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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2013

01-09-2013 | Bone and Soft Tissue Sarcomas

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GIST): The EORTC STBSG Experience

Authors: Piotr Rutkowski, MD, PhD, Alessandro Gronchi, MD, Peter Hohenberger, MD, PhD, Sylvie Bonvalot, MD, PhD, Patrick Schöffski, MD, MPH, Sebastian Bauer, MD, PhD, Elena Fumagalli, MD, Pawel Nyckowski, MD, PhD, Buu-Phuc Nguyen, MD, Jan Martijn Kerst, MD, PhD, Marco Fiore, MD, Elzbieta Bylina, BSc, Mathias Hoiczyk, MD, Annemieke Cats, MD, PhD, Paolo G. Casali, MD, Axel Le Cesne, MD, Jürgen Treckmann, MD, PhD, Eberhard Stoeckle, MD, Johannes. H. W. de Wilt, MD, PhD, Stefan Sleijfer, MD, PhD, Ronald Tielen, MD, Winette van der Graaf, MD, PhD, Cornelis Verhoef, MD, PhD, Frits van Coevorden, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2013

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Abstract

Background

Preoperative imatinib therapy of locally advanced GIST may facilitate resection and decrease morbidity of the procedure.

Methods

We have pooled databases from 10 EORTC STBSG sarcoma centers and analyzed disease-free survival (DFS) and disease-specific survival (DSS) in 161 patients with locally advanced, nonmetastatic GISTs who received neoadjuvant imatinib. OS was calculated from start of imatinib therapy for locally advanced disease until death or last follow-up (FU) after resection of the GIST. DFS was calculated from date of resection to date of disease recurrence or last FU. Median FU time was 46 months.

Results

The primary tumor was located in the stomach (55 %), followed by rectum (20 %), duodenum (10 %), ileum/jejunum/other (11 %), and esophagus (3 %). The tumor resection after preoperative imatinib (median time on therapy, 40 weeks) was R0 in 83 %. Only two patients have demonstrated disease progression during neoadjuvant therapy. Five-year DSS/DFS rates were 95/65 %, respectively, median OS was 104 months, and median DFS was not reached. There were 56 % of patients who continued imatinib after resection. Thirty-seven GIST recurrences were diagnosed (only 5 local relapses). The most common mutations affected exon 11 KIT (65 %). Poorer DFS was related to primary tumor location in small bowel and lack of postoperative therapy with imatinib.

Conclusions

Our analysis comprising the largest group of GIST patients treated with neoadjuvant imatinib in routine practice indicates excellent long-term results of combined therapy in locally advanced GISTs.
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Metadata
Title
Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GIST): The EORTC STBSG Experience
Authors
Piotr Rutkowski, MD, PhD
Alessandro Gronchi, MD
Peter Hohenberger, MD, PhD
Sylvie Bonvalot, MD, PhD
Patrick Schöffski, MD, MPH
Sebastian Bauer, MD, PhD
Elena Fumagalli, MD
Pawel Nyckowski, MD, PhD
Buu-Phuc Nguyen, MD
Jan Martijn Kerst, MD, PhD
Marco Fiore, MD
Elzbieta Bylina, BSc
Mathias Hoiczyk, MD
Annemieke Cats, MD, PhD
Paolo G. Casali, MD
Axel Le Cesne, MD
Jürgen Treckmann, MD, PhD
Eberhard Stoeckle, MD
Johannes. H. W. de Wilt, MD, PhD
Stefan Sleijfer, MD, PhD
Ronald Tielen, MD
Winette van der Graaf, MD, PhD
Cornelis Verhoef, MD, PhD
Frits van Coevorden, MD, PhD
Publication date
01-09-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3013-7

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