The effect of neoadjuvant Imatinib therapy on outcome and survival after rectal gastrointestinal stromal tumour

Machlenkin, Svetlana; Pinsk, Ilia; Tulchinsky, Hagit; Ziv, Yaniv; Sayfan, Joel; Duek, D; Rabau, Micha; Walfisch, Shlomo

doi:10.1111/j.1463-1318.2010.02442.x

Cited by 47 publications

(37 citation statements)

References 27 publications

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“…Therefore, surgeons and endoscopy experts must be fully acquainted with this disease. In addition, we found that most of the tumor sites were located in the lower two-thirds of rectum, as previously reported [16]. High-risk patients with rectal GISTs account for most cases (66.7%) in the present study.…”

Section: Discussionsupporting

confidence: 90%

Clinicopathologic, surgical characteristics and survival outcomes of rectal gastrointestinal stromal tumors

Shen¹,

CHEN²,

Yin³

et al. 2015

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Rectal gastrointestinal stromal tumors (GISTs) are rare, and limited information is available concerning their management and long-term outcomes. We retrospectively evaluated the clinicopathological characteristics, surgical management, and long-term outcomes of rectal GISTs from a single institution.All surgically treated patients with rectal GISTS at the Department of General Surgery, West China Hospital, Sichuan University were identified between January 2005 and May 2014. The overall survival (OS) and disease-free survival (DFS) were assessed by the Kaplan-Meier method.Forty-five patients with rectal GISTs (33 males and 12 females) were identified. Patients presented with rectal bleeding (n = 13; 28.9%) and altered bowel habits (n = 11; 24.4%). The cohort study of 45 patients included 4 very low-risk, 10 lowrisk, 1 intermediate-risk, and 30 high-risk patients. A total of 21, 13, and 11 patients underwent local resection (Group 1), abdominoperineal resection (Group 2), and super-low or low anterior resection (Group 3), respectively. Group 1 had a smaller tumor sizes and shorter distances from the anal verge compared with the other groups (P < 0.05). The one-, three-, and fiveyear DFS rates for the entire cohort study were 90.4%, 69.3%, and 57.0%, respectively. High National Institutes of Health (NIH) risk categories (HR = 1.62) were associated with low DFS rates (P = 0.035). The DFS was significantly improved by imatinib mesylate (IM) adjuvant therapy in the high-risk subgroup (P = 0.001).The type of surgery should be chosen based on the location and size of the rectal GISTs. Adjuvant IM therapy was associated with improved DFS in patients with high-risk tumors, and classification was strongly associated with the patient outcome.

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Section: Discussionsupporting

confidence: 90%

Clinicopathologic, surgical characteristics and survival outcomes of rectal gastrointestinal stromal tumors

Shen¹,

CHEN²,

Yin³

et al. 2015

neo

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“…In a study by Machlenkin et al 28 of 12 patients with a rectal GISTs, 71% of the patients who underwent surgery after neoadjuvant imatinib and adjuvant imatinib in the case R1 or R2 resection had no clinical or radiological recurrence, and 86% of all patients were alive after a median follow-up of 32 months. In a study by Rutkowski et al ,7 33 patients operated for rectal GIST after neoadjuvant imatinib showed a 3-year disease free survival rate of 88%.…”

Section: Discussionmentioning

confidence: 99%

Sphincter sparing resection of a large obstructive distal rectal gastrointestinal stromal tumour after neoadjuvant therapy with imatinib (Glivec)

Kramp

Omer²,

Schöffski

et al. 2015

BMJ Case Reports

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SUMMARYGastrointestinal stromal tumours (GISTs) are generally rare but are known to be the most common mesenchymal tumours of the gastrointestinal tract. We present a case of a patient who presented with persistent obstructive gastrointestinal and urological symptoms, a sense of incomplete evacuation and bleeding per rectum. A colonoscopy was performed and a biopsy was taken of a submucosal mass in the distal rectum that revealed a GIST with positive KIT immunostaining. A positron emission tomography (PET)/CT scan showed a large metabolically active distal rectal tumour of 8 cm with macroscopic invasion of surrounding structures. Neoadjuvant therapy with receptor tyrosine kinase inhibitor imatinib (400 mg orally daily) was initiated and an excellent partial response consisting of a significant decrease in the size of the tumour with complete metabolic resolution was observed within 3 months. Six months after initiation of the neoadjuvant therapy a rectum resection with manual side-to-end coloanal anastomosis was performed. Pathology showed a GIST of 5 cm located 0.1 cm from the distal section plane. Our case shows that in patients with a large invasive distal rectal GIST, neoadjuvant imatinib therapy can facilitate anal sphincter sparing surgery. BACKGROUND

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“…A phase 2 trial demonstrated that imatinib treatment for only one week could cause a reduction in the maximal standardized uptake value on 18-fluorodeoxyglucose positron emission tomography or decrease in blood flow in 60 to 70% of gastrointestinal GIST cases [5]. Previous studies reported a response rate of 73 to 78% with no progressive disease following preoperative imatinib therapy for 1 to 60 months [6-8]. Importantly, the clinical response to imatinib depends on the mutational status of c-kit and platelet-derived growth factor receptor alpha (PDGFRA).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic resection of a gastrointestinal stromal tumor of the lower rectum in a patient with coronary artery disease following long-term neoadjuvant imatinib treatment and anticoagulation therapy

et al. 2014

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Surgery is the mainstay of treatment for gastrointestinal stromal tumors (GISTs). However, complete resection of rectal GISTs is sometimes difficult because of bulkiness and/or anatomical reasons. Neoadjuvant imatinib therapy has gained attention as an alternative treatment to increase the chance of en bloc resection of rectal GISTs, although it usually takes several months. In this case report, we first demonstrated that neoadjuvant imatinib therapy can be performed safely not only to downsize tumors, but also to allow adequate time for the effective treatment of major comorbid illnesses. A 74-year-old man was diagnosed with a 45 mm GIST of the lower rectum. He also had severe stenosis in the proximal segment of the left anterior descending coronary artery. Following the implantation of a drug-eluting stent, the patient received imatinib together with dual anti-platelet therapy for 12 months without obvious side effects. Follow-up image studies revealed tumor shrinkage as well as stent patency. En bloc resection of the GIST was performed laparoscopically, which preserved the anus. The patient is currently alive without any evidence of relapse for 12 months after surgery.

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The effect of neoadjuvant Imatinib therapy on outcome and survival after rectal gastrointestinal stromal tumour

Abstract: Preoperative Imatinib therapy can shrink large rectal GISTs, improving the chances of successful radical surgery and decreasing the risk of considerable morbidity.

Cited by 47 publications

References 27 publications

Clinicopathologic, surgical characteristics and survival outcomes of rectal gastrointestinal stromal tumors

Clinicopathologic, surgical characteristics and survival outcomes of rectal gastrointestinal stromal tumors

Sphincter sparing resection of a large obstructive distal rectal gastrointestinal stromal tumour after neoadjuvant therapy with imatinib (Glivec)

Laparoscopic resection of a gastrointestinal stromal tumor of the lower rectum in a patient with coronary artery disease following long-term neoadjuvant imatinib treatment and anticoagulation therapy

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