Long-Term Control for a Retroperitoneal Metastasis of Malignant Gastrointestinal Stromal Tumor after Chemoradiotherapy and Immunotherapy

Shioyama, Youichi Yakeish Yoshiyuki

doi:10.1080/028418601750071154

Cited by 15 publications

(5 citation statements)

References 10 publications

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“…Several case reports throughout the literature have shown significant clinical and radiographic responses with the use of radiation therapy, with the ability to maintain long-term disease control and palliate bone and visceral metastases in certain cases [9-20]. However, these studies are limited by small patient numbers and the inherent selection and publication biases of single patient reports.…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports have indicated that radiation can reduce tumor burden and produce durable local control in locally advanced and metastatic tumors [9-20], but, to our knowledge, a robust analysis of its effect in a cohort of patients has not been performed. To further investigate the role of radiation therapy in the treatment of GISTs, we retrospectively analyzed our institutional experience with patients that had locally advanced or metastatic GISTs treated with radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

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External beam radiation therapy for locally advanced and metastatic gastrointestinal stromal tumors

et al. 2013

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BackgroundThe role of radiation therapy (RT) in the management of gastrointestinal stromal tumors (GIST) is not well described. Here we report our institutional experience for patients with locally advanced or metastatic GIST treated with RT.MethodsBetween 1997 and 2012, 15 patients with 22 GISTs were treated with RT at our center. The median age was 68 (range, 41–86). Fourteen patients had stage IV disease and 1 patient had stage IIIB disease, per the American Joint Committee on Cancer (AJCC), 7th Edition staging. Tumors were in a variety of locations, and were most commonly referred for palliative treatment. Eighteen of 22 tumors were symptomatic. Prior to RT, 14 of 15 patients received systemic therapy in the form of tyrosine kinase inhibitors (TKIs) (n = 11), chemotherapy (n = 4), or both (n = 1). TKIs were used concurrently for nine tumors (40.9%). No tumors were treated with concurrent chemotherapy. Several fractionation schemes were used, most commonly 3 Gy × 10 (n = 8). Local progression-free survival and overall survival were estimated using the Kaplan-Meier method. Acute toxicity was graded per Common Terminology Criteria for Adverse Events (CTCAE) v4.0.ResultsThe median follow-up was 5.1 months (range, 1.3-28.3). At the time of analysis, 12 patients have died (80%). The estimated 6-month local progression-free survival and overall survival were 57.0% and 57.8%, respectively. Among the 18 symptomatic tumors, at least partial palliation was achieved in 17 (94.4%), and symptoms were completely palliated in eight (44.4%). Treatment was well tolerated, with no Grade 4 or 5 toxicities. There was no Grade ≥3 toxicity associated with concurrent TKI use.ConclusionsIn this largest series to date of GISTs treated with RT, a high rate of palliation was achieved for symptomatic tumors in a cohort of advanced stage, heavily pretreated patients. Treatment was well tolerated, and concurrent use of tyrosine kinase inhibitor therapy was not associated with additional toxicity. While follow-up was short, durable control is possible for some patients, providing evidence that GIST is not universally radioresistant and that RT can provide an important benefit in patients with progressive or metastatic disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

External beam radiation therapy for locally advanced and metastatic gastrointestinal stromal tumors

et al. 2013

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“…10 The patient underwent total gastrectomy, distal pancreatectomy, and splenectomy in 1990 for GIST. In 1993, she presented with an 11 cm retroperitoneal metastasis, which was treated with radiotherapy and concomitant chemotherapy (carboplatin and epirubicin).…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy in the treatment of gastrointestinal stromal tumor

2011

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Gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal tumors of the gastrointestinal tract. Up to one-third of GISTs are malignant with a high rate of metastasis. Surgical resection is the mainstay of care for patients with resectable disease. Imatinib mesylate, a selective tyrosine kinase inhibitor, is the current standard of care for GISTs that cannot be completely resected or in cases of metastatic GIST. Although often overlooked, radiation therapy is a viable option for select patients with GIST. We report the case of a patient with unresectable GIST who was treated with local radiotherapy and achieved long-term response. We also present a review of the literature regarding the use of radiotherapy in the treatment of GIST. GIST has been shown to be a radiosensitive tumor. Radiotherapy can offer long-term local control and should be considered in the adjuvant or palliative setting. The role of radiotherapy delivered concurrently with imatinib in the treatment of GIST may warrant further investigation.

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“…8,10–11 In 2001 Shioyama et al 12 described a case of a retroperitoneal GIST treated with primary radiotherapy (5100 cGy) but also with arterial chemotherapy and immunotherapy (OK432). No change in tumor size was reported on early computed tomography whereas CT scan at long-term follow-up revealed a marked decrease of tumor size.…”

Section: Discussionmentioning

confidence: 99%

Successful radiotherapy for local control of progressively increasing metastasis of gastrointestinal stromal tumor

et al. 2011

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Gastrointestinal stromal tumors (GISTs) are known to be poorly responsive to conventional chemotherapy and historically considered resistant to radiotherapy. In the past the mainstay of GIST treatment was surgery, but the introduction of tyrosine kinase inhibitors (TKIs) imatinib and sunitinib marked the beginning of a new era in the treatment of GIST patients. To date, radiotherapy for GIST has not been administered in clinical practice except for limited palliative settings and there are no clear data on the administration of radiotherapy, alone or in combination with TKIs, with a purely cytoreductive intent. We describe the clinical case of a 48-year-old woman with metastatic GIST treated with external radiotherapy in a critical supraclavicular tumor localization progressively increasing in size with several symptoms and not responsive to systemic TKI therapies. We obtained an initial shrinkage of the mass and subsequent stabilization with an immediate and clear clinical benefit. Although the historical medical literature considered GISTs resistant to radiation therapy, our clinical case suggests this treatment may be appropriate in selected patients.

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Long-Term Control for a Retroperitoneal Metastasis of Malignant Gastrointestinal Stromal Tumor after Chemoradiotherapy and Immunotherapy

Cited by 15 publications

References 10 publications

External beam radiation therapy for locally advanced and metastatic gastrointestinal stromal tumors

External beam radiation therapy for locally advanced and metastatic gastrointestinal stromal tumors

Radiotherapy in the treatment of gastrointestinal stromal tumor

Successful radiotherapy for local control of progressively increasing metastasis of gastrointestinal stromal tumor

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