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Gastrointestinal Stromal Tumor of the Rectum: Results of Surgical and Multimodality Therapy in the Era of Imatinib

  • Bone and Soft Tissue Sarcomas
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Abstract

Background

The rectum is a rare site of gastrointestinal stromal tumor (GIST), and factors determining long-term outcome remain unclear. In a population study, we assessed the outcome of rectal GIST patients treated at two referral centers.

Methods

A total of 39 patients diagnosed with rectal GIST between January 2002 and December 2010 were identified in prospective databases. Tumor and patient characteristics, treatment details, and outcome were evaluated. Median follow-up was 41 (3–110) months.

Results

A male predominance was noticed (M/F = 29/10). Median age was 53 years (range, 32–80 years). The cohort included, of 39 patients, 12 low-risk, 26 high-risk, and 1 with M1 disease. Of 38 patients with nonmetastatic disease, 36 underwent surgery as transabdominal (15 of 36) or local (21 of 36) resection. There were 21 patients who received preoperative and/or postoperative imatinib treatment. Patients with preoperative imatinib (16 of 36) had a significantly higher rate of R0 resections (p = .02). Five patients developed local recurrences. All of them had undergone local tumor excision with positive margins and without perioperative imatinib. Also, five patients suffered from distant metastases. All belonged to the high-risk group and underwent tumor surgery (3 R0, 2 R1) without receiving perioperative imatinib. A total of three patients died of disease. Perioperative imatinib was associated with improved local disease-free, disease-free, and overall survival (p < .01, p < .01, and p = .03, respectively). Local disease-free survival was significantly improved by negative resection margins (p < .01).

Conclusions

Complete resection is recommended to achieve local disease control. Preoperative imatinib was associated with improved surgical margins. Perioperative imatinib was associated with improved local disease-free, disease-free, and overall survival.

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Acknowledgment

Supported by a Grant from the Conticanet (Connective Tissue Cancer Network, FP7 EU-funded Network of Excellence) mobility program 2007. Preliminary data were presented at the 44th Annual Meeting of the American Society of Clinical Oncology, Chicago, May 30 to June3 2008, Abstract No. 10560. J. Jakob, U. Ronellenfitsch, E. Wardelmann, A. Groncchi, and P. Hohenberger received funding from Novartis.

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Authors and Affiliations

  1. Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany

    Jens Jakob MD, Ulrich Ronellenfitsch MD & Peter Hohenberger MD

  2. Surgical Department, Humanitas Cancer Center, Milan, Italy

    Chiara Mussi MD

  3. Department of Pathology, University of Cologne, Cologne, Germany

    Eva Wardelmann MD

  4. Department of Experimental Molecular Pathology, Department of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

    Tiziana Negri PhD

  5. Melanoma and Sarcoma Unit, Department of Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

    Alessandro Gronchi MD

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  1. Jens Jakob MD
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Correspondence to Jens Jakob MD.

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Jakob, J., Mussi, C., Ronellenfitsch, U. et al. Gastrointestinal Stromal Tumor of the Rectum: Results of Surgical and Multimodality Therapy in the Era of Imatinib. Ann Surg Oncol 20, 586–592 (2013). https://doi.org/10.1245/s10434-012-2647-1

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  • DOI: https://doi.org/10.1245/s10434-012-2647-1

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