Imatinib Preoperative Treatment for Gastrointestinal Stromal Tumors Clinical Analysis of 16 Cases

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Imatinib Preoperative Treatment for Gastrointestinal Stromal Tumors Clinical Analysis of 16 Cases

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 1

Abstract

Objective To investigate the efficacy and safety of preoperative therapy with imatinib for unresectable/potentially resectable gaster and duodenum gastrointestinal stromal tumor (GIST). Methods The clinicopathological data of 16 patients diagnosed with unresectable/potential resectable gaster and duodenum GIST who received imatinib as preoperative therapy at the Affiliated Hospital of Inner Mongolia Medical University from July 2010 to June 2015 were retrospectively analyzed. Results The median time of preoperative therapy with imatinib was 7.5months. Image study for response assessment was achieved in all 16 cases, and all of them gained partial response PR after 3-9months preoperative therapy. Among them, 14 patients received R0 resection and 2 patients gave up surgery due to old age. During the preoperative treatment of imatinib, the incidence of adverse effect of grade 3 or above was 25.0% (4/16) , including 2 cases of neutropenia, 1 case of rash (grade 3), and 1 case of skin and digestive tract tissue edema (grade 4). The remaining patients were with grade 1 to 2 adverse effect. The median time of follow-up check was 47 (37-96) months, 3-year disease-free survival rate and overall survival rate are 81.25% and 100% respectively. Conclusion Preoperative imatinib therapy for unresectable/potentially resectable gaster and duodenum GISTs is generally well received. It is helpful to improve the surgical resection rate, reduce the operation range, avoid unnecessary joint organ resection, and protect the function of important structure. GIST is the most common mesenchymal tumor of the gastrointestinal tract [1]. The common onset sites are stomach, small intestine, colorectal, appendix, and esophagus. It may also occur in omentum, mesenteric, bladder, gallbladder, pancreas, retroperitoneal cavity, uterus, etc. [2]. Most GIST is caused by Cajal cell differentiation and have c-kit or PDGFRA receptor tyrosine kinase gene encoded activation mutations. In a few cases without c-kit or PDGFRA mutations, there are other molecular variants that may involve SDHX, BRAF, NF1, K/n-ras, and PIK3CA genes [1]. With the progress of molecular biological research, the treatment model has made a breakthrough. And the most important thing is the discover of the small molecule tyrosine kinase inhibitor imatinib, which can inhibit the growth of GIST cells by blocking the tyrosine kinase and promote apoptosis, thus to achieve good curative effect. But surgery is still an important means of treating GIST [3]. Since there was no obvious symptom in the early stage of GIST, about 30% of cases were unable to receive R0 resection when discovered [4]. As a result, preoperative imatinib treatment was used to make it possible to obtain a R0 resection of the GIST, and to improve the prognosis of patients. This study aims to investigate the efficacy and safety of preoperative therapy with imatinib for unresectable/potentially resectable gaster and duodenum GIST. Inclusion and Exclusion Criteria A retrospective analysis of gastric and duodenal GIST patients from July 2010 to June 2015 at the Affiliated Hospital of Inner Mongolia Medical University was carried out, which was confirmed by biopsy or endoscopic guided biopsy. Preoperative treatment inclusion criteria a) Surgical exploration or imaging evaluation of tumor involvement of important organs or vessels, and was estimated that it is difficult to achieve R0 resection b) Massive tumor size (>10 cm), prone to bleeding and rupture in surgery and may cause iatrogenic dissemination c) The tumor is located in the gastroesophageal junction and duodenum, and surgery is likely to damage the function of important organs d) The tumor can be removed but it is necessary to expand the range of excision, which may cause serious complications. Or high risk of recurrence and death after operation was expected e) It is estimated that multi-organ resection should be performed. When one of the above conditions is satisfied and simultaneously satisfies the following conditions: the ECOG was less than 3, examination of blood and important organs (heart, lung, liver, kidney, bone marrow) have normal results; at least one measurable tumor not transformed to other organs; treatment of imatinib, or chemotherapy and radiotherapy, were not received before the group; good patient compliance, who are able to complete regular follow-up checks.

Authors and Affiliations

Zhao Xueyu, Li Dong hai, Liu Ming

Keywords

Gastrointestinal stromal tumor Preoperative therapy Imatinib Lactation women Primary malignant tumors Gastroesophageal junction Imatinib mesylate

EP ID EP588491
DOI 10.26717/BJSTR.2018.09.001756
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