The Role of Neoadjuvant Imatinib Mesylate Therapy in Sphincter-Preserving Procedures for Anorectal Gastrointestinal Stromal Tumor

Abstract

Neoadjuvant IM therapy for anorectal GIST is safe and effective. Tumor shrinkage and an extension of the distance to anal edge have a clear benefit for the local excision, in terms of feasibility, function preservation, and safety.

Characteristics and prognosis of rectal gastrointestinal stromal tumors: an analysis of registry data

“…Thus, we think that imatinib treatment should be given for at least 2 months or more as neoadjuvant therapy. Given the lack of evidence concerning the role of neoadjuvant and adjuvant treatments, some trials have been conducted to show the potential survival benefit or feasibility of sphincter-preserving surgery [9,10,17,[19][20][21][22]. Thus, preoperative imatinib is a reasonable option for patients with locally advanced rectal GIST occupying the pelvic space, who require multivisceral resection to achieve clear surgical margins.…”

Transsacral excision with pre-operative imatinib mesylate treatment and approach for gastrointestinal stromal tumors in the rectum: A report of two cases

“…Transcoccygeal (transsacral) excision, is suitable for higher lesions (average distance from the dentate line, 5 cm) located in the posterior wall of the rectum (5,17,18). This location requires a paracoccygeal incision between the anus and coccyx, an S5 or coccygeal transection, and an incision of Waldeyer’s fascia, with exposure of the perirectal fat.…”

“…An alternative approach would be the use of pre-operative IM therapy for large rectal GISTs, which may result in tumor shrinkage (20). In a previous study, neoadjuvant therapy with IM was used prior to local excision via the Kraske approach (17), which showed that preoperative IM therapy resulted in the shrinkage of GISTs and exhibited a clear benefit with regard to local excision.…”

“…Several case studies have demonstrated that the use of pre-operative IM enables organ-sparing surgery and improves surgical outcomes in patients with rectal GISTs (17,24,29). …”

Neoadyuvancia Con Imatinib en El Manejo De Gist Gigante Del Tabique Rectovaginal

“…La potencia del imatinib en terapias de inducción de GIST del recto de alto riesgo se expresa en tasas de respuesta del 80% de los casos tratados, logrando habitualmente una respuesta parcial y una estabilización de la enfermedad, con algunos casos reportados de respuesta patológica completa 5,6 . La positiva experiencia de la neoadyuvancia con imatinib se ha multiplicado en los últimos años, determinando que actualmente sea el tratamiento estándar para los GIST de recto que requieren una cirugía radical o que está en riesgo el aparato esfinteriano [3][4][5][6][7][8][9][10] . En una experiencia de Japón, sobre 29 pacientes tratados en la era pre-imatinib por un GIST rectal, 19 fueron sometidos a una resección abdominoperineal 10 .…”