Preoperative adjuvant therapy for locally advanced and recurrent/metastatic gastrointestinal stromal tumors: a retrospective study

Abstract

Background Preoperative imatinib mesylate therapy for gastrointestinal stromal tumors (GISTs) is controversial. This study aimed to explore the clinical efficacy and optimal duration of preoperative imatinib mesylate (IM) therapy in patients with locally advanced and recurrent/metastatic GISTs. Methods We retrospectively examined patients who received preoperative imatinib mesylate therapy from January 2013 to December 2018 at Xiangya Hospital, Central South University and the Second Xiangya Hospital of Central South University, China. Clinical data, including the results of tests for mutations in KIT and PDGFR, findings from regularly conducted re-examinations, abdominal enhanced computed tomography/magnetic resonance imaging data, responses to imatinib, progression-free survival and overall cancer-specific survival, were recorded. Results A total of 25 patients were enrolled in our study, including 18 with a locally advanced GIST and 7 with recurrent or metastatic GISTs. Their ages ranged from 22 to 70 years (M:F = 1.6:0.9), with a mean age of 50.48±12.51 years. The tumor locations included the stomach (56.0%), rectum (16.0%), enterocoelic/retroperitoneal sites (12.0%) and the small intestine (12.0%). Based on testing for mutations in KIT and PDGFR, 22 patients received 400 mg/d KIT, and 3 patients received 600 mg/d PDGFR. The median duration of preoperative IM therapy was 8.96±4.81 months, ranging from 3 to 26 months. According to the Choi criteria, 24 patients achieved a partial response (PR), and 1 patient had stable disease (SD). All patients underwent surgery after preoperative IM therapy, and no postoperative complications appeared. The 2-year PFS and 5-year PFS were 92% and 60%, respectively, and the total 5-year cancer-specific survival (CSS) was 92%. Conclusion Preoperative imatinib therapy is feasible for locally advanced and recurrent/metastatic GISTs and can effectively shrink the tumor size, allow organ sparing and avoid extensive organ resection. Moreover, the optimal duration of preoperative IM therapy in patients with locally advanced and recurrent/metastatic GISTs was 8.96±4.81 months, ranging from 3 to 26 months, and gastric GISTs had a better response to preoperative IM therapy than did non-gastric GISTs.

Prognostic Factors and Management of Colorectal Gastrointestinal Stromal Tumors

“…7 12 42 Furthermore, it is now known that location has an impact in tumor response to TKIs, since non-gastric GISTs have worse response to these drugs than their gastric counterparts. 15…”

“…Approximately 20% of the patients with GIST present with metastases at the time of diagnosis. 15 The tumor usually metastasizes to the liver and peritoneum. 1 Metastases to lymph nodes are rare, except in pediatric and syndromic GISTs.…”

“…1 Metastases to lymph nodes are rare, except in pediatric and syndromic GISTs. 1 15 The lung and bone are also rare sites for the occurrence of metastases 3 .…”

“…1 5 Immunochemistry is also important for GIST diagnosis and for the differential diagnosis with other neoplasms, insofar most GISTs stain for CD117, CD34, and DOG-1. 7 10 15 17 18 19 Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are also useful tools that can be used when approaching a patient with suspected GIST. 11 17…”

Minimally Invasive Surgery Versus Open Surgery for the Treatment of Rectal Gastrointestinal Stromal Tumor: A Propensity Score Matching Analysis of Short- and Long-Term Outcomes

“…GIST could occur throughout the gastrointestinal tract, most frequently in the stomach and small intestine, and relatively rare in rectum [9,10]. Our research found that most of rectal GIST occurred in the lower location of the rectum, with 26 (81.2%) of the 32 patients located occurred within 5 cm to the anal edge, besides, Shu P, et al also found that 61(85.9%) of 71 rectal GIST located within 5 cm to the anal edge [11].…”