Skip to main content

Advertisement

SpringerLink
Log in

Impact of Surgery on Advanced Gastrointestinal Stromal Tumors (GIST) in the Imatinib Era

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role for surgery in patients with “unresectable” gastrointestinal stromal tumors (GIST) treated with imatinib is still not defined. The objective of this retrospective study was to evaluate the feasibility and benefit of this secondary surgery.

Methods

Progression-free survival (PFS) in a group of patients who underwent secondary surgery was compared to that of patients treated exclusively with imatinib.

Results

Of 180 patients with unresectable GIST treated with Imatinib, 22 (12%) underwent secondary surgery, following which one patient achieved a complete radiological response, 19 achieved a partial response (PR), in one patient the disease was stable, and in one patient there was reactivation of local occlusive disease after an initial PR. No patient with overall progression was to undergo surgery. At the beginning of imatinib therapy, five patients with metastases underwent emergency surgery [hemorrhage (n = 3) due to rupture of large necrotic masses], which ultimately resulted in three of the five patients dying postoperatively. A macroscopically complete resection was achieved in all primary tumors (5/5) and in ten of the 17 metastases. Pathological analysis revealed two complete response (CR) and 17 PR, and no treatment effect was evidenced in three patients. Two-year overall survival after surgery was 62%. The median PFS calculated from the initiation of imatinib therapy was 18.7 months for all operated patients and 23.4 months after planned surgery.

Conclusion

Primary tumors that become amenable to surgery with prior imatinib therapy, evolving necrosis and localized progression (to avoid life-threatening complications) could benefit from this secondary surgery. For the majority of other residual lesions, the potential benefit of secondary surgery should be evaluated in randomized studies in the future since PFS is similar to that reported among non-operated patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1. 
FIG. 2.
FIG. 3.
FIG. 4.
FIG. 5.

Similar content being viewed by others

References

  1. Duffaud F, Blay JY. Gastrointestinal stromal tumors: biology and treatment. Oncology 2003;65:187–97

    Article  PubMed  Google Scholar 

  2. Miettinen M, Lasota J. Gastrointestinal stromal tumors-definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 2001; 438:1–12–26

    Google Scholar 

  3. Joensuu H, et al. Brief Report : Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal Tumor. N Engl J Med 2001;344:14

    Article  Google Scholar 

  4. Verweij J, van Oosterom A, Blay JY, et al. Imatinibmesylate (STI-571 Glivec, Imatinib) is an active agent for gastrointestinal stromal tumours, but does not yield responses in other soft-tissue sarcomas that are unselected for a molecular target. Results from an EORTC Soft Tissue and Bone Sarcoma Group phase II study. Eur J Cancer 2003;39:2006–11

    Article  PubMed  CAS  Google Scholar 

  5. Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinibmesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002;347:472–80

    Article  PubMed  CAS  Google Scholar 

  6. Eisenberg BL, Judson I. Surgery and Imatinibin the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy. Ann Surg Oncol 2004;11:465–75

    Article  PubMed  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;364:1127–34

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Lassau N, Lamuraglia M, Leclère J, Bonvalot S, Vanel D, Robert C, Tursz T. Doppler-Ultrasonography with perfusion software and contrast medium injection as an early evaluation tool of gastro intestinal stromal tumor (GIST) treated by imatinib: results of a prospective study. Proceedings ASCO 2004, vol 23, abstract 9048

  10. Vanel D, Albiter M, Shapeero L, et al. Role of computed tomography in the follow up of hepatic and peritoneal metastases of GIST under imatinib mesylate treatment. A prospective study of 54 patients. Eur J Radiol 2005;54:118–23

    Article  PubMed  Google Scholar 

  11. Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol 1999;43(Suppl):S15–25

    Article  PubMed  Google Scholar 

  12. Kaplan EL, Meir P. Non-parametric estimation from incomplete observations. J Am Statist Assoc 1958;53:457–81

    Article  Google Scholar 

  13. Demetri GD. Targeting c-kit mutations in solid tumors: scientific rationale and novel therapeutic options. Semin Oncol 2001; 28(Suppl 17):19–26

    Article  PubMed  CAS  Google Scholar 

  14. De Matteo RP, Lewis JJ, Leug D, Mudan S, Woodruff JM, Brennan M. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51–8

    Article  Google Scholar 

  15. Scaife CL, Hunt KK, Patel SR, Benjamin RS, Burgess MA, Chen LL, Trent J, et al. Is there a role for surgery in patients with “unresectable” cKIT+ gastrointestinal stromal tumors treated with Imatinibmesylate? Am J Surg 2003;186:665–9

    Article  PubMed  Google Scholar 

  16. Bauer S, Hartman JT, Lang H, et al. Imatinib may enable complete resection in previously unresectable or metastatic GISTS. Proc ASCO 2004, 23:abstract 9023

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Aparicio T, Boige V, Sabourin JC, Crenn P, Ducreux M, Le Cesne A, Bonvalot S. Prognostic factors after complete resection of primary gastro intestinal stromal tumors. Eur J Surg Oncol 2004;30:1098–103

    Article  PubMed  CAS  Google Scholar 

  19. Blay JY, Bonvalot S, Casali P, et al. GIST consensus meeting panelists. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 2005;16(4):566–78

    Google Scholar 

  20. Benjamin RS, Blanke CD, Blay JY, Bonvalot S, Eisenberg B. Management of gastrointestinal stromal tumors in the imatinib era: selected case studies. Oncologist 2006;11:9–20

    Article  PubMed  Google Scholar 

  21. Bechtold RE, Chen MY, Stanton CA, Savage PD, Levine EA. Cystic changes in hepatic and peritoneal metastases from gastrointestinal stromal tumors treated with Imatinib. Abdom Imaging 2003;28:808–14

    Article  PubMed  CAS  Google Scholar 

  22. Van Oosterom AT, Judson IR, Verweij J, et al. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. Update of phase I study of Imatinib(STI 571) in advanced soft tissue sarcomas and gastrointestinal stromal tumors : a report of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer 2002; 38(Suppl 5):S83–7

    Article  PubMed  Google Scholar 

  23. Van Coevorden F, Peterse H, Rodenhuis S. Is there a role for post Imatinib (salvage) surgery in gastro intestinal tumors? Connective Tissue Oncology Society. In: 9th Annual Scientific Meeting 2003, abstract 147

  24. Desai J, Shankar S, Heinrich C, et al. Clonal evolution of resistance to Imatinibin patients with gastro intestinal tumors: molecular and radiologic evaluation of new lesions. Proc ASCO 2004;23: abstract 3010

    Google Scholar 

  25. Dileo P, Randhawa R, Vanonnenberg E, et al. Safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with GIST with clonal evolution of lesions refractory to imatinib. Proc ASCO 2004;23: abstract 9024

    Google Scholar 

  26. Wu PC, Langerman A, Ryan CW, et al. Surgical treatment of gastrointestinal stromal tumors in the Imatinib (STI-571) era. Surgery 2003;134:656–65

    Article  PubMed  Google Scholar 

  27. Blay JY, Berthaud P, Perol D, et al. Continuous versus intermittent Imatinib treatment in advanced GIST after one year: a prospective phase III randomised trial of the French sarcoma group. Proc ASCO 2004;23: abstract 9006

    Google Scholar 

Download references

Acknowledgments

The authors thank Mrs. Lorna Saint-Ange for editing.

Author information

Authors and Affiliations

  1. Department of Surgery, Institut Gustave Roussy, 94805, Villejuif, France

    S. Bonvalot, H. Eldweny & A. Cavalcanti

  2. Radiotherapy, Institut Gustave Roussy, Villejuif, France

    C. Le Péchoux

  3. Radiology, Institut Gustave Roussy, Villejuif, France

    D. Vanel & N. Lassau

  4. Pathology, Institut Gustave Roussy, Villejuif, France

    P. Terrier

  5. Medical Oncology, Institut Gustave Roussy, Villejuif, France

    C. Robert & A. Le Cesne

Authors
  1. S. Bonvalot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Eldweny
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Le Péchoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Vanel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Terrier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Cavalcanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Robert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. N. Lassau
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Le Cesne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Bonvalot.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bonvalot, S., Eldweny, H., Péchoux, C.L. et al. Impact of Surgery on Advanced Gastrointestinal Stromal Tumors (GIST) in the Imatinib Era. Ann Surg Oncol 13, 1596–1603 (2006). https://doi.org/10.1245/s10434-006-9047-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9047-3

Keywords

Search

Navigation