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Surgical Resection of Gastrointestinal Stromal Tumors After Treatment with Imatinib

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Abstract

Background

Surgical resection of gastrointestinal stromal tumors (GISTs) has been the most effective therapy for these rare tumors. Imatinib has been introduced as systemic therapy for locally advanced and metastatic GIST. In this study, the surgical resection rates and long-term outcomes of patients treated with preoperative imatinib for locally advanced primary, recurrent, or metastatic GISTs were evaluated.

Methods

Patients were retrospectively assessed for completeness of surgical resection and for disease-free and overall survival after resection.

Results

Forty-six patients underwent surgery after treatment with imatinib. Eleven were treated for locally advanced primary GISTs for a median of 11.9 months, followed by complete surgical resection. All eleven were alive at a median of 19.5 months, and ten were free of disease. Thirty-five patients were treated for recurrent or metastatic GIST. Of these, eleven underwent complete resection. Six of the eleven patients had recurrent disease at a median of 15.1 months. All eleven patients were alive at a median of 30.7 months. Patients with a partial radiographic tumor response to imatinib had significantly higher complete resection rates than patients with progressive disease (91% vs. 4%; P < .001). Of the 24 patients with incomplete resection, 18 initially responded to imatinib but were unable to undergo complete resection after they progressed before surgery.

Conclusions

Preoperative imatinib can decrease tumor volume and is associated with complete surgical resection in locally advanced primary GISTs. Early surgical intervention should be considered for imatinib-responsive recurrent or metastatic GIST, since complete resection is rarely achieved once tumor progression occurs.

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References

  1. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998; 152(5):1259–69

    PubMed  CAS  Google Scholar 

  2. Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 1999; 30(10):1213–20

    Article  PubMed  CAS  Google Scholar 

  3. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002; 33(5):459–65

    Article  PubMed  Google Scholar 

  4. Le Cesne A, Judson I, Crowther D, et al. Randomized phase III study comparing conventional-dose doxorubicin plus ifosfamide versus high-dose doxorubicin plus ifosfamide plus recombinant human granulocyte-macrophage colony-stimulating factor in advanced soft tissue sarcomas: A trial of the European Organization for Research and Treatment of Cancer/Soft Tissue and Bone Sarcoma Group. J Clin Oncol 2000; 18(14):2676–84

    PubMed  CAS  Google Scholar 

  5. Nielsen OS, Judson I, van Hoesel Q, et al. Effect of high-dose ifosfamide in advanced soft tissue sarcomas. A multicentre phase II study of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer 2000; 36(1):61–7

    Article  PubMed  CAS  Google Scholar 

  6. Patel SR, Gandhi V, Jenkins J, et al. Phase II clinical investigation of gemcitabine in advanced soft tissue sarcomas and window evaluation of dose rate on gemcitabine triphosphate accumulation. J Clin Oncol 2001; 19(15):3483–9

    PubMed  CAS  Google Scholar 

  7. Verweij J, Casali PG, Zalcberg J, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 2004; 364(9440):1127–34

    Article  PubMed  CAS  Google Scholar 

  8. van Oosterom AT, Judson I, Verweij J, et al. Safety and efficacy of imatinib (STI571) in metastatic gastrointestinal stromal tumours: a phase I study. Lancet 2001; 358(9291):1421–3

    Article  PubMed  Google Scholar 

  9. Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002; 347(7):472–80

    Article  PubMed  CAS  Google Scholar 

  10. Rankin C, von Mehren M, Blanke C, et al. Dose effect of imatinib in patients with metastatic GIST—Phase III Sarcoma Group Study S0033 [Abstract]. J Clin Oncol 2004; 22(14S):9005

    Google Scholar 

  11. Mudan SS, Conlon KC, Woodruff JM, Lewis JJ, Brennan MF. Salvage surgery for patients with recurrent gastrointestinal sarcoma: prognostic factors to guide patient selection. Cancer 2000; 88(1):66–74

    Article  PubMed  CAS  Google Scholar 

  12. Ng EH, Pollock RE, Romsdahl MM. Prognostic implications of patterns of failure for gastrointestinal leiomyosarcomas. Cancer 1992; 69(6):1334–41

    Article  PubMed  CAS  Google Scholar 

  13. Ng EH, Pollock RE, Munsell MF, Atkinson EN, Romsdahl MM. Prognostic factors influencing survival in gastrointestinal leiomyosarcomas. Implications for surgical management and staging. Ann Surg 1992; 215(1):68–77

    Article  PubMed  CAS  Google Scholar 

  14. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000; 231(1):51–8

    Article  PubMed  CAS  Google Scholar 

  15. Clary BM, DeMatteo RP, Lewis JJ, Leung D, Brennan MF. Gastrointestinal stromal tumors and leiomyosarcoma of the abdomen and retroperitoneum: a clinical comparison. Ann Surg Oncol 2001; 8(4):290–9

    Article  PubMed  CAS  Google Scholar 

  16. Scaife CL, Hunt KK, Patel SR, et al. Is there a role for surgery in patients with “unresectable” cKIT+ gastrointestinal stromal tumors treated with imatinib mesylate? Am J Surg 2003; 186(6):665–9

    Article  PubMed  Google Scholar 

  17. Trent J, Hunt KK (2003) A prospective, randomized, phase II study of preoperative plus postoperative imatinib mesylate (Gleevec, formerly STI-571) in patients with primary, recurrent, or metastatic resectable, kit-expressing, gastrointestinal stromal tumor (GIST). Available: http://www.utm-ext01a.mdacc.tmc.edu/dept/prot/clinicaltrialswp.nsf/index/id03-0023 [accessed August 14, 2006]

  18. Eisenberg B (2002) A phase II trail of neoadjuvant/adjuvant STI-571 (Gleevec NSC #716051) for primary and recurrent operable malignant GIST expressing the KIT receptor tyrosine kinase (CD117). Available: http://www.rtog.org/members/protocols/s0132/s0132.pdf [accessed August 14, 2006]

  19. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981; 47(1):207–14

    Article  PubMed  CAS  Google Scholar 

  20. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92(3):205–16

    Article  PubMed  CAS  Google Scholar 

  21. Casali PG, Fumagalli E, Messina A, et al. Tumor response to imatinib mesylate in advanced GIST [Abstract]. J Clin Oncol 2004; 22(14S):9028

    Google Scholar 

  22. Choi H, Charnsangavej C, de Castro Faria S, et al. CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol 2004; 183(6):1619–28

    PubMed  Google Scholar 

  23. Shankar S, van Sonnenberg E, Desai J, Dipiro PJ, Van Den Abbeele A, Dimitri GD. Gastrointestinal stromal tumor: new nodule-within-a-mass pattern of recurrence after partial response to imatinib mesylate. Radiology 2005; 235(3):892–8

    Article  PubMed  Google Scholar 

  24. Holdsworth CH, Manola J, Badawi RD, et al. Use of computerized tomography as an early prognostic indicator of response to imatinib mesylate in patients with gastrointestinal stromal tumors [Abstract]. J Clin Oncol 2004; 22(14S):3011

    Google Scholar 

  25. Choi H, Charnsangavej C, Macapinilac HA, et al. Correlation of computerized tomography and positron emission tomography in patients with metastatic GIST treated at a single instition with imatinib mesylate [Abstract]. Proc Am Soc Clin Oncol 2003; 22:819

    Google Scholar 

  26. Gayed I, Vu T, Iyer R, Johnson M, Macapinlac H, Swanston N, Podoloff D. The role of 18F-FDG PET in staging and early prediction of response to therapy of recurrent gastrointestinal stromal tumors. J Nucl Med 2004; 45(1):17–21

    PubMed  CAS  Google Scholar 

  27. Goerres GW, Stupp R, Barghouth G, et al. The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Eur J Nucl Med Mol Imaging 2005; 32(2):153–62

    Article  PubMed  CAS  Google Scholar 

  28. Katz D, Segal A, Alberton Y, Jurim O, Reissman P, Catane R, Cherny NI. Neoadjuvant imatinib for unresectable gastrointestinal stromal tumor. Anticancer Drugs 2004; 15(6):599–602

    Article  PubMed  CAS  Google Scholar 

  29. Hiramatsu Y, Konno H, Kamiya K, et al. A case of gastric GIST treated preoperatively by imatinib mesylate. Gan To Kagaku Ryoho 2004; 31(8):1219–23

    PubMed  Google Scholar 

  30. Bumming P, Andersson J, Meis-Kindblom JM, et al. Neoadjuvant, adjuvant and palliative treatment of gastrointestinal stromal tumours (GIST) with imatinib: a centre-based study of 17 patients. Br J Cancer 2003; 89(3):460–4

    Article  PubMed  CAS  Google Scholar 

  31. Conlon KC, Casper ES, Brennan MF. Primary gastrointestinal sarcomas: analysis of prognostic variables. Ann Surg Oncol 1995; 2(1):26–31

    Article  PubMed  CAS  Google Scholar 

  32. DeMatteo RP (2001) A phase III randomized double-blind study of adjuvant STI571 (Gleevec) versus placebo in patients following the resection of primary gastrointestinal stromal tumor (GIST). Available: http://www.acosog.org/studies/synopses/Z9001_Synopsis.pdf [accessed April 20, 2005]

  33. DeMatteo RP (2001) A phase II study of adjuvant STI571 (Gleevec) therapy in patients following completely resected high-risk primary gastrointestinal stromal tumor (GIST). Available: http://www.acosog.org/studies/synopses/Z9000_Synopsis.pdf [accessed August 14, 2006]

  34. Casali PG (2004) Phase III randomized study of adjuvant imatinib mesylate versus observation only in patients with completely resected localized gastrointestinal stromal tumor at intermediate- or high-risk of relapse. Available: http://www.eortc.be/protoc/Details.asp?Protocol=62024 [accessed August 14, 2006]

  35. Chen LL, Trent JC, Wu EF, et al. A missense mutation in KIT kinase domain 1 correlates with imatinib resistance in gastrointestinal stromal tumors. Cancer Res 2004; 64(17):5913–9

    Article  PubMed  CAS  Google Scholar 

  36. Tamborini E, Bonadiman L, Greco A, et al. A new mutation in the KIT ATP pocket causes acquired resistance to imatinib in a gastrointestinal stromal tumor patient. Gastroenterology 2004; 127(1):294–9

    Article  PubMed  CAS  Google Scholar 

  37. Wakai T, Kanda T, Hirota S, et al. Late resistance to imatinib therapy in a metastatic gastrointestinal stromal tumour is associated with a second KIT mutation. Br J Cancer 2004; 90(11):2059–61

    PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Elizabeth L. Hess of the M. D. Anderson Department of Scientific Publications for editing this manuscript and Dr. Joe Ensor of the M. D. Anderson Department of Biostatistics and Applied Mathematics for assistance with statistical analysis.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Unit 444, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Robert H. I. Andtbacka MD, CM, Janice N. Cormier MD, MPH, Kelly K. Hunt MD, Peter W. T. Pisters MD, Raphael E. Pollock MD, PhD & Barry W. Feig MD

  2. Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA

    Chaan S. Ng MD

  3. Department of Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA

    Robert S. Benjamin MD, Michael A. Burgess MD, Lei L. Chen MD, PhD, Jonathan Trent MD & Shreyaskumar R. Patel MD

  4. Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA

    Kevin Raymond MD

  5. Department of Surgery, University of Utah, Salt Lake City, UT, 84112, USA

    Courtney L. Scaife MD

Authors
  1. Robert H. I. Andtbacka MD, CM
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  2. Chaan S. Ng MD
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  3. Courtney L. Scaife MD
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  8. Robert S. Benjamin MD
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  11. Jonathan Trent MD
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  13. Kevin Raymond MD
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  14. Barry W. Feig MD
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Corresponding author

Correspondence to Robert H. I. Andtbacka MD, CM.

Additional information

Presented in part at the Annual Meeting of the Society of Surgical Oncology, Atlanta, GA, March 2005.

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Andtbacka, R.H.I., Ng, C.S., Scaife, C.L. et al. Surgical Resection of Gastrointestinal Stromal Tumors After Treatment with Imatinib. Ann Surg Oncol 14, 14–24 (2007). https://doi.org/10.1245/s10434-006-9034-8

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  • DOI: https://doi.org/10.1245/s10434-006-9034-8

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