration of neoadjuvant IM should be considered in locally advanced GIST prior to surgery and resection may be considered in responding metastatic patients. J Gastrointest Oncol 2016;7(4):624-631 jgo.amegroups.com spillage of tumor cells (8-10). There is growing evidence for neoadjuvant IM therapy in terms of disease free survival (DFS) and overall survival (OS), with major evidence of benefit shown in the EORTC-STBSG retrospective analysis (11)(12)(13)(14)(15).The purpose of this study was to evaluate the demographic profile, presentation and outcomes of 112 patients with GIST who underwent surgery at our institution and were potential candidates for either neoadjuvant or adjuvant IM over a period of 6 years. We also attempted to identify potential prognostic factors with respect to outcomes and placed special emphasis on patients receiving neoadjuvant IM. MethodsA retrospective analysis of prospectively maintained database of all GIST patients who underwent surgery and presented between January 2009 to March 2015 at Department of GI & Hepatopancreaticobiliary Oncology, Tata Memorial Hospital, Mumbai, was performed. Clinical and radiological data were recorded from patient files and electronic medical records. Patients presenting in the above study period were subdivided on the basis of clinical presentation and treatment received into localized operable, locally advanced, operated elsewhere on adjuvant treatment and incidental GISTs. Locally advanced GISTs were defined by the size, need for multivisceral resections, anatomic proximity with major vessels and risk of intraoperative tumor spillage. Patients opera...

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“…Recent studies have demonstrated the importance of neoadjuvant therapy on locally advanced/ unresectable GIST or tumors present in complicated anatomical locations such as rectum, duodenum, or esophagus [36-38]. Patients with rectal, duodenal, or other GIST may be a good target population for neoadjuvant therapy because preservation of organ functions and avoiding enlarging the operative extent such as total gastrectomy or PD.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological and Prognostic Features of Surgical Management in Duodenal Gastrointestinal Stromal Tumors

Shi¹,

Huang²,

Wang³

et al. 2017

Dig Surg

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Background and Objectives: The rarity of duodenal gastrointestinal stromal tumors (DGIST) led to only limited data being available on their management and prognosis. We retrospectively analyzed the clinicopathological features, surgical treatments, adjuvant therapy, and prognosis of DGIST. Methods: Sixty-one patients were identified at diagnosis of primary DGIST from February 2005 to December 2015. One hundred twenty six patients with small intestinal gastrointestinal stromal tutors (GIST) were selected as control groups. Survival analyses were calculated using the Kaplan-Meier method. Results: Three- and five-year recurrence/metastasis-free survival rates of patients with DGIST were similar to those of patients with small intestinal GIST (p > 0.05 for all). Out of 61 cases with DGIST, 45 patients were treated with Limited Resection (LR). Sixteen patients were treated with Pancreaticoduodenectomy (PD). The 3- and 5-year recurrence/metastasis-free survival rates of the PD group and LR group were of no significant difference (p > 0.05 for all). Univariate analysis indicated that factors including surgical approaches, mitotic count, size, and risk grades were significantly associated with recurrence/metastasis-free survival (log-rank test, p < 0.05). Multivariate analysis demonstrated that the mitotic count was independently correlated with a worse recurrence/metastasis-free survival. Conclusions: Patients with radical resected DGIST had a favourable prognosis, which is similar to that of small intestinal GIST. Both LR and PD were optimal choices for treating DGIST.

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Gastrointestinal Stromal Tumors: Case Series of 29 Patients Defining the Role of Imatinib Prior to Surgery

Cited by 21 publications

References 30 publications

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal stromal Tumours, Will Kit Mutation Analysis Be a Pathfinder?

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal stromal Tumours, Will Kit Mutation Analysis Be a Pathfinder?

Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib

Clinicopathological and Prognostic Features of Surgical Management in Duodenal Gastrointestinal Stromal Tumors

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