title: Surgical resection of gastrointestinal stromal tumors after treatment with imatinib.
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.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Unit 444, 1515 Holcombe Blvd., Houston, TX 77030, USA. robert_andtbacka@hotmail.com
authors.forename: Robert H I
authors.initials: RH
authors.lastname: Andtbacka
authors.forename: Chaan S
authors.initials: CS
authors.lastname: Ng
authors.forename: Courtney L
authors.initials: CL
authors.lastname: Scaife
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
authors.forename: Michael A
authors.initials: MA
authors.lastname: Burgess
authors.forename: Lei L
authors.initials: LL
authors.lastname: Chen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Trent
authors.forename: Shreyaskumar R
authors.initials: SR
authors.lastname: Patel
authors.forename: Kevin
authors.initials: K
authors.lastname: Raymond
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010879:Piperazines / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases