title: Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience.
abstract: BACKGROUND
  Preoperative imatinib therapy of locally advanced GIST may facilitate resection and decrease morbidity of the procedure.
  
  
  METHODS
  We have pooled databases from 10 EORTC STBSG sarcoma centers and analyzed disease-free survival (DFS) and disease-specific survival (DSS) in 161 patients with locally advanced, nonmetastatic GISTs who received neoadjuvant imatinib. OS was calculated from start of imatinib therapy for locally advanced disease until death or last follow-up (FU) after resection of the GIST. DFS was calculated from date of resection to date of disease recurrence or last FU. Median FU time was 46 months.
  
  
  RESULTS
  The primary tumor was located in the stomach (55%), followed by rectum (20%), duodenum (10%), ileum/jejunum/other (11%), and esophagus (3%). The tumor resection after preoperative imatinib (median time on therapy, 40 weeks) was R0 in 83%. Only two patients have demonstrated disease progression during neoadjuvant therapy. Five-year DSS/DFS rates were 95/65%, respectively, median OS was 104 months, and median DFS was not reached. There were 56% of patients who continued imatinib after resection. Thirty-seven GIST recurrences were diagnosed (only 5 local relapses). The most common mutations affected exon 11 KIT (65%). Poorer DFS was related to primary tumor location in small bowel and lack of postoperative therapy with imatinib.
  
  
  CONCLUSIONS
  Our analysis comprising the largest group of GIST patients treated with neoadjuvant imatinib in routine practice indicates excellent long-term results of combined therapy in locally advanced GISTs.
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Rutkowski
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gronchi
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
authors.forename: Patrick
authors.initials: P
authors.lastname: Schöffski
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bauer
authors.forename: Elena
authors.initials: E
authors.lastname: Fumagalli
authors.forename: Pawel
authors.initials: P
authors.lastname: Nyckowski
authors.forename: Buu-Phuc
authors.initials: BP
authors.lastname: Nguyen
authors.forename: Jan Martijn
authors.initials: JM
authors.lastname: Kerst
authors.forename: Marco
authors.initials: M
authors.lastname: Fiore
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Bylina
authors.forename: Mathias
authors.initials: M
authors.lastname: Hoiczyk
authors.forename: Annemieke
authors.initials: A
authors.lastname: Cats
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Casali
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.forename: Jürgen
authors.initials: J
authors.lastname: Treckmann
authors.forename: Eberhard
authors.initials: E
authors.lastname: Stoeckle
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Stefan
authors.initials: S
authors.lastname: Sleijfer
authors.forename: Ronald
authors.initials: R
authors.lastname: Tielen
authors.forename: Winette
authors.initials: W
authors.lastname: van der Graaf
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Frits
authors.initials: F
authors.lastname: van Coevorden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001549:Benzamides / Q000627:therapeutic use*; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D010879:Piperazines / Q000627:therapeutic use*; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D015996:Survival Rate
chemical_list: D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate