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Gbessi DG, Gnangnon FHR, Kpossou AR, Gbetchedji PP, Seidou F, Imorou Souaïbou Y, Attolou SGR, Lawani I, Laleye MC, Gangbo F, Dossou FM, Sehonou J, Mehinto DK. Challenge of gastro-intestinal stromal tumor management in low-income countries: example of Benin. World J Surg Oncol 2022; 20:247. [PMID: 36451201 PMCID: PMC9714201 DOI: 10.1186/s12957-022-02709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND GISTs are rare tumors but the most frequent mesenchymal tumors of the digestive tract. Diagnosis and treatment are challenging in low-income countries due to relatively poor access to immunohistochemistry and targeted therapy. In Africa, there are few studies about it. Imatinib, an oral targeted therapy, has been available in Benin since 2010 and free since 2016. This study describes the diagnosis and therapeutic management of GIST in Cotonou, Benin. METHODS This is a descriptive cross-sectional study, with retrospective data collection over a 10-year period from 2010 to 2020, focused on patients with histological confirmed gastro-intestinal stromal tumor (GIST). Cases were identified using the registry database and the archival files of the Hubert Koutoukou Maga National University Hospital of Cotonou (CNHU-HKM). RESULTS Fifteen GISTs were identified during the study period. The median age was 52 and the sex ratio was 2:1 (10 males and 5 females). The most frequent symptom was abdominal pain (n = 12). Delay in care seeking after onset of symptoms ranged from 24 h to 15 years. The most common site for GISTs was the stomach (n = 8). The median tumor size was 11 cm and the majority (n=10) was metastatic or locally advanced at the time of diagnosis. The tumors were often spindle-shaped at histology (n = 13) and the majority expressed KIT (n = 14). Most of the tumors (n = 12) were at high risk of recurrence according to the Joensuu scoring system. The availability of imatinib has improved the outcome of GIST with response in all cases it was used in neoadjuvant setting (n = 7). CONCLUSION GISTs are rare tumors and preferentially affect the stomach in Cotonou). Most of the tumors were large, unresectable at the time of diagnosis and at high risk of recurrence. Access to imatinib has revolutionized the management of those tumors in our country.
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Affiliation(s)
- Dansou Gaspard Gbessi
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | | | - Aboudou Raïmi Kpossou
- grid.420217.2Department of Hepato-Gastroenterology, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Pacifique Prudent Gbetchedji
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Falilatou Seidou
- Department of Pathology, Faculty of Health Sciences/ Abomey-Calavi University (FSS/UAC), Cotonou, Republic of Benin
| | - Yacoubou Imorou Souaïbou
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Setondji Gilles Roger Attolou
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Ismaïl Lawani
- Department of General Surgery, Departmental University Hospital Oueme-Plateau (CHDU-OP), Porto-Novo, Republic of Benin
| | - Marie-Christel Laleye
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Flore Gangbo
- Department of Pathology, Faculty of Health Sciences/ Abomey-Calavi University (FSS/UAC), Cotonou, Republic of Benin
| | - Francis Moïse Dossou
- Department of General Surgery, Departmental University Hospital Oueme-Plateau (CHDU-OP), Porto-Novo, Republic of Benin
| | - Jean Sehonou
- grid.420217.2Department of Hepato-Gastroenterology, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Delphin Kuassi Mehinto
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
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Ramdani A, Bouhout T, Serji B, Khannoussi W, El Harroudi T. The Outcome of Neoadjuvant Imatinib Therapy Combined With Surgery for Rectal Gastrointestinal Stromal Tumors: A Report of Three Cases and a Review of the Literature. Cureus 2020; 12:e12100. [PMID: 33489517 PMCID: PMC7806191 DOI: 10.7759/cureus.12100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) represent the most frequent mesenchymal tumors of the gastrointestinal tract. They occur most frequently in the stomach. Rectal localization remains rare and represents only 5% of all GIST cases and 0.1% of all rectal tumors. Immunohistochemical staining (CD117, DOG1) and molecular analysis remain the gold standard for diagnosis; DOG1 represents a very sensitive marker regardless of CD117 expression. Complete en-bloc resection constitutes the only curative treatment; however, surgical management of rectal GIST remains challenging and can involve extensive surgery such as abdominoperineal resection with significant morbidity. The role of neoadjuvant Imatinib therapy in rectal GISTs is controversial and mainly indicated in a locally advanced tumor or sphincter invasion to increase the chance of complete resection and sphincter preservation. Herein, we report three cases of a rectal GIST treated with neoadjuvant Imatinib therapy and who underwent extensive surgery with complete resection (R0), as well as a recent review of the literature, to study clinicopathological features, surgical challenges, and perioperative Imatinib therapy outcome of rectal GISTs.
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Affiliation(s)
- Abdelbassir Ramdani
- Surgical Oncology, Regional Oncology Center, Mohammed VI University Hospital, Oujda, MAR
| | - Tariq Bouhout
- Surgical Oncology, Regional Oncology Center, Mohammed VI University Hospital, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Regional Oncology Center, Mohammed VI University Hospital, Oujda, MAR
| | - Wafaa Khannoussi
- Gastroenterology and Hepatology, Mohammed VI University Hospital Center/Mohammed First University, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Regional Oncology Center, Mohammed VI University Hospital, Oujda, MAR
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Landi B, Blay JY, Bonvalot S, Brasseur M, Coindre JM, Emile JF, Hautefeuille V, Honore C, Lartigau E, Mantion G, Pracht M, Le Cesne A, Ducreux M, Bouche O. Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis 2019; 51:1223-1231. [PMID: 31387778 DOI: 10.1016/j.dld.2019.07.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND This document is a summary of the French Intergroup guidelines regarding the management of gastrointestinal stromal tumours (GISTs) updated in December 2018. DESIGN This collaborative work summarizes clinical practice recommendations (guidelines) on the management of GISTs. It is based on recent literature review, ESMO recommendations and expert opinions. RESULTS The diagnosis of GIST is based on histological examination and immunohistochemistry with markers KIT and DOG-1. Each case must be discussed within a multidisciplinary team. Complete surgical resection tumour, avoiding peroperative perforation, is the potentially curative treatment of localized GISTs. The estimation of the recurrence risk is essential, or adjuvant treatment,and follow-up adaptation. Genotyping (KIT and PDGFRA) of all but very low-risk GISTs is recommended. The nature of mutation has a prognostic value and predictive influence on drug efficacy. Imatinib, a tyrosine-kinase inhibitor, is the standard adjuvant treatment after R0 resection of a GIST with a high risk of recurrence, and the first line therapy for advanced GISTs. Suninitib and regorafenib are respectively the second- and third-line standard treatments for advanced GISTs. CONCLUSION Guidelines for management of GISTs are continuously evolving and need to be regularly updated. This constant progress is made possible through clinical and translational research.
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Affiliation(s)
- Bruno Landi
- Departments of Hepatogastroenterology and Digestive Oncology, European Georges Pompidou Hospital, Paris, France.
| | - Jean-Yves Blay
- Departments of Medical Oncology, Léon Bérard Center, Lyon, France
| | | | - Mathilde Brasseur
- Departments of Hepatogastroenterology and Digestive Oncology, CHU Robert Debré Hospital, Reims, France
| | | | - Jean François Emile
- Departments of Pathology, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Vincent Hautefeuille
- Departments of Hepatogastroenterology and Digestive Oncology, CHU Amiens Picardie, Amiens, France
| | - Charles Honore
- Departments of Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Eric Lartigau
- Departments of Radiotherapy, Oscar Lambret Center, Lille, France
| | | | - Marc Pracht
- Departments of Medical Oncology, Eugène Marquis Center, Rennes, France
| | - Axel Le Cesne
- Departments of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Michel Ducreux
- Departments of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivier Bouche
- Departments of Hepatogastroenterology and Digestive Oncology, CHU Robert Debré Hospital, Reims, France
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Bachet JB, Landi B, Laurent-Puig P, Italiano A, Le Cesne A, Lévy P, Safar V, Duffaud F, Blay JY, Emile JF. Diagnosis, prognosis and treatment of patients with gastrointestinal stromal tumour (GIST) and germline mutation of KIT exon 13. Eur J Cancer 2013; 49:2531-41. [DOI: 10.1016/j.ejca.2013.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 12/15/2022]
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Sekkate S, Kairouani M, Abahssain H, Serji B, Boutayeb S, Mrabti H, Errihani H. [Gastrointestinal stromal tumors]. Presse Med 2012; 41:917-26. [PMID: 22281391 DOI: 10.1016/j.lpm.2011.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/24/2011] [Accepted: 11/30/2011] [Indexed: 12/20/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) are the most common sarcomas of the gastrointestinal tract. They affect all segments of the digestive tract. They develop from the interstitial cells of Cajal. Mutations in the Kit gene is present in 86% of cases and in PDGFR gene in 15% of cases. The marker CD 117 is present in 95% of cases. Surgery is the standard treatment in localized forms. The tyrosine kinase inhibitor, imatinib is standard in first-line metastatic gastrointestinal stromal tumors, as well as adjuvant treatment after surgery. Sunitinib is the standard in second line.
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Affiliation(s)
- Sakina Sekkate
- Institut national d'oncologie, service d'oncologie médicale, 10100 Rabat, Maroc.
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