Management of gastrointestinal stromal tumours in the Imatinib era: a surgeon's perspective.
BACKGROUND
Surgical resection has remained the mainstay of treatment of GIST with a 5-year-survival of 28-35%. Tyrosine kinase inhibitor (Imatinib) has revolutionised the treatment of these tumours. The current research is directed towards expanding the role of this drug in the treatment of GIST. We present our experience of managing GIST in this institute.


METHODS
This is a case note study of patients identified from a prospectively kept database from January 2000 to August 2007.


RESULTS
16 patients were diagnosed with GIST. The median age was 66 years (range 46 to 82) and the male to female ratio was 9:7. Eleven patients underwent surgery, 9 of which had R0 resection (2 laparoscopic, 1 converted to open), one had an open biopsy and one had a debulking procedure. 3 patients were inoperable and 2 were found to be unfit for surgery. Five patients received Imatinib (2 postoperatively). The risk assessment based on morphological criteria showed that 4 patients had low, 4 had intermediate and 8 had high malignant potential. The median follow up was for 12 months (range 3-72); 2 patients died of unrelated causes at 6 and 9 months after diagnosis.


CONCLUSIONS
Most GISTs can be managed effectively using existing protocols. However currently there is no evidence based guidance available on the management of GIST in the following situations-role of debulking surgery, the follow up of benign tumours not requiring surgical resection and role of laparoscopic surgery. Further research is needed to answer these questions.
Date
Ravindra S
RS
Department of Gastrointestinal Surgery, Lancashire Teaching Hospital NHS, Foundation Trust, Preston Road, Chorley, Lancashire, PR7 1PP, UK. ravidate@hotmail.com
Stylianides
Nicholas A
NA
Pursnani
Kishore G
KG
Ward
Jeremy B
JB
Mughal
Muntzer M
MM
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010879:Piperazines / Q000627:therapeutic use*; D011379:Prognosis; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases