Abstract
BackgroundPreoperative imatinib mesylate (IM) treatment has not yet been standardized. Here, we aim to further explore such therapy on patients with gastrointestinal stromal tumors (GIST) retrospectively.MethodsPatients experiencing preoperative IM were identified from January 2009 to February 2015.ResultsA total of 28 GIST patients were identified. The patients received preoperative IM treatment for a median length of 13.5 months, ranging from 5 to 37 months. PR and SD were observed in 24 (85.7%) and 4 (15.3%) patients, respectively. The tumor shrinkage occurred predominantly within 6 to 12 months, and slight tumor shrinkage could be observed after 12 months in certain patients. Nineteen patients (67.9%) received surgery, and R0 resection was acquired in 18 (94.7%) patients. The initial mean maximum diameter was 10.5 (5.2 to 19.0) cm and decreased to 5.9 (2.7 to 19.0) cm after preoperative treatment with a median length of 12 (ranging from 5 to 36) months (P < 0.001) in patients receiving operations. Three in 7 cases of rectum GIST underwent abdominoperineal resection, and four others adopted sphincter-sparing resection. Partial gastrectomy was performed in four patients.ConclusionsIM prior to surgery can effectively prevent tumor rupture and facilitate surgery with low surgical morbidity for GIST patients. Tumor shrinkage following IM occurred predominantly within 6 to 12 months, and slight tumor shrinkage could be observed after 12 months in certain patients. In selected patients, prolonged exposure to IM is seemingly advisable under close radiological surveillance.
Highlights
Preoperative imatinib mesylate (IM) treatment has not yet been standardized
The following is the inclusion criteria: (1) patients were pathologically confirmed as primary or recurrent/metastatic gastrointestinal stromal tumors (GIST) stained positive for CD117 and/or Dog-1, whose specimens were obtained by fine needle biopsy or surgery or endoscope; (2) GIST were diagnosed to be unresectable, or more mutilating surgery was needed due to locally advanced or metastatic disease or rupture tendency, assessed by a multidisciplinary team of experienced radiologists, oncologists, and surgeons; and (3) patients with recurrent/metastatic disease who had no history of taking IM
Maximum tumor diameter was calculated with computed tomography (CT) and magnetic resonance imaging (MRI), and all exceeded 5 cm with >8.3 cm accounting for 75% prior to IM treatment
Summary
Preoperative imatinib mesylate (IM) treatment has not yet been standardized. We aim to further explore such therapy on patients with gastrointestinal stromal tumors (GIST) retrospectively. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of alimentary tract, accounting for approximately 1 to 3% of all malignant gastrointestinal neoplasms [1]. Surgery is the mainstay of localized GIST treatment for curative intention. The majority of GIST patients are candidates for complete resection of tumors at the first presentation. A poor survival rate was acquired during follow-up before imatinib era, as demonstrated by a study of 1458 patients [2], let alone among cases with advanced or metastatic disease. Imatinib mesylate (IM) is applied in GIST patients gradually based on the discovery that GIST is initiated.
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