Surgical Management After Neoadjuvant Imatinib Therapy in Gastrointestinal Stromal Tumours (GISTs) with Respect to Imatinib Resistance Caused by Secondary KIT Mutations

Haller, Florian; Detken, Sven; Schulten, Hans-Juergen; Happel, Nicole; Gunawan, Bastian; Kuhlgatz, Jens; Füzesi, L.

doi:10.1245/s10434-006-9228-0

Cited by 96 publications

(70 citation statements)

References 28 publications

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“…This approach has proven feasible in two series, with over 80 per cent of patients experiencing a substantial reduction in tumour volume, with subsequent R0 resection 97,98 . In addition, preliminary data from a trial by the Radiation Therapy Oncology Group have established that neoadjuvant imatinib therapy does not increase the risk of postoperative complications 99 .…”

Section: Neoadjuvant Imatinib Mesylate Therapymentioning

confidence: 99%

Surgical management of gastrointestinal stromal tumours

Gervaz

Huber

Morel

2009

British Journal of Surgery

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Background: Over the past decade, gastrointestinal stromal tumours (GISTs) have served as a model for the application of tyrosine kinase inhibitors in the treatment of solid neoplasms. Operative and medical management of GISTs is rapidly evolving, but current guidelines appear restricted to basic non-organ-specific recommendations.Methods: A PubMed search was made of the English literature from 1998 to 2008 for references containing the terms 'gastrointestinal stromal tumours' and 'surgery'. This paper reviews the various operative strategies so far reported for GISTs within the digestive tract.Results: Many original procedures tailored to the specific characteristics of these rare sarcomas have been reported. GISTs exhibit distinct features, in particular an absence of metastases within locoregional lymph nodes. Operations requiring extended lymph node dissection, typically designed for adenocarcinomas, such as gastrectomy with extended lymph node dissection, Whipple's procedure and total mesorectum excision, are inappropriate for treating GISTs originating from the stomach, duodenum and rectum respectively.

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Section: Neoadjuvant Imatinib Mesylate Therapymentioning

confidence: 99%

Surgical management of gastrointestinal stromal tumours

Gervaz

Huber

Morel

2009

British Journal of Surgery

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“…5,6 Therefore, the best treatment regimen for patients with malignant GISTs, like doing imatinib preoperatively or postoperatively, is still under debate. [7][8][9] The guideline for the selection of patients for adjuvant therapy varies among experts, mainly due to the criteria predicting patients with a high risk of recurrence after the surgical removal of primary GISTs have yet to be established. Clinically, some patients with malignant GIST are highly aggressive, developing recurrence within short time after surgical removal of the primary tumor, whereas others can be treated effectively by surgical resection alone or had a long latency to develop recurrence.…”

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confidence: 99%

Stage and histological grade of gastrointestinal stromal tumors based on a new approach are strongly associated with clinical behaviors

Hou

Zhou

et al. 2009

Modern Pathology

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Tumor stage and grade for gastrointestinal stromal tumors are poorly defined. To develop a better evaluation system, we assessed 12 clinical and pathological parameters in 613 patients with follow-up information. These parameters were classified into two gross spread parameters including liver metastasis and peritoneal dissemination, five microscopic spread parameters including lymph node metastasis, vascular, fat, nerve and mucosal infiltration, and five histological parameters including mitotic count Z10 per 50 high-power fields, muscularis propria infiltration, coagulative necrosis, perivascular pattern and severe nuclear atypia. The 5-year disease-free survival and overall survival of 293 patients without any of these predictive parameters of malignancy were 99% and 100%, respectively. They were regarded as nonmalignant and further evaluations on the stage and grade of these tumors were not performed. At least one and at most seven predictive parameters of malignancy were identified in 320 patients. For these patients, the 5-year disease-free survival and overall survival rates were 44% (mean 6.7 years) and 60% (mean 9.3 years), respectively. The disease-free survival showed significant difference between patients with and without gross spread (Po0.0001), with and without microscopic spread (P ¼ 0.0009). Disease-free survival and overall survival were associated with the number of predictive parameters of malignancy in patients without gross spread (Po0.0001 for both disease-free survival and overall survival), but not in patients with gross spread (P ¼ 0.882 and 0.441, respectively). Malignant gastrointestinal stromal tumors could be divided into clinical stage I and II based on the absence and presence of gross spread, respectively. The degree of malignancy of patients in clinical stage I could be graded according to the number of predictive parameters of malignancy. Patients in clinical stage II were of the highest degree of malignancy regardless of the number of parameters. We found that the clinical stage and grade were strongly associated with prognosis.

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“…The optimal duration of neoadjuvant therapy for GIST remains controversial. Theoretically, neoadjuvant therapy may be continued until the tumor size decreases or its metabolic activity reaches a plateau phase, but the development of resistance due to secondary KIT mutations during this stage remains a risk (21). The duration of neoadjuvant imatinib therapy in a metastatic setting should be case-based, depending on the response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Giant gastrointestinal stromal tumor of the vermiform appendix: A case report

Kaneko

Kawai

Murono

et al. 2017

Molecular and Clinical Oncology

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Abstract.Gastrointestinal stromal tumors (GISTs) of the vermiform appendix are rare, measuring <3 cm in 82.4% of the reported cases. Neoadjuvant therapy with the receptor tyrosine kinase inhibitor imatinib mesylate has the potential to improve resectability and organ preservation rates in locally advanced or metastatic/recurrent GISTs. We herein report the case of a 67-year-old male patient with an unusually large GIST (22 cm in diameter) of uncertain origin in the right lower abdominal quadrant, with a solitary peritoneal metastasis. Due to the size of this GIST and presence of metastatic disease, neoadjuvant therapy with imatinib (400 mg/day orally) was administered. Follow-up imaging studies revealed marked shrinkage of the primary and metastatic tumors. Subsequently, laparoscopic exploration revealed that the main tumor originated from the tip of the vermiform appendix, and that the peritoneal metastasis was located in the ascending mesocolon. The patient underwent laparoscopic appendectomy and excision of the peritoneal metastasis, without tumor rupture. Therefore, in appropriately selected patients, neoadjuvant imatinib for borderline resectable or oligometastatic GISTs may be a reasonable choice.

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Surgical Management After Neoadjuvant Imatinib Therapy in Gastrointestinal Stromal Tumours (GISTs) with Respect to Imatinib Resistance Caused by Secondary KIT Mutations

Cited by 96 publications

References 28 publications

Surgical management of gastrointestinal stromal tumours

Surgical management of gastrointestinal stromal tumours

Stage and histological grade of gastrointestinal stromal tumors based on a new approach are strongly associated with clinical behaviors

Giant gastrointestinal stromal tumor of the vermiform appendix: A case report

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