title: Surgical intervention following imatinib treatment in patients with advanced gastrointestinal stromal tumors (GISTs).
abstract: 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.
authors.affiliation: Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sun Jin
authors.initials: SJ
authors.lastname: Sym
authors.forename: Min-Hee
authors.initials: MH
authors.lastname: Ryu
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.forename: Heung Moon
authors.initials: HM
authors.lastname: Chang
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Ki Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
authors.forename: Yoon-Koo
authors.initials: YK
authors.lastname: Kang
mesh_terms: 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
chemical_list: 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