Fluid retention associated with imatinib treatment in patients with gastrointestinal stromal tumor: quantitative radiologic assessment and implications for management.
OBJECTIVE
We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management.


METHODS
In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores.


RESULTS
The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction.


CONCLUSIONS
Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.
Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. ; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Kyung Won
KW
Kim
Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Atul B
AB
Shinagare
Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Katherine M
KM
Krajewski
The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA.
Junhee
J
Pyo
Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Sree Harsha
SH
Tirumani
Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Jyothi P
JP
Jagannathan
Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Nikhil H
NH
Ramaiya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001201:Ascites / Q000000981:diagnostic imaging / Q000473:pathology; D001549:Benzamides / Q000009:adverse effects* / Q000627:therapeutic use; D004452:Echocardiography / Q000379:methods; D004487:Edema / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging* / Q000473:pathology; D006333:Heart Failure / Q000000981:diagnostic imaging; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000009:adverse effects*; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000473:pathology; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D011871:Radiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate
Ascites; Computed tomography; Fluid retention; Imatinib; Subcutaneous edema