The Role of Surgical Resection Following Imatinib Treatment in Patients with Recurrent or Metastatic Gastrointestinal Stromal Tumors: Results of Propensity Score Analyses

Park, Seong Joon; Ryu, Min Hee; Ryoo, Baek Yeol; Park, Young Su; Sohn, Byeong Seok; Kim, Hwa Jung; Kim, Chan Wook; Kim, Ki Hun; Yu, Chang Sik; Yook, Jeong Hwan; Kim, Byung Sik; Kang, Yoon Koo

doi:10.1245/s10434-014-3866-4

Cited by 45 publications

(49 citation statements)

References 24 publications

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“…Even in presence of peritoneal metastasis, considering surgery for primary along with oligo metastasis after anterior IM therapy should be considered. However, these are small numbers and the benefit of surgery in patients with metastatic GISTs still remains controversial (26,27).…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib

Ramaswamy¹,

Jain²,

Sahu³

et al. 2016

J. Gastrointest. Oncol.

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Background: Multimodality treatment of gastrointestinal stromal tumor (GIST) with surgery and adjuvant imatinib mesylate (IM), along with an emerging role for neoadjuvant IM prior to evaluation for resectability has resulted in high survival rates. Methods: We conducted a retrospective analysis of prospectively collected data of patients who underwent surgery for GIST, prior to or followed by IM therapy. A total of 112 patients underwent surgery between January 2009 and March 2015 at our centre. This included 27 patients with upfront resectable disease, 76 patients with locally advanced GIST who received neoadjuvant IM followed by surgery and 9 patients with metastatic disease who had excellent response to IM and were taken for surgery. Results: The primary tumor in the non metastatic patients was in the stomach (53%), duodenum (16%), rectum (12%), jejunum (11%), ileum (7%), and others (2%). Median duration of neoadjuvant IM was 5 months with 4 patients showing disease progression during neoadjuvant IM. Ninety-three percent of all patients had R0 resections, while 7% had R+ resections. The estimated 3-and 5-year DFS in non-metastatic patients was 86.1% and 67% respectively with a 3-and 5-year median OS of 95.4% and 91.7% respectively.Five-year PFS and OS for the metastatic patients was 88.8% and 100% respectively. Lack of adjuvant IM was the only factor related to inferior PFS and OS. Conclusions: Longer duration of neoadjuvant IM should be considered in locally advanced GIST prior to surgery and resection may be considered in responding metastatic patients. J Gastrointest Oncol 2016;7(4):624-631 jgo.amegroups.com spillage of tumor cells (8-10). There is growing evidence for neoadjuvant IM therapy in terms of disease free survival (DFS) and overall survival (OS), with major evidence of benefit shown in the EORTC-STBSG retrospective analysis (11)(12)(13)(14)(15).The purpose of this study was to evaluate the demographic profile, presentation and outcomes of 112 patients with GIST who underwent surgery at our institution and were potential candidates for either neoadjuvant or adjuvant IM over a period of 6 years. We also attempted to identify potential prognostic factors with respect to outcomes and placed special emphasis on patients receiving neoadjuvant IM. MethodsA retrospective analysis of prospectively maintained database of all GIST patients who underwent surgery and presented between January 2009 to March 2015 at Department of GI & Hepatopancreaticobiliary Oncology, Tata Memorial Hospital, Mumbai, was performed. Clinical and radiological data were recorded from patient files and electronic medical records. Patients presenting in the above study period were subdivided on the basis of clinical presentation and treatment received into localized operable, locally advanced, operated elsewhere on adjuvant treatment and incidental GISTs. Locally advanced GISTs were defined by the size, need for multivisceral resections, anatomic proximity with major vessels and risk of intraoperative tumor spillage. Patients opera...

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib

Ramaswamy¹,

Jain²,

Sahu³

et al. 2016

J. Gastrointest. Oncol.

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“…The authors concluded that operative resection after imatinib therapy was beneficial for patients with recurrent/metastatic disease. 78 A more recent study 79 addresses the question regarding surgical removal of residual tumor after initial treatment with imatinib for metastatic GIST. The patients in the operative group (n = 42) were more likely to have a greater tumor burden than patients treated only with imatinib (n = 92); however, after appropriate statistical weighting and multivariable analysis, the surgical group had better outcomes for PFS (HR, 2.326; P = .0412) and OS (HR, 5.464; P = .0117), suggesting a role for metastectomy in patients with advanced GIST.…”

Section: The Role Of Metastasectomy In the Management Of Recurrent Gistmentioning

confidence: 99%

Current management of gastrointestinal stromal tumors: Surgery, current biomarkers, mutations, and therapy

Valsangkar

Sehdev

Misra

et al. 2015

Surgery

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“…The Spanish group for research on sarcomas did a retrospective analysis of two cohorts with 171 patients and found that patients who had surgery after response or stable disease by imatinib had longer median OS than those who did not have surgery, 87 vs. 59 months [32 & ]. Also a Korean retrospective evaluation of 134 patients responding on imatinib treatment showed a significant benefit on progression-free survival and OS with surgery [33].…”

Section: Gastrointestinal Stromal Tumoursmentioning

confidence: 99%

Present and future role of surgery in metastatic gastrointestinal malignancies

Naredi

Bagge²

2016

Current Opinion in Oncology

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The Role of Surgical Resection Following Imatinib Treatment in Patients with Recurrent or Metastatic Gastrointestinal Stromal Tumors: Results of Propensity Score Analyses

Abstract: Surgical resection of residual lesions after disease control with imatinib is likely to be beneficial to patients with recurrent or metastatic GISTs.

Cited by 45 publications

References 24 publications

Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib

Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib

Current management of gastrointestinal stromal tumors: Surgery, current biomarkers, mutations, and therapy

Present and future role of surgery in metastatic gastrointestinal malignancies

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