TY - JOUR
T1 - Is surgery mandatory in locally advanced gastrointestinal stromal tumors after imatinib? A case report and literature review.
AU - Ricci, Riccardo
AU - Martini, Maurizio
AU - Cassano, Alessandra
AU - Congedo, Maria Teresa
AU - Di Noia, Vincenzo Pio
AU - Di Dio, Carmela
AU - Quirino, Michela
AU - Barone, Carlo Antonio
AU - Rossi, Sabrina
PY - 2016
Y1 - 2016
N2 - Oesophageal gastrointestinal stromal tumors (GISTs) are rare neoplasms (about 2% ofall 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.
AB - Oesophageal gastrointestinal stromal tumors (GISTs) are rare neoplasms (about 2% ofall 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.
KW - GIST
KW - Molecular targeted therapy
KW - GIST
KW - Molecular targeted therapy
UR - http://hdl.handle.net/10807/93106
U2 - http://dx.doi.org/10.21037/jgo.2016.12.02
DO - http://dx.doi.org/10.21037/jgo.2016.12.02
M3 - Article
VL - 2017
SP - E4-E9
JO - Journal of Gastrointestinal Oncology
JF - Journal of Gastrointestinal Oncology
SN - 2078-6891
ER -