Downstaging of a Rectal Gastrointestinal Stromal Tumor by Neoadjuvant Imatinib Therapy Allowing for a Conservative Surgical Approach

Fernandes, Gustavo dos Santos; Cotti, Guilherme Cutait de Castro; Freitas, Daneila; Cutait, Raul; Hoff, Paulo M.

doi:10.1590/s1807-59322009000800018

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Thus, this treatment was feasible, safe, and effective. Since 2005, several case reports or small series regarding the use of preoperative imatinib treatment for rectal GISTs have been published [ 10 - 13 , 32 - 35 ]. All concluded that preoperative imatinib therapy has an important role in downsizing large rectal GISTs and in reducing the mitotic activity.…”

Section: Discussionmentioning

confidence: 99%

Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group

et al. 2014

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BackgroundRectal and pararectal gastrointestinal stromal tumors (GISTs) are rare. The optimal management strategy for primary localized GISTs remains poorly defined.MethodsWe conducted a retrospective analysis of 41 patients with localized rectal or pararectal GISTs treated between 1991 and 2011 in 13 French Sarcoma Group centers.ResultsOf 12 patients who received preoperative imatinib therapy for a median duration of 7 (2-12) months, 8 experienced a partial response, 3 had stable disease, and 1 had a complete response. Thirty and 11 patients underwent function-sparing conservative surgery and abdominoperineal resection, respectively. Tumor resections were mostly R0 and R1 in 35 patients. Tumor rupture occurred in 12 patients. Eleven patients received postoperative imatinib with a median follow-up of 59 (2.4-186) months. The median time to disease relapse was 36 (9.8-62) months. The 5-year overall survival rate was 86.5%. Twenty patients developed local recurrence after surgery alone, two developed recurrence after resection combined with preoperative and/or postoperative imatinib, and eight developed metastases. In univariate analysis, the mitotic index (≤5) and tumor size (≤5 cm) were associated with a significantly decreased risk of local relapse. Perioperative imatinib was associated with a significantly reduced risk of overall relapse and local relapse.ConclusionsPerioperative imatinib therapy was associated with improved disease-free survival. Preoperative imatinib was effective. Tumor shrinkage has a clear benefit for local excision in terms of feasibility and function preservation. Given the complexity of rectal GISTs, referral of patients with this rare disease to expert centers to undergo a multidisciplinary approach is recommended.

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Section: Discussionmentioning

confidence: 99%

Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group

et al. 2014

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“…Neoadjuvant therapy has been shown successfully to downsize tumours and aid organ‐preserving surgery in patients with high‐risk GIST tumours arising elsewhere in the gastrointestinal tract. Limited evidence from individual case reports and small case series suggests similar positive outcomes in patients with rectal GISTs.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib

Wilkinson

Fitzgerald

Strauß

et al. 2015

British Journal of Surgery

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“…For rectal adenocarcinoma, a total mesorectal excision is the preferred approach as this includes all relevant regional lymph nodes. Because lymphatic metastases are rare for GIST, mesorectal resections, including the lymph nodes along the mesenteric vessels or mesorectum are unnecessary 10, 11. On the other hand, locally advanced GISTs are often large, bulky tumors.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of rectal gastrointestinal stromal tumors

Tielen

Verhoef

Coevorden

et al. 2012

Journal of Surgical Oncology

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Downstaging of a Rectal Gastrointestinal Stromal Tumor by Neoadjuvant Imatinib Therapy Allowing for a Conservative Surgical Approach

Cited by 5 publications

References 12 publications

Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group

Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group

Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib

Surgical management of rectal gastrointestinal stromal tumors

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