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

Wilkinson, Michelle; Fitzgerald, J Edward; Strauß, D.; Hayes, Andrew; Thomas, Joseph; Messiou, Christina; Fisher, Cyril; Benson, Charlotte; Tekkis, Paris; Judson, Ian

doi:10.1002/bjs.9818

Cited by 78 publications

(103 citation statements)

References 30 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our report is distinct from other modern series 13–15,18–20 . First, our data represent the largest single-institution experience, coming from a prospectively maintained database with mature follow-up, as opposed to multiple institutions where treatment strategies and follow-up patterns vary.…”

Section: Discussioncontrasting

confidence: 94%

“…First, our data represent the largest single-institution experience, coming from a prospectively maintained database with mature follow-up, as opposed to multiple institutions where treatment strategies and follow-up patterns vary. Our series spans the historical and imatinib eras, while some publications were only in the recent era 14,15,18,19 . Some included patients who did not receive imatinib either due to availability (pre-imatinib) or because it was not felt to be indicated clinically; often these patients were analyzed as one group or without clear designation 13,18,20 .…”

Section: Discussionmentioning

confidence: 99%

“…Neoadjuvant imatinib is sometimes employed in an attempt to downsize locally advanced GISTs and may allow R0 resection in up to 83% of patients. 11 The benefit of neoadjuvant imatinib in rectal GIST is uncertain, although small, retrospective series have been reported 12–15 Here, we present the largest single-institution experience with rectal GIST.…”

Section: Introductionmentioning

confidence: 90%

See 2 more Smart Citations

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

et al. 2017

View full text Add to dashboard Cite

INTRODUCTION About 5% of GISTs originate in the rectum and historically radical resection was commonly performed. Little is known about the outcome of rectal GIST in the era of imatinib. METHODS Using a prospectively maintained database, we retrospectively analyzed 47 localized, primary rectal GISTs treated at our center from 1982 to 2016, stratified by when imatinib became available in 2000. Overall, disease-specific, and recurrence-free survival (OS, DSS, and RFS) were analyzed by the Kaplan-Meier method. RESULTS Rectal GISTs represented 7.1% of 663 primary GISTs. There were 17 patients in the pre-imatinib era and 30 in the imatinib era. The 2 groups had similar follow-up, age, gender, Miettinen risk, and distance to the anal verge. In the imatinib era, tumors were smaller at diagnosis (median 4.0 vs. 5.0 cm, p=0.029) and 24 of 30 patients received perioperative imatinib. In high-risk patients, organ-preservation and negative margins were more common in the 13 patients treated with neoadjuvant imatinib compared to the 21 treated directly with surgery. High-risk patients who received perioperative imatinib (n=15) had greater (or nearly significantly greater) 5yr OS, DSS, local RFS, and distant RFS than those (n=19) who did not (91, 100, 100, and 71% compared to 47, 65, 74, and 41%, p=0.049, 0.052, 0.077, 0.051, respectively). In the imatinib era, no patient has had a local recurrence or death due to GIST. CONCLUSIONS The use of imatinib is associated with organ-preservation and improved oncologic outcome in rectal GIST.

show abstract

Section: Discussioncontrasting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

See 1 more Smart Citation

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Consequently, patients with EGISTs are considered to have a poorer prognosis compared to alimentary GISTs (9). Imatinib treatment may be considered preoperatively in order to inhibit tumor activity, and works by minimizing the tumor load and eliminating potential satellite lesions (21). Post-operatively, imatinib may be administered for adjuvant treatment for patients with a high recurrence risk, which is similar to the guidelines for their alimentary counterparts (22).…”

Section: Discussionmentioning

confidence: 99%

Primary gastrointestinal stromal tumor of the liver: A case report and review of the literature

et al. 2016

View full text Add to dashboard Cite

Abstract. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. A small portion of GISTs are observed in extra-gastrointestinal regions, primarily in the omentum, mesentery and retroperioneum, and these types of GISTs are referred to as extra-gastrointestinal stromal tumors. The present study reports of a patient with unique primary liver GIST. The patient underwent en bloc resection and post-operative administration of imatinib, and subsequently experienced a good prognosis. The present case is followed by a brief review of reported cases of liver GISTs identified in the literature. The literature revealed that primary liver GISTs are usually large in size and possess a high mitotic index, which contributes to malignant characterization, thus classifying these tumors as high-risk. En bloc resection remains the mainstay of treatment for resectable primary liver GISTs. However, the prognosis of these patients is not favorable. Perioperative administration of imatinib may be useful to a certain extent, and interventional therapy, including radiofrequency ablation, should be considered.

show abstract

“…Transanal local excision leaves the peritoneal cavity intact and may thus reduce the rate of peritoneal metastases [16]. Whereas the latter is a theoretical advantage, sphincter preservation in rectal GIST after preoperative downsizing has been clearly demonstrated in a number of case series [17]. In case of gastric GIST, located in the cardia, local excision without resection of the esophagogastric junction may be achieved (fig.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

Abstract: The use of neoadjuvant imatinib for rectal GISTs significantly decreased both tumour size and mitotic activity, which permitted less radical sphincter-preserving surgery.

Cited by 78 publications

References 30 publications

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

Primary gastrointestinal stromal tumor of the liver: A case report and review of the literature

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

Contact Info

Product

Resources

About