Surgical Treatment of Gastrointestinal Stromal Tumors Located in the Stomach in the Imatinib Era

Stiekema, J.; Kol, Sabrine Q.; Cats, Annemieke; Yazdi, Amir Talebian; Coevorden, Frits van; Sandick, Johanna W. van

doi:10.1097/coc.0b013e3182a78de9

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…In case of gastric GIST, located in the cardia, local excision without resection of the esophagogastric junction may be achieved (fig. 1); in case of duodenal GIST, a wedge resection may replace a Whipple's procedure [18,19,20,21]. …”

Section: Principles Of Surgery and Different Rationales For Preoperatmentioning

confidence: 99%

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Jakob¹,

Hohenberger²

2018

Visc Med

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Introduction: Gastrointestinal stromal tumors (GIST) are rare malignant tumors in terms of incidence, and they are not linked to specific symptoms. Often, primary tumors, particularly of the stomach, rectum, or rectovaginal space, are quite large when detected, and multivisceral resection seems to be the treatment of choice as the mainstay of therapy is complete tumor removal. If a gain-of-function mutation in the KIT gene is present, drug therapy with receptor tyrosine kinase inhibitors (RTKIs) might significantly downstage primary GIST tumors. Methods: A review of the literature was performed to identify the current evidence for preoperative treatment of GIST regarding toxicity, efficacy, and oncological outcome, including mutational data from our own database. Results: Four phase II as well as several cohort studies showed acceptable toxicity and no increased perioperative morbidity of preoperative imatinib. Progressive disease during preoperative treatment was a rare event, and partial response was achieved in 40-80% of all patients. For methodological reasons, the trials cannot prove an oncological long-term superiority of preoperative treatment. Conclusion: Preoperative therapy with imatinib is safe and recommended for patients with locally advanced GIST. Neoadjuvant imatinib therapy may enable less invasive and organ-sparing surgery, avoid tumor rupture during extensive resectional procedures, and improve the quality of perioperative RTKI treatment.

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Section: Principles Of Surgery and Different Rationales For Preoperatmentioning

confidence: 99%

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Jakob¹,

Hohenberger²

2018

Visc Med

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“…The biopsy needle might breach the tumor pseudocapsule which might potentially lead to seeding in the needle tract area or intra-abdominal cavity. Tumor spill, spontaneously or due to periprocedural or perioperative rupture, is shown a poor prognostic factor in several studies 7–10 . Both the European Society of Medical Oncology (ESMO) and American Society for Clinical Oncology (ASCO) guidelines recommend endoscopic transluminal biopsy, but do not give substantial evidence against transcutaneous biopsy.…”

Section: Approach To Biopsymentioning

confidence: 99%

Oncological Outcome After Diagnostic Biopsies in Gastrointestinal Stromal Tumors

et al. 2019

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Objective:To analyze whether the route of preoperative biopsy influences oncological outcome in GIST patients.Summary of Background Data:Preoperative biopsies are widely used for diagnosing GIST. Little is known about the risk of tumor seeding after different routes of biopsy.Methods:Patients who underwent resection of a primary GIST between 1996 and 2014 were identified from 2 databases from 2 tertiary referral centers. Survival data were obtained using the Kaplan-Meier method. Possible confounders were identified using Cox regression analysis. The primary endpoint was local recurrence free survival (RFS) and the secondary endpoint was DSS.Results:A total of 228 patients were included, with a median age of 62 years (range 17–86) and a median follow-up time of 53 months (range 1–204). From these patients, 42 patients did not have a biopsy (18%), 70 underwent a transcutaneous biopsy (31%), and 116 a transluminal biopsy (51%). A total of 42 patients (19.0%) had a local and/or distant recurrence. From the 70 patients with a transcutaneous biopsy, only 1 patient developed a needle tract recurrence (1.4%). Local RFS and DSS were both significantly shorter in the transcutaneous biopsy group on univariate analysis compared to the other groups; however, in multivariate analysis the route of biopsy did not influence local RFS (P = 0.128) or DSS (P = 0.096).Conclusions:Transluminal or transcutaneous biopsies for diagnosing GIST do not significantly alter the risk of local recurrent disease or DSS in multivariate Cox regressions. The risk of needle tract seeding after transcutaneous biopsy was low.

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“…In den letzten Jahren wird eine Zunahme des Gesamtüberlebens und des rezidivfreien Überlebens von Patienten mit einem GIST vermerkt, vor allem bei solchen mit Rezidiven oder lokal fortgeschrittener Erkrankung. Dies ist verbunden mit der Einführung von Medikamenten, die den c-KIT-Rezeptor auf den Stammzellen inhibieren, den Kluster BCR-ABL und die ABL-Tyrosin-Kinase (Imatinib, Glivec ® , Novartis AG, Basel, Schweiz) [10,18,19]. Das 2-Jahres-Überleben bei metastasierten Patienten wurde bei c-KIT-positiven gastrointestinalen Stromatumoren von 20 auf 70 % gesteigert [21,22].…”

Section: Abstract !unclassified

“…Nach neoadjuvanter Chemotherapie hat er im radiologischen Restaging einen partiellen Response gezeigt und ist multiviszeral reseziert und simultan bilobär atypisch leberreseziert worden. Der Patient hat darauf eine Erhaltungstherapie mit Imatinib 800 mg erhalten, aber bereits 6 Monate postoperativ Zeichen für ein lokales Tumorrezidiv am Pankreas und neu aufgetretene Lebermetastasen gezeigt, was die schlechte Prognose von GIST mit c-KIT-Expression auf Exon 9 belegt [17,18,35].…”

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Gastrointestinale Stromatumore größer als 20 cm: Erfahrungen mit Imatinib in neoadjuvanter Intention

et al. 2014

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The size of the primary tumour is considered the most important risk factor for the development of metastasis or local recurrence in case of gastrointestinal stromal tumour (GIST). Until now no prospective data are available in the literature about the role of neadjuvant therapy with Imatinib. Between 2009 and 2012 seven patients with a giant GIST > 20 cm underwent a neadjuvant treatment with Imatinib, a radical operation, followed by an adjuvant therapy. These patients were controlled with regard to peri- and postoperative morbidity and disease-free survival. Two patients were considered not resectable and one patient showed liver metastasis at the time of diagnosis. RECIST responses to the neoadjuvant Imatinib were: 2/7 patients with stable disease, 3/7 partial response, 2/7 partial response with down-staging (resectable disease). Because of the following tumour localisations (6 gastric and 1 rectal), six gastrectomies (one en-bloc with left pancreas) and one Holm operation were performed. The patient with simultaneous liver metastasis developed a tumour progression during the follow-up but the others are still tumour free after 2 years. We detected a significant tumour volume regression due to the neadjuvant chemotherapy in cases of GIST > 20 cm (30 %). Our series showed good results for a neadjuvant therapy in cases of giant GIST with the achievement of 100 % R0 resection without a high morbidity rate (in the literature a tumor size > 10 cm and poor localisation is associated to a high risk of R1 - 2 and high morbidity). Peri- and postoperative morbidity are acceptable and the tumour free survival at 2 years is 85 %.

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Surgical Treatment of Gastrointestinal Stromal Tumors Located in the Stomach in the Imatinib Era

Abstract: In this surgical series of gastric GIST patients, preoperative imatinib led to a major reduction in tumor size. Irradical resection, tumor spill, and progressive disease at the time of surgery were associated with poor prognosis.

Cited by 8 publications

References 26 publications

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Oncological Outcome After Diagnostic Biopsies in Gastrointestinal Stromal Tumors

Gastrointestinale Stromatumore größer als 20 cm: Erfahrungen mit Imatinib in neoadjuvanter Intention

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