title: Resection of residual disease in patients with metastatic gastrointestinal stromal tumors responding to treatment with imatinib.
abstract: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Long-term survival of patients with metastatic disease has only been observed in patients with completely resected disease. Recently, the tyrosine kinase inhibitor imatinib has been found to yield responses in the majority of patients with metastatic GIST suggesting improved resectability in responding patients. Combined treatment approaches including resective surgery after imatinib treatment in patients with advanced metastatic disease have rarely been explored. We report a series of 90 patients with metastatic GIST in whom treatment with imatinib enabled 12 patients with mostly recurrent and extensive disease to be considered for resection of residual disease. In 11 of these patients, complete resection could be achieved. Viable tumor cells were found in all but one resected specimens suggesting that despite favorable radiological or clinical responses, imatinib is unlikely to induce pathological complete responses. Until more mature data from prospective trials are available, these data suggest that an early aggressive surgical approach should be considered for all patients with metastatic GIST. Further trials investigating a combined surgical and pre/postoperative treatment with imatinib in patients with advanced metastatic GIST are warranted.
authors.affiliation: Department of Internal Medicine (Cancer Research), University of Essen Medical School, Essen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bauer
authors.forename: Jörg Thomas
authors.initials: JT
authors.lastname: Hartmann
authors.forename: Maike
authors.initials: M
authors.lastname: de Wit
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Florian
authors.initials: F
authors.lastname: Grabellus
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Niebel
authors.forename: Jochen
authors.initials: J
authors.lastname: Erhard
authors.forename: Peter
authors.initials: P
authors.lastname: Ebeling
authors.forename: Matthias
authors.initials: M
authors.lastname: Zeth
authors.forename: Georg
authors.initials: G
authors.lastname: Taeger
authors.forename: Siegfried
authors.initials: S
authors.lastname: Seeber
authors.forename: Michael
authors.initials: M
authors.lastname: Flasshove
authors.forename: Jochen
authors.initials: J
authors.lastname: Schütte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018365:Neoplasm, Residual / Q000188:drug therapy*; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate