title: Role of surgery in patients with recurrent, metastatic, or unresectable locally advanced gastrointestinal stromal tumors sensitive to imatinib: a retrospective analysis of the Spanish Group for Research on Sarcoma (GEIS).
abstract: BACKGROUND
  Recurrent, metastatic, and locally advanced gastrointestinal stromal tumors (GISTs) can be treated successfully with imatinib mesylate. Surgery for residual disease has been suggested for nonrefractory metastatic GISTs to reduce the probability of resistant recurrent clones, although no randomized Phase III trial has been performed to answer the question about its benefit. We carried out an analysis of the outcome of patients with recurrent unresectable locally advanced or metastatic imatinib-sensitive priamary GIST in 14 institutions in Spain. We compared two cohorts: treated or not treated with surgery after partial response or stabilization by imatinib.
  
  
  METHODS
  Data were obtained from the online GIST registry of the Spanish Group for Research in Sarcomas. Selected patients were then divided into two groups: group A, treated initially only with imatinib, and group B, treated additionally with metastasectomy. Baseline characteristics between groups were compared, and univariate and multivariate analysis for progression-free survival and overall survival (OS) were performed.
  
  
  RESULTS
  Analysis was undertaken in 171 patients considered nonrefractory to imatinib. The median follow-up time was 56.6 months. Focusing on OS, the Eastern Cooperative Oncology Group performance status different than 0, extent of disease limited to one metastatic organ, and comparison between groups A or B achieved statistical difference in the multivariate analysis. Median survival was 59.9 months in group A and 87.6 months in group B.
  
  
  CONCLUSIONS
  Based in its benefit in OS, our study supports surgery of metastatic disease in GIST patients who respond to imatinib therapy.
authors.affiliation: Department of Medical Oncology, Institut Català d'Oncologia de Girona, Hospital Josep Trueta, Girona, Spain, jrubio@iconcologia.net.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rubió-Casadevall
authors.forename: Javier
authors.initials: J
authors.lastname: Martinez-Trufero
authors.forename: Xabier
authors.initials: X
authors.lastname: Garcia-Albeniz
authors.forename: Silvia
authors.initials: S
authors.lastname: Calabuig
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Pousa
authors.forename: Javier Garcia
authors.initials: JG
authors.lastname: Del Muro
authors.forename: Joaquin
authors.initials: J
authors.lastname: Fra
authors.forename: Andrés
authors.initials: A
authors.lastname: Redondo
authors.forename: Nuria
authors.initials: N
authors.lastname: Lainez
authors.forename: Andrés
authors.initials: A
authors.lastname: Poveda
authors.forename: Claudia
authors.initials: C
authors.lastname: Valverde
authors.forename: Ana
authors.initials: A
authors.lastname: De Juan
authors.forename: Isabel
authors.initials: I
authors.lastname: Sevilla
authors.forename: Antonio
authors.initials: A
authors.lastname: Casado
authors.forename: Raquel
authors.initials: R
authors.lastname: Andres
authors.forename: Josefina
authors.initials: J
authors.lastname: Cruz
authors.forename: Javier
authors.initials: J
authors.lastname: Martin-Broto
authors.forename: Joan
authors.initials: J
authors.lastname: Maurel
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D008297:Male; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate