The role of neoadjuvant imatinib therapy of patients with primary locally advanced GIST.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11037-11037
Author(s):  
Peter Arkhiri ◽  
Irina Poddubnaya ◽  
Sergey N. Nered ◽  
Ivan N. Peregorodiev ◽  
Maxim P. Nikulin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Resection ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Percutaneous Biopsy ◽  
Imatinib Therapy ◽  
Maximal Response ◽  
Optimal Timing ◽  
Adjuvant Imatinib ◽  
Advanced Gist

11037 Background: percutaneous biopsy of gastrointestinal tumors is contraindicated, that is why prospective randomized trials of efficiency of preoperative imatinib therapy weren't conducted. According to the results of theRTOG S-0132/ACRIN 6665, CST1571-BDE43 and other studies, neoadjuvant imatinib therapy increase tumor resectability and improve progression-free and disease-specific survival. The optimal timing of surgical intervention is likely during the maximal response on treatment (6 to 12 months as a rule). Methods: We have analyzed the treatment results of 86 patients with locally advanced GIST which were treated since January 1st 2002 till 20 January 2016 at N.N. Blokhin Russian Cancer Centre. The primary tumor was located in the stomach - 32 pts (37,2%), duodenum and small bowel - 37 (43,1%), other (colon, rectum and extraorgan) – 17 pts ( 19,7%). The median follow-up time was 4.9 years. There are 4 groups in the trail: group 1 - 29 patients received only surgical treatment, group 2 - 12 pts– surgical resection with adjuvant imatinib therapy for 1 year; group 3 - 25 pts – adjuvant imatinib therapy for 3 years and group 4 - 17 pts– surgical resection with neoadjuvant and adjuvant imatinib therapy (1 - 3 years). The remained 3 patients received surgical resection with adjuvant imatinib therapy for 5 years. Results: Survival analyses showed a significant improvement of RFS and OS in patients who received combined treatment with neoadjuvant and adjuvant imatinib therapy. The five-year RFS in first group of patients was 10,8%, in 2 group - 16,7%, in 3 group - 68,4%, and 4 group - 79,8% (p = 0.0001). The 5-year overall survival in these groups was 42,6%, 66,7%, 76,1% and 91.6% ( p = 0,0072) respectively. In the patients with 5-years adjuvant therapy, diseases progression was not noted. During neoadjuvant therapy disease progression has been registered in two patients. The median time of preoperative imatinib therapy was 11 month (from 3 to 24 month). Neoadjuvant imatinib therapy increased the rate of R0 (14 pts – 82,4%) and organ-sparing (12 pts – 70,6%) resections. Conclusions: The optimal approach in patients with locally advanced GIST is combined surgical treatment with neoadjuvant and adjuvant (at least for 3 years) imatinib therapy.

scholarly journals Results of surgical treatment of localized and locally advanced adrenocortical cancer in children

2021 ◽  
Vol 8 (2) ◽  
pp. 42-49
Author(s):  
A. S. Temniy ◽  
A. P. Kazantsev ◽  
P. A. Kerimov ◽  
N. Yu. Kalinchenko ◽  
M. V. Rubanskaya ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Surgical Excision ◽  
Stage I ◽  
Adrenocortical Cancer ◽  
Ki 67 ◽  
Results Of Treatment ◽  
Low Incidence ◽  
Radical Surgical Resection

Introduction. Adrenal cortical carcinoma (ACC) is a rare cancer but is the most common primary cancer in the adrenal gland. Despite the low incidence of ACC the mortality rate ranges from 0.04 to 0.2 %, in the overall structure of cancer mortality. Treatment of ACC is mainly surgical and radical surgical excision is the treatment of choice for local disease stages.Aim of the study — to present our results of surgical treatment of localized and locally advanced ACC in children and to determine the risk factors of relapse.Materials and methods. Twenty-eight patients (median age of 47.8 (06—216) mo.) with localized and locally advanced ACC underwent a retrospectively analysis. Stage I, II, and III revealed in 12 (45 %), 7 (25 %), and 9 (30 %), respectively. In 19 (68 %) cases the secretion of one or more hormone observed. Macroscopically and microscopically complete resection were performed in 26 (93 %) and 23 (82 %) patients, respectively. The median tumor volume was 183 (3.6—1608) cm3 and the median tumor weight was 207.9 (48—710) g.Results. Five-year overall (OS) and relapse-free (RFS) survival were 71 % and 69 %, respectively. OS and RFS according to stage I, II, and III were 100 % vs. 71 % vs. 17 % and 100 % vs. 71 % vs. 14 % respectively. The radical surgical resection and the level of Ki-67 expression influenced significantly the rates of OS and RFS (p < 0.001).Conclusion. The main factor affecting the survival rate of ACC in children with stages I—III is the radical surgical resection. It should be taken into account when planning postoperative therapy. Some of biological characteristics of the tumor could also significantly affect the results of treatment.

Neoadjuvant imatinib in patients with locally advanced GIST in the prospective BFR14 trial

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10551-10551 ◽  
Author(s):  
P. A. Cassier ◽  
A. A. Blesius ◽  
D. Perol ◽  
I. Ray-Coquard ◽  
A. Adenis ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Phase Iii ◽  
Phase Iii Trial ◽  
Free Survival ◽  
Primary Gist ◽  
Advanced Gist

10551 Background: The role of surgery in the management of patients with advanced gastrointestinal stromal tumors (GIST) in the era of imatinib mesylate (IM) remains unknown. We sought to assess the outcome of patients with locally advanced primary GIST tumors without metastases treated with IM in the neoadjuvant setting within the prospective BFR14 phase III trial. Methods: The data base of the BFR14 trial was searched for patients with locally advanced disease and no metastases. Patients with recurrent disease were excluded. Results: Twenty five patients (9 females, 16 males) met these criteria. Twenty patients were PS 0 or 1, primary tumor sites were: small intestine (n=7), peritoneum (n=7), rectum (n=4), stomach (n=4), esophagus (n=2), and pelvis (n=1). Nine of the 25 patients underwent surgical resection of the primary tumor after a median of 7.3 (range 3.4–12.1) months of treatment with IM. There was a significant improvement in progression-free survival (PFS) for patient who underwent surgical resection versus those who did not: median PFS: 28.7 month vs 12.9 months respectively (p=0.0463) this benefit did not however translate into a significant benefit in overall survival (OS), although the trend favoured the resected group: median OS median not reached vs 29.4 months (p=0.0677). Conclusions: Surgery may increase progression-free survival in patients with locally advanced GIST who become resectable following treatment with IM. [Table: see text]

scholarly journals 616 Rare KIT gene mutation in a recurrent GIST: Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N O'Neill ◽  
D McManus ◽  
A Kennedy ◽  
M Eatock ◽  
E Napier
Keyword(s):  
Recurrent Disease ◽  
Locally Advanced ◽  
Complete Response ◽  
Maximal Response ◽  
Molecular Testing ◽  
Gastric Gist ◽  
Adjuvant Imatinib ◽  
Residual Stomach ◽  
Exon 11 ◽  
Viable Tumour

Abstract Introduction The diagnosis and treatment of Gastro-intestinal stromal tumours (GISTs) has been revolutionized by molecular pathology and targeted therapy. Description This patient was diagnosed with locally advanced gastric GIST in 2009. He was initially treated neoadjuvantly with imatinib from 2009- 2010. He underwent laparoscopic resection in 2010. Pathology showed almost complete response with only 1.5mm focus of viable tumour. He did not receive adjuvant imatinib as this was not established practice in 2010. Recurrent disease was resected in 2011. Mitotic count was 200/50hpf. Adjuvant imatinib was given for 5 years then discontinued in 2016. Imaging showed no recurrence over this time period. Molecular testing showed Kit Exon 11 mutation- this is common in GISTs and associated with response to imatinib. Recurrent disease was diagnosed 2018 with a 10x9cm mass between residual stomach and liver– he recommenced imatinib with partial response (maximal response was reached in 2020, but a new 3cm lesion was noted) He underwent further resection of the residual stomach and liver segmentectomy in 2020. Histology showed acellular areas of myxoid degeneration, indicating treatment response however viable tumour remained. Sequencing was performed. This showed the expected mutation in exon 11 but also a mutation in exon 13 of KIT- this has been shown recently to confer resistance to imatinib. Discussion Over 90% of GISTs harbour mutations in c-KIT. Recent work has demonstrated that some tumours acquire secondary mutations conferring resistance, following prolonged TKI therapy. Radiological and histopathological features correlate with such events and assist in deciding surgical management.

Intra-arterial chemotherapy using docetaxel and cisplatin + RT with radiomodification in combined treatment of patients with locally advanced SCC of the oral cavity

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16543-16543
Author(s):  
D. G. Adilbay ◽  
G. B. Adilbayev ◽  
D. N. Ahmetov ◽  
G. Z. Kydirbaeva
Keyword(s):  
Surgical Treatment ◽  
Induction Chemotherapy ◽  
Response Rate ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Preoperative Chemoradiotherapy ◽  
Clinical Effects ◽  
Grade Iii

16543 Background: Our previous studies of using intra-arterial induction chemotherapy in locally advanced SCCHN have showed a low level of toxicities, we haven't experienced any III grade toxicity, there was only 18,8% of grade I and II leucopenia. So this method allows intensify chemoradiotherapy. The addition of radiomodificant agent to standard RT increases its response rate. In our study we have used radiomodification with Arglabin, which showed a good results in different studies performed in Kazakhstan and Russia. To elevate the effect of intra-arterial induction chemotherapy + RT we have studied intensified preoperative chemoradiotherapy. Methods: 15 patients with previously untreated oral cancer (T3–4N0–2M0) received chemoradiotherapy by followed scheme: 1st day intra-arterial chemotherapy by catheterization of the feeding arteries of tumor through the superficial temporal artery: docetaxel - 80 mg/m2, cysplatin - 100 mg/m2, from 2nd to 21st day RT with intra-arterial radiomodification arglabin-70 mg/m2 (28 Gy by 4 Gy - 3 times week), 22nd day second course of intra-arterial chemotherapy and after RT (total dose- 60 Gy by 2 Gy 5 times week), depending on the results surgical treatment in necessary volumes. Results: The clinical effects were CR in 12 (80.0%) patients, PR in 3 (20,0%) patients. The following main toxicities of chemoradiotherapy were observed: only 1 case of grade III neutropenia, Non-hemathologic toxicity: 13% grade III mucosal events, alopecia 66,7%. All results have been confirmed by cytomorphology. All patients have being followed up. Conclusions: Using intra-arterial path of delivery allows intensify chemoradiotherapy. And adding radiomodification increases the results of combined treatment. Therefore this method needs further investigations. No significant financial relationships to disclose.

scholarly journals Modern approaches to the choice of treatment tactics in patients with cervical cancer

2021 ◽  
Vol 17 (3) ◽  
pp. 128-133
Author(s):  
A. L. Chernyshova ◽  
L. A. Kolomiets ◽  
Yu. M. Trushchuk ◽  
O. V. Shpileva ◽  
E. V. Denisov ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Surgical Treatment ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Point Of View ◽  
Advanced Cervical Cancer ◽  
Choice Of Treatment

Currently, approaches to the choice of treatment tactics for cervical cancer have changed significantly. According to the recommendations of ESGO (2018), RUSSCO (2020), the use of a combination of surgical treatment and radiation therapy significantly increases the incidence of complications. Therefore, when planning the treatment of patients with IB1–IIA1, a combination of surgical treatment and radiation therapy should be avoided. The article presents an analysis of modern approaches to the treatment of initial, locally advanced and advanced cervical cancer. Modern approaches to organ-preserving treatment are considered, including the view from the point of view of expanding the indications for trachelectomy as part of combined treatment. The question of the expediency of using hyperthermia and indications for this type of treatment in combination with radiation therapy is considered. The author presents his own view of the problem as a whole and possible ways to solve this problem.

scholarly journals The role of neoadjuvant imatinib therapy of patients with primary locally advanced GIST

2016 ◽  
Vol 27 ◽  
pp. vi490
Author(s):  
P. Arkhiri ◽  
I. Poddubnaya ◽  
S. Nered ◽  
V.Y. Bokhian ◽  
I. Peregorodiev ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Imatinib Therapy ◽  
Advanced Gist

Optimal Timing of Surgical Resection After Radiation in Locally Advanced Rectal Adenocarcinoma: An Analysis of the National Cancer Database

2015 ◽  
Vol 23 (3) ◽  
pp. 877-887 ◽  
Author(s):  
Ciara R. Huntington ◽  
Danielle Boselli ◽  
James Symanowski ◽  
Joshua S. Hill ◽  
Anthony Crimaldi ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Locally Advanced ◽  
Rectal Adenocarcinoma ◽  
Optimal Timing ◽  
National Cancer Database

scholarly journals Aggressive Surgical Resection Combined With Imatinib Therapy for Liver Metastases From a Gastrointestinal Stromal Tumor

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1295-1300
Author(s):  
Mariko Tsukagoshi ◽  
Hideki Suzuki ◽  
Kenichiro Araki ◽  
Norihiro Ishii ◽  
Akira Watanabe ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Surgical Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Complete Response ◽  
Imatinib Therapy ◽  
Imatinib Treatment ◽  
Stromal Tumors ◽  
Left Lateral Segment ◽  
Multiple Liver Metastases ◽  
Advanced Gist

The use of imatinib mesylate has influenced survival in patients with advanced gastrointestinal stromal tumors (GISTs). However, whether a combination of imatinib and surgical resection can further prolong survival in these patients has not yet been fully elucidated. We report a case of a 59-year-old woman with multiple liver metastases from a jejunal GIST. The patient received imatinib therapy after partial resection of the jejunum, and she subsequently underwent right hepatic trisectionectomy. However, liver metastasis was detected again after surgery. Secondary imatinib therapy was started, and the patient underwent partial hepatectomy at the left lateral segment. Postoperatively, the patient underwent imatinib treatment and has survived without recurrence for 3 years. Imatinib is recommended for the treatment of advanced GIST; however, a complete response is rare, and approximately half of all patients develop resistance to imatinib. Aggressive surgical resection combined with imatinib may be effective for the control of advanced GIST.

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