scholarly journals Prospective Evaluation of Neoadjuvant Imatinib Use in Locally Advanced Gastrointestinal Stromal Tumors: Emphasis on the Optimal Duration of Neoadjuvant Imatinib Use, Safety, and Oncological Outcome

Cancers ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 424 ◽  
Author(s):  
Shang-Yu Wang ◽  
Chiao-En Wu ◽  
Chun-Chi Lai ◽  
Jen-Shi Chen ◽  
Chun-Yi Tsai ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Surgical Intervention ◽  
Locally Advanced ◽  
Tumor Resection ◽  
Long Term Results ◽  
Routine Practice ◽  
Primary Tumors ◽  
Stromal Tumors ◽  
Optimal Duration

Background: Neoadjuvant imatinib therapy has been proposed for routine practice with favorable long-term results for patients with locally advanced gastrointestinal stromal tumors (GISTs). However, clarification of the optimal duration, safety, and oncological outcomes of neoadjuvant imatinib use before surgical intervention remains necessary. Methods: We prospectively analyzed the treatment outcomes of 51 patients with locally advanced, nonmetastatic GISTs treated with neoadjuvant imatinib followed by surgery. The optimal duration was defined as the timepoint when there was a <10% change in the treatment response or a size decrease of less than 5 mm between two consecutive computed tomography scans. Results: Primary tumors were located in the stomach (23/51; 45%), followed by the rectum (17/51; 33%), ileum/jejunum (9/51; 18%), and esophagus (2/51; 4%). The median maximal shrinkage time was 6.1 months, beyond which further treatment may not be beneficial. However, the maximal shrinkage time was 4.3 months for the stomach, 8.6 months for the small bowel and 6.9 months for the rectum. The R0 tumor resection rate in 27 patients after neoadjuvant imatinib and surgery was 81.5%, and 70.4% of resection procedures succeeded in organ preservation. However, 10 of 51 patients (19.6%) had complications following neoadjuvant imatinib use (six from imatinib and four from surgery). Conclusion: Our analysis supports treating GIST patients with neoadjuvant imatinib, which demonstrated favorable long-term results of combined therapy. However, careful monitoring of complications is necessary. The optimal duration of neoadjuvant imatinib use before surgical intervention is, on average, 6.1 months.

scholarly journals Influence of neodymium laser radiation on the frequency of recurrence and continued growth of extramedullary tumors

2021 ◽  
Vol 18 (3) ◽  
pp. 77-85
Author(s):  
I. A. Eliseenko ◽  
S. G. Struts ◽  
V. V. Stupak
Keyword(s):  
Laser Radiation ◽  
Tumor Resection ◽  
Relative Number ◽  
Neodymium Laser ◽  
Long Term Results ◽  
Primary Tumors ◽  
Classical Technique ◽  
Long Term Follow Up ◽  
Microsurgical Techniques

Objective. To assess the effect of neodymium laser radiation on the recurrence rate and continued growth of primary extramedullary tumors on the basis of clinical data obtained in the long-term follow-up period in operated patients with extramedullary tumors.Material and Methods. The long-term results of surgical treatment of two groups of patients (n = 412) with primary extramedullary tumors operated on from 1998 to 2014 were studied and systematized. Patients of comparison group (n = 277; 67.2 %) underwent removal of tumors using standard microsurgical techniques, and the neoplasms in patients of the study group (n = 135; 32.8 %) were removed with additionally used neodymium (Nd:YAG) laser.Results. The use of the developed laser technologies for the resection of extramedullary intracanal primary tumors made it possible to reliably reduce the relative number of recurrence and continued growth from 11.1 % to 1.2% compared with patients treated with standard surgery methods. The proportion of recurrences was 3.5 %, all of them were detected only in the group with the classical technique of tumor resection (p <0.01).Conclusion. The use of a neodymium laser as an additional technology to the classical microsurgical resection of extramedullary tumors is effective for the prevention of their recurrence and continued growth.

scholarly journals Correlation of Long-term Results of Imatinib in Advanced Gastrointestinal Stromal Tumors With Next-Generation Sequencing Results

JAMA Oncology ◽  
2017 ◽  
Vol 3 (7) ◽  
pp. 944 ◽  
Author(s):  
Michael C. Heinrich ◽  
Cathryn Rankin ◽  
Charles D. Blanke ◽  
George D. Demetri ◽  
Ernest C. Borden ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Gastrointestinal Stromal Tumors ◽  
Long Term Results ◽  
Next Generation ◽  
Stromal Tumors ◽  
Generation Sequencing

Neoadjuvant imatinib and organ preservation in locally advanced gastrointestinal stromal tumors (GIST)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10550-10550 ◽  
Author(s):  
P. Hohenberger ◽  
O. Oladeji ◽  
T. Licht ◽  
A. Dimitrakopoulou-Strauss ◽  
J. Jakob ◽  
...  
Keyword(s):  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Organ Preservation ◽  
Locally Advanced ◽  
Response To Therapy ◽  
Long Term Results ◽  
Stromal Tumors ◽  
Local Recurrences ◽  
Tumor Boards ◽  
Exon 9

10550 Background: We assessed the outcome of patients with locally advanced gastrointestinal stromal tumors (GIST) undergoing preoperative therapy with imatinib. Methods: 36 patients with biopsy proven GIST (23 f, 13 m, median age 58 (27–85) yrs, 31 primary tumors, 5 local recurrences) of the esophagus/EGJ (n=5), stomach (n=17), duodenum (n=2), small bowel (n=3), or rectum (n=9) were treated with imatinib 400mg/d for 6 mos. preop. Six pts had been found unresectable at exploratory lap. and no pt. had signs of metastases on CT/MRI and/or FDG-PET. Average tumor size was 10.5 cm (4–28 cm). According to Consensus two tumors were low risk, 11 intermediate, and 23 were high risk for aggressive behaviour. 33 pts were symptomatic. Extent of surgery, local outcome, morbidity and response to therapy were analyzed; median follow-up is 22 mos. Results: Median treatment duration was 11 mos. (range 2–31 mos). Successful dose adjustment for exon 9 mutation to 800 mg imatinib/d was used in two pts. 33 pts. completed the treatment schedule, two died from unrelated disease, another one had to be operated for tumor rupture. Of the remaining 33, median tumor size shrank to 55 mm. Two elderly patients refused surgery and continued with the drug; one pt. was found still unresectable. Complete tumor removal was possible in 28 pts without operative mortality, but two pts showed previously undetected peritoneal spread (R2 resection). Histologically, one pCR and 11 near CR/good PRs were found. The extent of resection found 5 of 6 inoperable pts now resectable and in 21/25 pts a less extensive procedure could be performed in comparison to recommendations by previous tumor boards (segmental gastric resection for gastrectomy, avoidance of pancreatectomy, transanal resection instead of colo-anal anastomosis). Two local recurrences were detected at 31 and 44 mos. postop. Conclusions: Locoregionally advanced GIST can be treated successfully with upfront imatinib at 400mg/ (800 mg in exon 9 mutation). Substantial tumor shrinkage facilitates radical but conservative surgery and results in organ-preservation in the overwhelming majority of patients. PET monitoring proved very helpful and added to CT/MRI evaluation. Long-term results on survival and metastatic spread have to be awaited. [Table: see text]

scholarly journals Prospective Observational Study of Imatinib Therapy in Japanese Patients with Advanced Gastrointestinal Stromal Tumors: Long-term Follow-up and Second Malignancy

2012 ◽  
Vol 42 (7) ◽  
pp. 578-585 ◽  
Author(s):  
Tatsuo Kanda ◽  
Takashi Ishikawa ◽  
Seiichi Hirota ◽  
Kazuhito Yajima ◽  
Shin-ichi Kosugi ◽  
...  
Keyword(s):  
Observational Study ◽  
Gastrointestinal Stromal Tumors ◽  
Prospective Observational Study ◽  
Japanese Patients ◽  
Imatinib Therapy ◽  
Long Term Results ◽  
Second Malignancies ◽  
Stromal Tumors

Abstract Objective Limited data are available concerning long-term results of imatinib therapy in patients with advanced gastrointestinal stromal tumors. We aimed to clarify the long-term outcomes of imatinib therapy in Japanese patients with advanced gastrointestinal stromal tumors. Methods A prospective, observational study of imatinib therapy for unresectable and metastatic gastrointestinal stromal tumors was conducted in our institution. Imatinib was initiated at a dose of 400 mg daily and continued until disease progression. Safety, efficacy and long-term tolerability and survival were evaluated in an intent-to-treat population. The median follow-up period in this study was 68 months. Results Seventy patients were enrolled between December 2001 and December 2009. Treatment-related Grade 3/4 adverse events occurred in 49 patients (70.0%). Although 14 patients required adverse effect management with hospitalization, only 5 patients (7.1%) withdrew from the treatment owing to imatinib intolerance. The tumor response and clinical benefit rates were 61.4 and 85.7%, respectively. Thirty-seven patients (52.9%) maintained the treatment at 400 mg daily imatinib, whereas 33 patients (47.1%) had their dose reduced to 300 mg daily or less. The overall survival rate at 5 years was 60.9% and the median survival time was 70 months. The median progression-free survival time of all the 70 enrolled patients was 30 months. Seven patients (10.0%) suffered from second malignancies, including three patients with genitourinary carcinomas. Conclusions Despite the need for dose reduction, the long-term results of imatinib therapy for advanced gastrointestinal stromal tumors were good in Japanese patients. Physicians should pay attention to the occurrence of second malignancies during imatinib therapy for gastrointestinal stromal tumor patients.

scholarly journals The analysis of the long-term outcomes of sorafenib therapy in routine practice in imatinib and sunitinib resistant gastrointestinal stromal tumors (GIST)*

2017 ◽  
Vol 21 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Piotr Rutkowski ◽  
Beata Jagielska ◽  
Jolanta Andrzejuk ◽  
Elzbieta Bylina ◽  
Iwona Lugowska ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Routine Practice ◽  
Long Term Outcomes ◽  
Stromal Tumors ◽  
Sorafenib Therapy

scholarly journals Biology- and Location-Oriented Precision Treatment of Rectal Cancer: Present and Future

2020 ◽  
Vol 36 (5) ◽  
pp. 381-387
Author(s):  
Stefan Fichtner-Feigl
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Imaging Techniques ◽  
Locally Advanced ◽  
Preoperative Staging ◽  
Tumor Resection ◽  
Long Term Results ◽  
Mesorectal Excision ◽  
Treatment Pathways

<b><i>Background:</i></b> The surgical approach in rectal cancer treatment has evolved in the last decades and a standardized surgical technique for tumor resection – total mesorectal excision – has been established. <b><i>Summary:</i></b> In a multidisciplinary effort with the use of total mesorectal excision in combination with adjuvant and neoadjuvant treatments to compliment surgery disease management can achieve excellent long-term local control and improved patient survival. Further improvements in imaging techniques and the ability to identify prognostic factors such as tumor regression, extramural venous invasion, and threatened margins have introduced the concept of decision-making based on preoperative staging information. <b><i>Key Message:</i></b> Therefore, in the modern era treatment algorithms are based on high-resolution imaging to plan neoadjuvant therapy and precision surgery followed by pathological and molecular analysis to stratify patients for the need of adjuvant chemotherapy. Despite excellent results with guideline structured treatment pathways, there is still a need to improve long-term results especially for individuals with locally advanced or metastatic tumors.

Outcome and Long Term Results of Surgical Resection for Gastrointestinal Stromal Tumors (GIST)

2003 ◽  
Vol 92 (3) ◽  
pp. 195-199 ◽  
Author(s):  
I. Besana-Ciani ◽  
L. Boni ◽  
G. Dionigi ◽  
A. Benevento ◽  
R. Dionigi
Keyword(s):  
Surgical Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Long Term Results ◽  
Stromal Tumors

scholarly journals Preoperative adjuvant therapy for locally advanced and recurrent/metastatic gastrointestinal stromal tumors: a retrospective study

2020 ◽  
Author(s):  
Jing Qi ◽  
He-li Liu ◽  
Feng Ren ◽  
Sheng Liu ◽  
Wei Shi ◽  
...  
Keyword(s):  
Imatinib Mesylate ◽  
Gastrointestinal Stromal Tumors ◽  
Locally Advanced ◽  
Imaging Data ◽  
Cancer Specific Survival ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Choi Criteria ◽  
Optimal Duration ◽  
Central South

Abstract Background Preoperative imatinib mesylate therapy for gastrointestinal stromal tumors (GISTs) is controversial. This study aimed to explore the clinical efficacy and optimal duration of preoperative imatinib mesylate (IM) therapy in patients with locally advanced and recurrent/metastatic GISTs. Methods We retrospectively examined patients who received preoperative imatinib mesylate therapy from January 2013 to December 2018 at Xiangya Hospital, Central South University and the Second Xiangya Hospital of Central South University, China. Clinical data, including the results of tests for mutations in KIT and PDGFR, findings from regularly conducted re-examinations, abdominal enhanced computed tomography/magnetic resonance imaging data, responses to imatinib, progression-free survival and overall cancer-specific survival, were recorded. Results A total of 25 patients were enrolled in our study, including 18 with a locally advanced GIST and 7 with recurrent or metastatic GISTs. Their ages ranged from 22 to 70 years (M:F = 1.6:0.9), with a mean age of 50.48±12.51 years. The tumor locations included the stomach (56.0%), rectum (16.0%), enterocoelic/retroperitoneal sites (12.0%) and the small intestine (12.0%). Based on testing for mutations in KIT and PDGFR, 22 patients received 400 mg/d KIT, and 3 patients received 600 mg/d PDGFR. The median duration of preoperative IM therapy was 8.96±4.81 months, ranging from 3 to 26 months. According to the Choi criteria, 24 patients achieved a partial response (PR), and 1 patient had stable disease (SD). All patients underwent surgery after preoperative IM therapy, and no postoperative complications appeared. The 2-year PFS and 5-year PFS were 92% and 60%, respectively, and the total 5-year cancer-specific survival (CSS) was 92%. Conclusion Preoperative imatinib therapy is feasible for locally advanced and recurrent/metastatic GISTs and can effectively shrink the tumor size, allow organ sparing and avoid extensive organ resection. Moreover, the optimal duration of preoperative IM therapy in patients with locally advanced and recurrent/metastatic GISTs was 8.96±4.81 months, ranging from 3 to 26 months, and gastric GISTs had a better response to preoperative IM therapy than did non-gastric GISTs.

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