Surgical intervention following imatinib treatment in patients with advanced gastrointestinal stromal tumors (GISTs).
BACKGROUND
We investigated the role of surgical intervention for advanced GIST after imatinib.


METHODS
Among 256 patients treated with imatinib for advanced GIST, the medical records of the 34 patients who underwent surgery of residual tumors after imatinib treatment were reviewed.


RESULTS
Surgery was performed on 24 patients with responsive disease (RD) after imatinib, on 3 with focal progressive disease (FP), and on 7 with generalized progressive disease (GP). All gross tumors were completely resected in 19/24 (79%), 1/3 (33%), and 1/7 (14%) patients, respectively. Disease status at surgery was associated with prognosis after surgery; with a median follow-up of 25.7 months, the median progression-free survival of patients resected for RD, FP, and GP were 27.8 months (95% CI, 17.8-37.8 months), 5.1 months (95% CI, 4.7-5.6 months), and 3.3 months (95% CI, 2.7-3.9 months), respectively (P < 0.001). Median overall survival was not reached in patients resected for RD, and was 22.5 months (95% CI, 1.4-43.0 months) and 23.5 months (95% CI, 3.0-43.9) for patients resected for FP and GP, respectively (P < 0.001).


CONCLUSIONS
Surgical resection of tumors responsive to imatinib may be beneficial in patients with advanced GIST. Debulking surgery, however, is not recommended for patients who have already developed imatinib resistance.
Sym
Sun Jin
SJ
Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ryu
Min-Hee
MH
Lee
Jae-Lyun
JL
Chang
Heung Moon
HM
Kim
Tae-Won
TW
Kim
Hee Cheol
HC
Kim
Ki Hun
KH
Yook
Jeong Hwan
JH
Kim
Byung Sik
BS
Kang
Yoon-Koo
YK
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001549:Benzamides; D004067:Digestive System Neoplasms / Q000556:secondary; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D018365:Neoplasm, Residual / Q000601:surgery*; D010879:Piperazines / Q000008:administration & dosage*; D011292:Premedication; D011379:Prognosis; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics; D011743:Pyrimidines / Q000008:administration & dosage*; D020796:Receptor, Platelet-Derived Growth Factor alpha / Q000235:genetics; D015996:Survival Rate
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D019009:Proto-Oncogene Proteins c-kit; D020796:Receptor, Platelet-Derived Growth Factor alpha