title: Follow-up of hepatic and peritoneal metastases of gastrointestinal tumors (GIST) under Imatinib therapy requires different criteria of radiological evaluation (size is not everything!!!).
abstract: OBJECTIVE
  To define computed tomography (CT) criteria for evaluating the response of patients with gastrointestinal stromal tumors (GIST) who are receiving Imatinib (tyrosine-kinase inhibitor therapy).
  
  
  METHODS
  This prospective CT study evaluated 107 consecutive patients with advanced metastatic GIST treated with Imatinib.
  
  
  RESULTS
  Seventy patients had total or partial cystic-like transformation of hepatic and/or peritoneal metastases. These pseudocysts remained unchanged in size or stable in size on successive CT examinations (stable disease according to RECIST criteria). Forty-six patients developed metastases, 17 patients showed increasing parietal thickness and 29 patients with peripheral enhancing nodules. These CT changes represented local recurrence consistent with GIST resistance to Imatinib treatment. WHO or RECIST criteria did not provide a reliable evaluation of disease evolution or recurrence. Development of new enhancement of lesions (parietal thickness or nodule) was the only reliable criterion.
  
  
  CONCLUSIONS
  The development of peripheral thickening or enhancing nodules within cystic-like metastatic lesions, even without any change in size, represented progressive GIST under Imatinib, growing in a short time and should alert the clinician for the possible need for a change in therapy.
authors.affiliation: Department of Radiology, Institut Gustave-Roussy, Villejuif, France.
authors.forename: Mylène
authors.initials: M
authors.lastname: Mabille
authors.forename: Daniel
authors.initials: D
authors.lastname: Vanel
authors.forename: Marcela
authors.initials: M
authors.lastname: Albiter
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
authors.forename: Cécile
authors.initials: C
authors.lastname: Le Péchoux
authors.forename: Philippe
authors.initials: P
authors.lastname: Terrier
authors.forename: Lorraine G
authors.initials: LG
authors.lastname: Shapeero
authors.forename: Clarisse
authors.initials: C
authors.lastname: Dromain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001549:Benzamides; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D006801:Humans; D000068877:Imatinib Mesylate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate