title: Is surgery mandatory in locally advanced gastrointestinal stromal tumors after imatinib? A case report and literature review.
abstract: Oesophageal gastrointestinal stromal tumors (GISTs) are rare neoplasms (about 2% of all GISTs); radical surgery is the standard treatment of all GISTs but in case of locally advanced and unresectable disease no clear treatment guide lines are available. Studies including neoadjuvant imatinib mesylate (IM) are relatively recent, includes small sample size of heterogeneous patients and do not report a standardized duration of neoadjuvant treatment. The main question still remains whether surgery after neoadjuvant IM gives a survival benefit in locally advanced disease. A 46-year-old man with locally advanced unresectable oesophageal GIST harboring KIT exon 11 mutation was treated in our institution for 12 months with neoadjuvant IM; a reduction of 83% of tumor volume was obtained in 9-month of neoadjuvant IM, but in the last 3 months no further response was seen. After neoadjuvant therapy, patient underwent radical surgery and adjuvant IM, which is still ongoing. Since no definitive data are available about survival benefit of surgery after neoadjuvant IM in locally advanced GISTs, a careful balance between morbidity and mortality derived from surgery should be considered and more studies are needed to better define the utility and the optimal duration of neoadjuvant treatment.
authors.affiliation: Department of Medical Oncology, Humanitas Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Department of Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Congedo
authors.affiliation: Department of Pathology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ricci
authors.affiliation: Department of Pathology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martini
authors.affiliation: Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Noia
authors.affiliation: Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Di Dio
authors.affiliation: Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Quirino
authors.affiliation: Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Barone
authors.affiliation: Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cassano
keywords: Oesophageal GIST; imatinib; neoadjuvant