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Hompland I, Boye K, Wiedswang AM, Papakonstantinou A, Røsok B, Joensuu H, Bruland Ø. Discontinuation of imatinib in patients with oligometastatic gastrointestinal stromal tumour who are in complete radiological remission: a prospective multicentre phase II study. Acta Oncol 2024; 63:288-293. [PMID: 38712513 DOI: 10.2340/1651-226x.2024.39851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/16/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Metastatic gastrointestinal stromal tumour (GIST) is considered incurable, and life-long treatment with tyrosine kinase inhibitors is recommended. We investigated whether selected patients with metastatic GIST may remain in durable remission despite imatinib discontinuation. PATIENTS In this 1-group, prospective, multicentre phase II trial selected patients with oligometastatic (≤3 metastases) GIST discontinued imatinib treatment. Eligible patients had been treated with imatinib >5 years without progression and had no radiologically detectable metastases after metastasectomy, radiofrequency ablation (RFA) or complete response to imatinib. The primary endpoint was progression-free survival (PFS) 3-years after stopping imatinib. Overall survival (OS) and quality of life (QoL) were secondary endpoints. RESULTS The trial closed prematurely due to slow accrual. Between January 5, 2017, and June 5, 2019, 13 patients were enrolled, of whom 12 discontinued imatinib. The median follow-up time was 55 months (range, 36 to 69) after study entry. Five (42%) of the 12 eligible patients remained progression free, and seven (58%) progressed with a median time to progression 10 months. Median PFS was 23 months and the estimated 3-year PFS 41%. Six of the seven patients who progressed restarted imatinib, and all six responded. Three-year OS was 100%, and all patients were alive at the time of the study analysis. QoL measured 5 and 11 months after discontinuation of imatinib demonstrated improvement compared to the baseline. INTERPRETATION A substantial proportion of selected patients with oligometastatic GIST treated with imatinib and metastasis surgery/RFA may remain disease-free for ≥3 years with improved QoL after stopping of imatinib.
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Affiliation(s)
- Ivar Hompland
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Andri Papakonstantinou
- Department of Breast Cancer, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Bård Røsok
- Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Øyvind Bruland
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wardelmann E, Kuntze A, Voloshin A, Elges S, Trautmann M, Hartmann W. [Gastrointestinal stromal tumors : Where do we stand?]. Pathologie (Heidelb) 2024; 45:223-232. [PMID: 38587549 PMCID: PMC11045643 DOI: 10.1007/s00292-024-01318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 04/09/2024]
Abstract
For more than 20 years gastrointestinal stromal tumors (GIST) have been a paradigm for a targeted treatment with tyrosine kinase inhibitors. A fundamental prerequisite for a neoadjuvant or adjuvant treatment of localized GIST or an additive treatment of metastatic GIST is the molecular typing of tumors, ideally at the initial diagnosis. In addition, the possibility of a hereditary or syndromic predisposition must be considered because this results in consequences for the treatment and a different follow-up strategy.
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Affiliation(s)
- Eva Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - Anna Kuntze
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Artem Voloshin
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Sandra Elges
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Marcel Trautmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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Roets E, Ijzerman NS, Ho VKY, Desar IME, Reyners AKL, Gelderblom H, Grünhagen DJ, Van Etten B, Van Houdt WJ, Van der Graaf WTA, Steeghs N. Referral patterns of GIST patients: data from a nationwide study. Acta Oncol 2024; 63:28-34. [PMID: 38353407 DOI: 10.2340/1651-226x.2024.23722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/25/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND This study compares the characteristics, referral and treatment patterns and overall survival (OS) of gastrointestinal stromal tumor (GIST) patients treated in reference and non-reference centers in the Netherlands. PATIENTS AND METHODS This retrospective cohort study on patients diagnosed between 2016 and 2019, utilises data from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Database. Patients were categorized into two groups: patients diagnosed in or referred to reference centers and patients diagnosed in non-reference centers without referral. RESULTS This study included 1,550 GIST patients with a median age of 67.0 in reference and 68.0 years in non-reference centers. Eighty-seven per cent of patients were diagnosed in non-reference centers, of which 36.5% (493/1,352) were referred to a reference center. Referral rates were higher for high-risk (62.2% [74/119]) and metastatic patients (67.2% [90/134]). Mutation analysis was performed in 96.9% and 87.6% of these cases in reference and in non-reference centers (p < 0.01), respectively. Systemic therapy was given in reference centers versus non-reference in 89.5% versus 82.0% (p < 0.01) of high-risk and in 94.1% versus 65.9% (p < 0.01) of metastatic patients, respectively. The proportion of positive resection margins and tumor rupture did not differ between reference and non-reference centers. Median OS was not reached. CONCLUSION A substantial amount of metastatic GIST patients in non-reference centers did not receive systemic treatment. This might be due to valid reasons. However, optimisation of the referral strategy of GIST patients in the Netherlands could benefit patients. Further research is needed to explore reasons for not starting systemic treatment in metastatic GIST patients.
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Affiliation(s)
- Evelyne Roets
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nikki S Ijzerman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent K Y Ho
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Boudewijn Van Etten
- University of Groningen, University Medical Center Groningen, Department of Surgical Oncology and gastrointestinal surgery, Groningen, the Netherlands
| | - Winan J Van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Winette T A Van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Li C, Wang Q, Jiang KW, Ye YJ. Hallmarks and novel insights for gastrointestinal stromal tumors: A bibliometric analysis. Eur J Surg Oncol 2023; 49:107079. [PMID: 37826966 DOI: 10.1016/j.ejso.2023.107079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Due to the increasing recognition of gastrointestinal stromal tumor (GIST), novel insights have appeared in both preclinical and clinical research and begun to reshape the field. This study aims to map the research landscape through bibliometric analysis and provide a brief overview for the future of the GIST field. METHODS We searched the Web of Science Core Collection without publication data restrictions for GISTs and performed a bibliometric analysis with CiteSpace and VOSviewer software. RESULTS In sum, 5,911 of 13,776 records were included, and these studies were published in 948 journals and written by 24,965 authors from 4,633 institutions in 100 countries. Referring to published reviews and bibliometric analysis, we classified the future trends in four groups. In epidemiological study, precise incidence and clinicopathological features in different regions and races might become potential hotspots. Novel therapy, such as drugs, modified strategies, radioligand therapy, was persistent hotspots in GIST fields, and ctDNA-guided diagnosis, monitoring, and treatment might meet future clinical needs. The debate over serosa surgery vs. mucosa surgery will remain active for a long time in GIST surgery, and function reserve surgery, biology-based surgery will play an important role in future. Moreover, rare GIST type, like NF-1-associated GIST, Carney triads and SDH mutant GIST, need more studies in pathogenesis and genetic mutation to provide appropriate treatment for this orphan GIST patients. CONCLUSIONS Potential hotspots in future GIST trends might involve epidemiology, agents, resection therapy and rare type GIST, moreover, researchers could pay more attention in these four fields.
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Affiliation(s)
- Chen Li
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, China
| | - Quan Wang
- Ambulatory Surgery Center, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, China
| | - Ke-Wei Jiang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, China.
| | - Ying-Jiang Ye
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, China.
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Serrano C, Álvarez R, Carrasco JA, Marquina G, Martínez-García J, Martínez-Marín V, Sala MÁ, Sebio A, Sevilla I, Martín-Broto J. SEOM-GEIS clinical guideline for gastrointestinal stromal tumors (2022). Clin Transl Oncol 2023; 25:2707-2717. [PMID: 37129716 PMCID: PMC10425520 DOI: 10.1007/s12094-023-03177-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/03/2023]
Abstract
Gastrointestinal stromal tumor (GIST) is the most common malignant neoplasm of mesenchymal origin, and a paradigmatic model for a successful rational development of targeted therapies in cancer. The introduction of tyrosine kinase inhibitors with activity against KIT/PDGFRA in both localized and advanced stages has remarkably improved the survival in a disease formerly deemed resistant to all systemic therapies. These guidelines are elaborated by the conjoint effort of the Spanish Society of Medical Oncology (SEOM) and the Spanish Sarcoma Research Group (GEIS) and provide a multidisciplinary and updated consensus for the diagnosis and treatment of GIST patients. We strongly encourage that the managing of these patients should be performed within multidisciplinary teams in reference centers.
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Affiliation(s)
- César Serrano
- Sarcoma Translational Research Group, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitario Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, C/Natzaret, 115-117, 08035 Barcelona, Spain
| | - Rosa Álvarez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Antonio Carrasco
- Hospital Álvaro Cunqueiro–Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain
| | | | | | | | | | - Ana Sebio
- Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Isabel Sevilla
- Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain
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Bangolo A, Fwelo P, Al-Qatish T, Bukasa-Kakamba J, Lee T, Cayago AG, Potiguara S, Nagesh VK, Kawall J, Ahmed R, Asjad Abbas M, Nursjamsi N, Lee SH, Meti S, Arana GV, Joseph CA, Mohamed A, Alencar A, Hassan HG, Aryal P, Javed A, Kalinin M, Lawal G, Khalaf IY, Mathew M, Karamthoti P, Gupta B, Weissman S. Outcomes of Patients with Gastrointestinal Stromal Tumors in the Past Decade. Med Sci (Basel) 2023; 11:54. [PMID: 37755158 PMCID: PMC10536810 DOI: 10.3390/medsci11030054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract (GIT) that represent approximately 1 to 2 percent of primary gastrointestinal (GI) cancers. Owing to their rarity, very little is known about their overall epidemiology, and the prognostic factors of their pathology. The current study aimed to evaluate the independent determinants of mortality in patients diagnosed with GISTs over the past decade. METHODS Our study comprised 2374 patients diagnosed with GISTs from 2000 to 2017 from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed the baseline characteristics, and overall mortality (OM), as well as the cancer-specific mortality (CSM) of GISTs. Variables with a p value < 0.01 in the univariate Cox regression were incorporated into the multivariate Cox model, to determine the independent prognostic factors. RESULTS Multivariate Cox proportional hazard regression analyses of factors affecting the all-cause mortality and GIST-related mortality among US patients between 2010 and 2017 revealed a higher overall mortality in non-Hispanic Black patients (HR = 1.516, 95% CI 1.172-1.961, p = 0.002), patients aged 80+ (HR = 9.783, 95% CI 4.185-22.868, p = 0), followed by those aged 60-79 (HR = 3.408, 95% CI 1.488-7.807, p = 0.004); male patients (HR = 1.795, 95% CI 1.461-2.206, p < 0.001); patients with advanced disease with distant metastasis (HR = 3.865, 95% CI 2.977-5.019, p < 0.001), followed by cases with regional involvement via both direct extension and lymph node involvement (HR = 3.853, 95% CI 1.551-9.57, p = 0.004); and widowed patients (HR = 1.975, 95% CI 1.494-2.61, p < 0.001), followed by single patients (HR = 1.53, 95% CI 1.154-2.028, p = 0.003). The highest CSM was observed in the same groups, except widowed patients and patients aged 60-79. The highest CSM was also observed among patients that underwent chemotherapy (HR = 1.687, 95% CI 1.19-2.392, p = 0.003). CONCLUSION In this updated study on the outcomes of patients with GISTs, we found that non-Hispanic Black patients, male patients, and patients older than 60 years have a higher mortality with GISTs. Furthermore, patients who have received chemotherapy have a higher GIST-specific mortality, and married patients have a lower mortality. However, we do not know to what extent these independent prognostic factors interact with each other to influence mortality. This study paves the way for future studies addressing these interactions. The results of this study may help treating clinicians to identify patient populations associated with a dismal prognosis, as those may require closer follow-up and more intensive therapy; furthermore, with married patients having a better survival rate, we hope to encourage clinicians to involve family members of the affected patients early in the disease course, as the social support might impact the prognosis.
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Affiliation(s)
- Ayrton Bangolo
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Pierre Fwelo
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77204, USA
| | - Tha’er Al-Qatish
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - John Bukasa-Kakamba
- Division of Endocrinology, Department of Medicine, Kinshasa University Clinics, Kinshasa 7948, Democratic Republic of the Congo;
| | - Tiffany Lee
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Akira G. Cayago
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Sarah Potiguara
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Vignesh K. Nagesh
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Jessica Kawall
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Rashid Ahmed
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Muhammad Asjad Abbas
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Narissa Nursjamsi
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Stacy H. Lee
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Shagi Meti
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Georgemar V. Arana
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Chrishanti A. Joseph
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Abdifitah Mohamed
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Arthur Alencar
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Huzaifa G. Hassan
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Pramanu Aryal
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Aleena Javed
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Maksim Kalinin
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Gbenga Lawal
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Ibtihal Y. Khalaf
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Midhun Mathew
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Praveena Karamthoti
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Bhavna Gupta
- Division of Hematology and Oncology, Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
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Zagami P, Comandone A, Fiore M, Baldi GG, Grignani G, Vincenzi B, Gronchi A, Antonarelli G, Boglione A, Pennacchioli E, Curigliano G, Conforti F, De Pas TM. The rare entity of gastrointestinal leiomyosarcomas: An Italian multicenter retrospective study in high-volume referral centers. Cancer Med 2023; 12:17047-17055. [PMID: 37455549 PMCID: PMC10501229 DOI: 10.1002/cam4.6340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND After a huge efficacy of imatinib in treating patients with gastrointestinal stromal tumors (GISTs) was proven, a maximum effort was made to make a differential diagnosis between GISTs and gastrointestinal leiomyosarcomas (GI-LMS), showing the latter to be an extremely rare tumor entity. Limited data on GI-LMS biology, clinical behavior and drug-sensibility are available, and the clinical decision-making in this subgroup of patients is usually challenging. METHODS We conducted a multicenter, retrospective observational study on patients with diagnosed GI-LMS from 2004 to 2020 within six high-volume referral centers in Italy. RESULTS Thirty-three patients had diagnosis of KIT-negative GI-LMS confirmed by sarcoma-expert pathologist. The most common site of origin was the intestine. Twenty-two patients had localized disease and underwent surgery: with a median follow-up of 72 months, median disease-free survival was 42 months. Overall survival (OS)-rate at 5 years was 73% and median OS was 193 months. Five out of 10 patients with local relapse received a salvage surgery, and 2/5 remained with no evidence of disease. Thirteen patients received neoadjuvant (6) or adjuvant (7) chemotherapy, and 2/13 patients remained free from relapse. The median OS for patients with metastatic LMS was 16.4 months. CONCLUSION GI-LMS is very rare and extremely aggressive subgroup of sarcomas with a high tendency to systemic spread. Localized GI-LMS at diagnosis may be cured if treated with adequate surgery with or without (neo) adjuvant chemotherapy, while de-novo metastatic disease appeared to have a poor prognosis. Clinical effort to understand GI-LMS biology and clinical behavior and to develop active treatment strategy, especially for metastatic-disease, is warranted.
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Affiliation(s)
- Paola Zagami
- Department of Oncology and HematologyUniversity of MilanMilanItaly
| | | | - Marco Fiore
- Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Giovanni Grignani
- Medical OncologyCandiolo Cancer Institute‐FPO, IRCCSCandioloItaly
- Department of Oncology AOU Citta della Salute e della Scienza di TorinoTorinoItaly
| | - Bruno Vincenzi
- Department of Medical OncologyUniversità Campus Bio‐Medico di RomaRomeItaly
| | | | | | | | | | - Giuseppe Curigliano
- Department of Oncology and HematologyUniversity of MilanMilanItaly
- Division of New Drugs and Early Drug Development for Innovative TherapiesEuropean Institute of Oncology, IRCCSMilanItaly
| | - Fabio Conforti
- Division of Medical Oncology of MelanomaSarcoma and Rare tumors, European Institute of Oncology, IRCCSMilanItaly
- Oncology DepartmentHumanitas GavazzeniBergamoItaly
| | - Tommaso Martino De Pas
- Division of Medical Oncology of MelanomaSarcoma and Rare tumors, European Institute of Oncology, IRCCSMilanItaly
- Oncology DepartmentHumanitas GavazzeniBergamoItaly
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Abdalla TSA, Pieper L, Kist M, Thomaschewski M, Klinkhammer-Schalke M, Zeissig SR, Tol KKV, Wellner UF, Keck T, Hummel R. Gastrointestinal stromal tumors of the upper GI tract: population-based analysis of epidemiology, treatment and outcome based on data from the German Clinical Cancer Registry Group. J Cancer Res Clin Oncol 2023; 149:7461-7469. [PMID: 36959341 PMCID: PMC10374476 DOI: 10.1007/s00432-023-04690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. They are most frequently located in the stomach but are also found in the esophagus and the gastroesophageal junction (GEJ). Information regarding the prognostic factors associated with upper gastrointestinal GIST is still scarse. METHODS In this study, datasets provided by the German Clinical Cancer Registry Group, including a total of 93,069 patients with malignant tumors in the upper GI tract (C15, C16) between 2000 and 2016 were analyzed to investigate clinical outcomes of GIST in the entire upper GI tract. RESULTS We identified 1361 patients with GIST of the upper GI tract. Tumors were located in the esophagus in 37(2.7%) patients, at the GEJ in 70 (5.1%) patients, and in the stomach in 1254 (91.2%) patients. The incidence of GIST increased over time, reaching 5% of all UGI tumors in 2015. The median age was 69 years. The incidence of GIST was similar between males and females (53% vs 47%, respectively). However, the proportion of GIST in female patients increased continuously with advancing age, ranging from 34.7% (41-50 years) to 71.4% (91-100 years). Male patients were twice as likely to develop tumors in the esophagus and GEJ compared to females (3.4% vs. 1.9% and 6.7% vs. 3.4%, respectively). The median overall survival of upper gastrointestinal GIST was 129 months. The 1-year, 5-year, and 10-year OS was 93%, 79%, and 52% respectively. Nevertheless, tumors located in the esophagus and GEJ were associated with shorter OS compared to gastric GIST (130 vs. 111 months, p = 0.001). The incidence of documented distant metastasis increased with more proximal location of GIST (gastric vs. GEJ vs. esophagus: 13% vs. 16% vs. 27%) at presentation. CONCLUSION GIST of the esophagus and GEJ are rare soft tissue sarcomas with increasing incidence in Germany. They are characterized by worse survival outcomes and increased risk of metastasis compared to gastric GIST.
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Affiliation(s)
- Thaer S A Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany.
| | - Lina Pieper
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Markus Kist
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Michael Thomaschewski
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Monika Klinkhammer-Schalke
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
| | - Sylke Ruth Zeissig
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Kees Kleihues-van Tol
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
| | - Ulrich Friedrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany.
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Zhu H, Yang G, Ma Y, Huo Q, Wan D, Yang Q. Update of epidemiology, survival and initial treatment in patients with gastrointestinal stromal tumour in the USA: a retrospective study based on SEER database. BMJ Open 2023; 13:e072945. [PMID: 37419634 PMCID: PMC10335486 DOI: 10.1136/bmjopen-2023-072945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES An updated epidemiological analysis of gastrointestinal stromal tumour (GIST), the change of cancer-specific survival (CSS) and patterns of initial treatment are of interest. DESIGN A retrospective study using data from the Surveillance, Epidemiology and End Results (SEER) database. SETTING AND PARTICIPANTS A total of 5625 patients with GIST diagnosed between 2010 and 2019 were identified. PRIMARY OUTCOME MEASURES Age-standardised incidence rate (ASIR) and annual prevalence rate were calculated. SEER combined stage, period CSS rate and initial treatment were summarised. All the data were calculated by SEER*Stat software. RESULTS From 2010 to 2019, the ASIR of GIST increased from 0.79 to 1.02 per 100 000 person-years, with an increase of 2.4% annually. The increase was across age and sex subgroups. The prevalence trend was similar with the ASIR trend in each subgroup. The stage distributions were similar between different age groups, but varied among different primary tumour sites. More importantly, a stage shift from regional stage to localized stage at diagnosis was found, which may result in the improvement of CSS over years. Overall, the 5-year CSS rate of GIST was approximately 81.3%. Even for metastatic GIST, the rate exceeded 50%. Surgery was the most common treatment regimen for GIST, followed by surgery and systemic treatment. Whereas approximately 7.0% patients were undertreated, which was more pronounced among patients with distant and unknown stages. CONCLUSIONS The findings of this study suggest an improving early detection of GIST and an improving ability of accurate staging. Though most patients are effectively treated and perform good survivals, approximate 7.0% patients may be undertreated.
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Affiliation(s)
- Haizhen Zhu
- Department of Oncology, Guizhou Provincial People's Hospital, Medical School of Guizhou University, Guizhou Cancer Center, Guiyang, Guizhou, China
| | - Guangrong Yang
- Department of Oncology, The People's Hospital of Qijiang District, Chongqing, Chongqing, China
| | - Ying Ma
- Department of Gastroenterology, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, Qinghai, China
| | - Qianwen Huo
- The 941st Hospital of the PLA Joint Logistic Support Force, Xining, Qinghai, China
| | - Deli Wan
- Department of Gastroenterology, The People's Hospital of Qijiang District, Chongqing, Chongqing, China
| | - Qiao Yang
- Department of Ultrasound, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, Qinghai, China
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10
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Wu H, Ding P, Wu J, Sun C, Guo H, Chen S, Lowe S, Yang P, Tian Y, Liu Y, Zhao Q. A New Online Dynamic Nomogram: Construction and Validation of a Predictive Model for Distant Metastasis Risk and Prognosis in Patients with Gastrointestinal Stromal Tumors. J Gastrointest Surg 2023; 27:1429-1444. [PMID: 37231240 DOI: 10.1007/s11605-023-05706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumor (GIST) is the most common sarcoma of the digestive tract, among which patients with distant metastases tend to have a poor prognosis. This study aimed to develop a model for predicting distant metastasis in GIST patients and to develop two models for monitoring overall survival (OS) and cancer-specific survival (CSS) in GIST patients with metastasis. This would allow us to develop an optimal, individualized treatment strategy. METHODS We reviewed demographic and clinicopathological characteristics data from 2010 to 2017 of patients diagnosed with GIST in the Surveillance, Epidemiology, and End Results (SEER) database. The data of the external validation group was reviewed from the Forth Hospital of Hebei Medical University. Univariate and multivariate logistic regression analyses were used to confirm the independent risk factors for distant metastasis in the GIST patients, and univariate and multivariate Cox regression analyses were performed to identify the independent prognostic factors for OS and CSS in the GIST patients with distant metastasis. Subsequently, three web-based novel nomograms were developed, which were evaluated by the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS Of the 3639 patients who met the inclusion criteria, 418 (11.4%) had distant metastases. The risk factors for distant metastasis in GIST patients included sex, primary site, grade, N stage, tumor size, and mitotic count. For OS, the independent prognosis factors for GIST patients with metastasis included age, race, marital, primary site, chemotherapy, mitotic count, and metastasis at the lung, and for CSS, age, race, marital, primary site, and metastasis at the lung were the independent prognosis factors. Three web-based nomograms were constructed based on these independent factors, respectively. The ROC curves, calibration curves, and DCA were performed in the training, testing, and validation sets which confirmed the high accuracy and strong clinical practice power for the nomograms. CONCLUSION Population-based nomograms can help clinicians predict the occurrence and prognosis of distant metastases in patients with GIST, which may be helpful for clinicians to formulate clinical management and appropriate treatment strategies.
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Affiliation(s)
- Haotian Wu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Ping'an Ding
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Jiaxiang Wu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA
| | - Honghai Guo
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Shuya Chen
- Newham University Hospital, Glen Road, Plaistow, E13 8SL, London, UK
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, USA
| | - Peigang Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yuan Tian
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yang Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Qun Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
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11
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Zidane H, Kebbati Z, Khettab M. [Gastrointestinal stromal tumors: a retrospective study]. Pan Afr Med J 2023; 45:97. [PMID: 37692978 PMCID: PMC10491712 DOI: 10.11604/pamj.2023.45.97.36563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction although rare, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. The aim of this work is to study the clinical, paraclinical, therapeutic and evolutionary features of GIST. Methods we conducted a descriptive retrospective, monocentric study (April 2017-April 2021) collecting data from the medical records of all patients with GIST treated at the medical oncology department of the University Hospital of Mostaganem. Results we collected data from the medical records of 23 patients, with a median age of 54.4 years, sex ratio 1.8, over a period of 4 years. Abdominal pain was the most frequent symptom (78.3%, n=18); 47.8% of patients (n=11) had a tumor in the small bowel. The diagnosis was made at an early stage in 69.6% of cases (n=16). Surgical treatment was performed in 20 of the 23 patients, 18 of whom with R0. Of the 15 operated patients with a localized tumor, 13 received adjuvant medical treatment (Imatinib). Disease progression was reported in three patients treated with imatinib, then 2nd line therapy (Sunitinib) was started. During the study period, all patients were alive except two who died due to disease progression. Conclusion the diagnosis of GIST is mainly based on histology and immunohistochemistry, which is often not performed by our pathologists. Molecular biology makes it possible to predict the prognosis and consequently adapt the therapies. The outcome of patients with GIST is often favorable but marked by recurrences despite a supposedly curative treatment requiring prolonged monitoring.
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Affiliation(s)
- Habib Zidane
- Service d’Oncologie Médicale, Centre Hospitalier Universitaire de Mostaganem, Faculté de Médecine de Mostaganem, Mostaganem, Algérie
| | - Zakia Kebbati
- Service d’Oncologie Médicale, Centre Hospitalier Universitaire de Mostaganem, Faculté de Médecine de Mostaganem, Mostaganem, Algérie
| | - Mohamed Khettab
- Service d´Hémato-Oncologie, Centre Hospitalier Universitaire de la Réunion, Groupe Hospitalier Sud Réunion, Saint-Pierre, France
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12
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El Charif MH, Amro S, Boulos F, Khalife M, Shamseddine A, Assi H, Sbaity E. Extra-gastrointestinal stromal tumors (EGISTs): A case report for a mischief entity. Medicine (Baltimore) 2023; 102:e33394. [PMID: 37000068 PMCID: PMC10063283 DOI: 10.1097/md.0000000000033394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Extra-gastrointestinal stromal tumor is a rare subtype of soft tissue sarcomas with significantly variable presentation, management, and prognosis. This makes it crucial to report the different institutional experiences of encountering extra-gastrointestinal stromal tumors (EGIST). CASE PRESENTATION We report 3 cases of EGIST diagnosis at American University of Beirut Medical Center for 2 males and 1 female in the 5th, 6th, and 7th decades of life, respectively. For the first case, the tumor was initially suspected to be ovarian cancer, but biopsy revealed a diagnosis of EGIST, and the patient was started on neoadjuvant therapy. In the second case, the tumor was retro-gastric and prelim diagnosis was gastric cancer but again biopsy revealed an EGIST histopathology, and the patient underwent surgery and adjuvant treatment. For the third case, a previous history of testicular cancer prompted an initial suspicion of recurrence with metastasis but biopsy and immunohistochemistry staining revealed EGIST with related markers. The patient underwent treatment at a different institution in his home country. CONCLUSION This report sheds light on the importance of keeping EGIST amongst any differential list for abdominal and pelvic tumors. It also shows that EGIST-focused studies are needed to assess the effectiveness of the different treatment modalities available when utilized specifically for EGIST. This would allow for better oncological outcomes and improved quality of life.
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Affiliation(s)
- Mohamad Hadi El Charif
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara Amro
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Khalife
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hazem Assi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Sbaity
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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13
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von Mehren M, Kane JM, Riedel RF, Sicklick JK, Pollack SM, Agulnik M, Bui MM, Carr-Ascher J, Choy E, Connelly M, Dry S, Ganjoo KN, Gonzalez RJ, Holder A, Homsi J, Keedy V, Kelly CM, Kim E, Liebner D, McCarter M, McGarry SV, Mesko NW, Meyer C, Pappo AS, Parkes AM, Petersen IA, Poppe M, Schuetze S, Shabason J, Spraker MB, Zimel M, Bergman MA, Sundar H, Hang LE. NCCN Guidelines® Insights: Gastrointestinal Stromal Tumors, Version 2.2022. J Natl Compr Canc Netw 2022; 20:1204-1214. [PMID: 36351335 PMCID: PMC10245542 DOI: 10.6004/jnccn.2022.0058] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastrointestinal stromal tumors (GIST) are the most common type of soft tissue sarcoma that occur throughout the gastrointestinal tract. Most of these tumors are caused by oncogenic activating mutations in the KIT or PDGFRA genes. The NCCN Guidelines for GIST provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with these tumors. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised systemic therapy options for unresectable, progressive, or metastatic GIST based on mutational status, and updated recommendations for the management of GIST that develop resistance to specific tyrosine kinase inhibitors.
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Affiliation(s)
| | | | | | | | - Seth M Pollack
- 5Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Edwin Choy
- 9Massachusetts General Hospital Cancer Center
| | - Mary Connelly
- 10The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Sarah Dry
- 11UCLA Jonsson Comprehensive Cancer Center
| | | | | | | | - Jade Homsi
- 14UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - David Liebner
- 10The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Nathan W Mesko
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Christian Meyer
- 21The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Alberto S Pappo
- 22St. Jude Children's Research Hospital/University of Tennessee Health Science Center
| | | | | | - Matthew Poppe
- 25Huntsman Cancer Institute at the University of Utah
| | | | - Jacob Shabason
- 27Abramson Cancer Center at the University of Pennsylvania
| | - Matthew B Spraker
- 28Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Melissa Zimel
- 29UCSF Helen Diller Family Comprehensive Cancer Center; and
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14
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Ravegnini G, Nannini M, Indio V, Serrano C, Gorini F, Astolfi A, Di Vito A, Morroni F, Pantaleo MA, Hrelia P, Angelini S. miRNA Expression May Have Implications for Immunotherapy in PDGFRA Mutant GISTs. Int J Mol Sci 2022; 23:ijms232012248. [PMID: 36293105 PMCID: PMC9603477 DOI: 10.3390/ijms232012248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) harboring mutations in the PDGFRA gene occur in only about 5-7% of patients. The most common PDGFRA mutation is exon 18 D842V, which is correlated with specific clinico-pathological features compared to the other PDGFRA mutated GISTs. Herein, we present a miRNA expression profile comparison of PDGFRA D842V mutant GISTs and PDGFRA with mutations other than D842V (non-D842V). miRNA expression profiling was carried out on 10 patients using a TLDA miRNA array. Then, miRNA expression was followed by bioinformatic analysis aimed at evaluating differential expression, pathway enrichment, and miRNA-mRNA networks. We highlighted 24 differentially expressed miRNAs between D842V and non-D842V GIST patients. Pathway enrichment analysis showed that deregulated miRNAs targeted genes that are mainly involved in the immune response pathways. The miRNA-mRNA networks highlighted a signature of miRNAs/mRNA that could explain the indolent behavior of the D842V mutated GIST. The results highlighted a different miRNA fingerprint in PDGFRA D842V GISTs compared to non-D842Vmutated patients, which could explain the different biological behavior of this GIST subset.
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Affiliation(s)
- Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Division of Oncology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Indio
- Department of Veterinary Medical Sciences, University of Bologna, 40164 Ozzano, Italy
| | - Cesar Serrano
- Sarcoma Translational Research Laboratory, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Campus, C/ Natzaret 115-117, 08035 Barcelona, Spain
- Department of Medical Oncology, Vall d’Hebron University Hospital, P/Vall d’Hebron 119, 08035 Barcelona, Spain
| | - Francesca Gorini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Annalisa Astolfi
- Department of Specialized, Experimental and Diagnostic Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Aldo Di Vito
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Fabiana Morroni
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Maria Abbondanza Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Division of Oncology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Sabrina Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
- Inter-Departmental Center for Health Sciences & Technologies, CIRI-SDV, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Correspondence:
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15
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Carbajal-López EB, Juárez-García DM, Espinoza-Velazco A, Calderillo-Ruiz G. Internet-Delivered Cognitive Behavioral Therapy and Psychoeducation Program for Patients with Gastrointestinal Stromal Tumors. J Cancer Educ 2022; 37:668-674. [PMID: 32894418 DOI: 10.1007/s13187-020-01866-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gastrointestinal stromal tumors (GIST) account for 0.2-3% of all cancer diagnoses and are thus considered a rare type of cancer. Severe levels of fatigue occur in 33% of patients on imatinib, but besides treatment, fatigue is also associated with psychological distress. As far as we know, only one previous study has reported on the design of a psychoeducational intervention for caregivers and patients with GIST. The current study was conducted to compare the preliminary effectiveness of an Internet-delivered cognitive behavioral stress management intervention and psychoeducation program for anxiety, depression, fatigue, and quality of life in patients with gastrointestinal stromal tumors (GIST). This study had an experimental pre-test post-test design with a control group. Ninety-nine patients were randomly allocated to an Internet-delivered cognitive program (n = 50) or psychoeducation control group (n = 49). Participants completed the questionnaires at three time points (pre-test, post-test, and 3-month follow-up). Twenty-seven participants completed the intervention. A significant interaction effect between groups and time was found for general fatigue [F(2, 28) = 8.2, p < 0.001, ƞ2p = 0.25], reduced motivation [F(2, 28) = 3.5, p < 0.05, ƞ2p = 0.12], distress [F(2, 28) = 3.4, p < 0.05, ƞ2p = 0.12], and global health status [F(2, 28) = 3.8, p < 0.05, ƞ2p = 0.13]. Both intervention programs showed reductions in the dimensions of fatigue and improvements in distress and dimensions of quality of life. Additional research on a larger sample size is needed to confirm the effects obtained in this study.
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Affiliation(s)
| | - Dehisy Marisol Juárez-García
- Psychology School, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
- Health Psychology Unit, Center for Research and Development in Health Sciences, Universidad Autónoma de Nuevo León, Dr. Carlos Canseco s/n, Mitras Centro, 64460, Monterrey, NL, Mexico.
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16
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Casali PG, Blay JY, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brodowicz T, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dufresne A, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Miah AB, Mir O, Montemurro M, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss SJ, Hall KS, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Gronchi A, Stacchiotti S. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:20-33. [PMID: 34560242 DOI: 10.1016/j.annonc.2021.09.005] [Citation(s) in RCA: 179] [Impact Index Per Article: 89.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Oncology and Hemato-oncology University of Milan, Milan, Italy
| | - J Y Blay
- Centre Leon Berard and UCBL1, Lyon, France
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bauer
- Department of Medical Oncology, Interdisciplinary Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - E De Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Padova, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - A Dufresne
- Département d'Oncologie Médicale, Centre Leon Berard, Lyon, France
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- P. A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Gasperoni
- Department of Oncology and Robotic Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Gouin
- Centre Leon-Berard Lyon, Lyon, France
| | - G Grignani
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - A B Hassan
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | - N Hindi
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - P Hohenberger
- Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - C Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kopeckova
- University Hospital Motol, Prague, Czech Republic
| | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - F Le Grange
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - E Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - A Lopez-Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - O Merimsky
- Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - A B Miah
- Department of Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - O Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - M Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - E Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria, di Bologna, Bologna, Italy
| | - R Piana
- Azienda Ospedaliero, Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padova, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D Strauss
- Department of Surgery, Royal Marsden Hospital, London, UK
| | - S J Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - M A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Frebourg
- Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Normandie University, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Farag S, IJzerman NS, Houdijk MPM, Reyners AKL, Arens AI, Grünhagen DJ, Desar IME, Gelderblom H, Steeghs N, de Geus-Oei LF. Early response evaluation using 18F-FDG-PET/CT does not influence management of patients with metastatic gastrointestinal stromal tumors (GIST) treated with palliative intent. Nuklearmedizin 2021; 60:411-416. [PMID: 34479374 DOI: 10.1055/a-1542-6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM The aim of this study was to investigate the impact of 18F-FDG-PET/CT on treatment decision making in metastatic gastrointestinal stromal tumor (GIST) patients. METHODS This study retrospectively evaluated 18F-FDG-PET/CT scans to monitor response of metastatic GIST patients treated with palliative intent. Data from the Dutch GIST Registry was used. Early scans (<10 weeks after start of treatment) and late scans (>10 weeks after start of treatment) were scored on the impact in change of treatment. RESULTS Sixty-one PET/CT scans were performed for treatment evaluation in 39 patients with metastatic GIST of which 36 were early scans and 25 were late scans. Early PET/CT scans led to a change in management in 5.6% of patients and late PET/CT scans led to a change in management in 56% of patients. Change in management was more often seen after scans with lack of metabolic response (48% vs. 11% in scans with metabolic response, p=0.002). Neither metabolic response nor change in treatment were more often seen in patients with KIT mutations compared to patients with non-KIT mutations (metabolic response 65% KIT vs. 46% non-KIT, p=0.33, and change in management 28% KIT vs. 21% non-KIT, p=0.74). CONCLUSION 18F-FDG-PET/CT is not recommended for early response evaluation in an unselected patient population with metastatic GIST, since it does not influence treatment decisions. 18F-FDG-PET/CT, however, can be useful for late response assessment, especially in case of indeterminate CT results.
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Affiliation(s)
- Sheima Farag
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Nikki S IJzerman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - An K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, Netherlands
| | - Anne Ij Arens
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
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18
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Wu H, Li C, Li H, Shang L, Jing HY, Liu J, Fang Z, Du FY, Liu Y, Fu MD, Jiang KW, Li LP. Clinicopathological characteristics and longterm survival of patients with synchronous multiple primary gastrointestinal stromal tumors: A propensity score matching analysis. World J Gastroenterol 2021; 27:6128-6141. [PMID: 34629824 PMCID: PMC8476333 DOI: 10.3748/wjg.v27.i36.6128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple gastrointestinal stromal tumors (MGISTs) are specific and rare. Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors (GIST). The diagnosis, treatment and follow-up strategies of MGISTs is not specifically described in guidelines.
AIM To compare the clinicopathological characteristics and prognosis of MGISTs and solitary GISTs (SGISTs)
METHODS Patients diagnosed with primary GISTs from March 2010 to January 2020 were included. Due to the inhomogeneous distribution of several baseline characteristics and uneven MGIST and SGIST group sizes, propensity score matching was performed according to comorbidities, body mass index, tumor location, mitotic index, sex, age and American Society of Anesthesiologists score. Differences in clinicopathological characteristics and prognosis between patients with MGISTs and patients with SGISTs were compared.
RESULTS Among the entire cohort of 983 patients, the incidence of MGISTs was 4.17%. Before matching, patients with MGISTs and those with SGISTs had disparities in body mass index, surgical approach, tumor size and mitotic index. After 1:4 ratio matching, the clinical baseline data were comparable. The 5-year progression-free survival rate was 52.17% in the MGIST group and 75.00% in the SGIST group (P = 0.031). On multivariate analysis, tumor location, tumor size, mitotic index, imatinib treatment and MGISTs (hazard ratio = 2.431, 95% confidence interval = 1.097-5.386, P = 0.029) were identified as independent prognostic factors of progression-free survival. However, overall survival was similar between the SGIST and MGIST groups.
CONCLUSION Patients with MGISTs had poorer progression-free survival than patients with SGISTs. Risk criteria and diagnostic and treatment strategies should be developed to achieve personalized precision therapy and maximize the survival benefit.
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Affiliation(s)
- Hao Wu
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Chen Li
- Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Han Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Liang Shang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
- Department of Digestive Tumor Translational Medicine, Engineering Laboratory of Shandong Province, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250021, Shandong Province, China
| | - Hai-Yan Jing
- Department of Pathology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Jin Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Zhen Fang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Feng-Ying Du
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Yang Liu
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Meng-Di Fu
- Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Ke-Wei Jiang
- Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Le-Ping Li
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
- Department of Digestive Tumor Translational Medicine, Engineering Laboratory of Shandong Province, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250021, Shandong Province, China
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19
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Roulleaux Dugage M, Jones RL, Trent J, Champiat S, Dumont S. Beyond the Driver Mutation: Immunotherapies in Gastrointestinal Stromal Tumors. Front Immunol 2021; 12:715727. [PMID: 34489967 PMCID: PMC8417712 DOI: 10.3389/fimmu.2021.715727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are a subtype of soft tissue sarcoma (STS), and have become a concept of oncogenic addiction and targeted therapies.The large majority of these tumors develop after a mutation in KIT or platelet derived growth factor receptor α (PDGFRα), resulting in uncontrolled proliferation. GISTs are highly sensitive to imatinib. GISTs are immune infiltrated tumors with a predominance of tumor-associated macrophages (TAMs) and T-cells, including many CD8+ T-cells, whose numbers are prognostic. The genomic expression profile is that of an inhibited Th1 response and the presence of tertiary lymphoid structures and B cell signatures, which are known as predictive to response to ICI. However, the microtumoral environment has immunosuppressive attributes, with immunosuppressive M2 macrophages, overexpression of indoleamine 2,3-dioxygenase (IDO) or PD-L1, and loss of major histocompatibility complex type 1. In addition to inhibiting the KIT oncogene, imatinib appears to act by promoting cytotoxic T-cell activity, interacting with natural killer cells, and inhibiting the expression of PD-L1. Paradoxically, imatinib also appears to induce M2 polarization of macrophages. There have been few immunotherapy trials with anti-CTLA-4 or anti-PD-L1drugs and available clinical data are not very promising. Based on this comprehensive analysis of TME, we believe three immunotherapeutic strategies must be underlined in GIST. First, patients included in clinical trials must be better selected, based on the identified driver mutation (such as PDGFRα D842V mutation), the presence of tertiary lymphoid structures (TLS) or PD-L1 expression. Moreover, innovative immunotherapeutic agents also provide great interest in GIST, and there is a strong rationale for exploring IDO targeting after disease progression during imatinib therapy. Finally and most importantly, there is a strong rationale to combine of c-kit inhibition with immune checkpoint inhibitors.
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Affiliation(s)
| | - Robin Lewis Jones
- Division of Clinical Studies, Institute of Cancer Research & Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jonathan Trent
- Department of Medicine, Division of Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stéphane Champiat
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Sarah Dumont
- Département d’Oncologie Médicale, Gustave Roussy, Université Paris Saclay, Villejuif, France
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20
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Deo KB, Gautam S, Awale L, Yadav TN, Pradhan A, Pandit N. Cystic Ileal Gastrointestinal Stromal Tumor Masquerading as Metastatic Adnexal Carcinoma. J Gastrointest Cancer 2021; 51:1053-1056. [PMID: 32303996 DOI: 10.1007/s12029-020-00403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kunal Bikram Deo
- Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
| | - Sujan Gautam
- Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Laligen Awale
- Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Tek Narayan Yadav
- Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Anju Pradhan
- Department of Pathology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Narendra Pandit
- Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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21
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Qian XH, Yan YC, Gao BQ, Wang WL. Prevalence, diagnosis, and treatment of primary hepatic gastrointestinal stromal tumors. World J Gastroenterol 2020; 26:6195-6206. [PMID: 33177793 PMCID: PMC7596635 DOI: 10.3748/wjg.v26.i40.6195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/27/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GIST), which is the most common mesenchymal tumor of the digestive tract, account for 1%-3% of gastrointestinal tumors. Primary stromal tumors outside the gastrointestinal tract are collectively referred to as extra GISTs, and stromal tumors in different regions often have different prognoses. A primary hepatic GIST is a rare tumor with an unknown origin, which may be related to interstitial Cajal-like cells. Although primary hepatic GIST has certain characteristics on imaging, it lacks specific symptoms and signs; thus, the final diagnosis depends on pathological and genetic evidence. This review summarizes all cases of primary hepatic GIST described in the literature and comprehensively analyzes the detailed clinical data of all patients. In terms of treatment, local resection alone or with adjuvant therapy was the prioritized choice to obtain better disease-free survival and longer survival time. For advanced unresectable cases, imatinib mesylate was applied as the first-line chemotherapy agent. Moreover, transcatheter arterial chemoembolization, radiofrequency ablation, and microwave ablation were shown to improve overall survival for selected patients. Liver transplantation was a final treatment option after resistance to chemotherapy developed.
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Affiliation(s)
- Xiao-Hui Qian
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Ying-Cai Yan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Bing-Qiang Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Wei-Lin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
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22
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Zhao WY, Zhao G, Wang M. [Updates and interpretations of the NCCN Clinical Practice Guidelines (2019 6th version) on gastrointestinal stromal tumor]. Zhonghua Wei Chang Wai Ke Za Zhi 2020; 23:866-871. [PMID: 32927511 DOI: 10.3760/cma.j.cn.441530-20200731-00454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The diagnosis and treatment of gastrointestinal stromal tumor (GIST) is getting more and more standardized. In the last two decades, due to the elucidation of molecular mechanism of tumorigenesis, as well as the effectiveness of tyrosine kinase inhibitors, GIST has become well-known as one of the most classical models of targeted therapy on solid tumors in the precision medicine era. The National Comprehensive Cancer Network (NCCN) issued the latest version of clinical practice guideline on soft tissue sarcoma in February 2020. Compared with previous versions, the new version of the guideline highlighted the treatment recommendations of avapritinib, which further promoted the precise targeted treatment of GIST.
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Affiliation(s)
- W Y Zhao
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - G Zhao
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - M Wang
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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23
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Chicago Consensus Working Group. The Chicago Consensus on Peritoneal Surface Malignancies: Management of Desmoplastic Small Round Cell Tumor, Breast, and Gastrointestinal Stromal Tumors. Ann Surg Oncol 2020; 27:1793-7. [PMID: 32285268 DOI: 10.1245/s10434-020-08319-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Indexed: 12/14/2022]
Abstract
The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of desmoplastic small round cell tumor, breast, and gastrointestinal stromal tumor specifically related to peritoneal surface malignancy. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.
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Kawabata K, Takahashi T, Nakajima K, Tanaka K, Miyazaki Y, Makino T, Kurokawa Y, Yamasaki M, Mori M, Doki Y. [Laparoscopic Resection of a Huge Gastric Gastrointestinal Stromal Tumor after Neoadjuvant Chemotherapy-A Case Report]. Gan To Kagaku Ryoho 2020; 47:670-672. [PMID: 32389979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An 83-year-old woman was hospitalized with abdominal discomfort. Abdominal computed tomography(CT)revealed a hugetumor (size, 15 cm)in thegastric body. Based on thefindings of endoscopic ultrasonography-guided fine-needle aspiration, she was diagnosed with gastrointestinal stromal tumor(GIST). Invasion of thesurrounding viscera and distant metastasis were not observed; however, owing to the tumor size(>10 cm), we initiated neoadjuvant chemotherapy with imatinib. CT performed a month after chemotherapy revealed tumor shrinkage, and CT repeated 6 months after the second CT revealed tumor shrinkage to 8 cm. The patient showed a partial response to chemotherapy. She was deemed suitable to undergo laparoscopic radical resection and subsequently underwent laparoscopic partial gastric resection. Histopathological examination of the resected specimen(measuring 10 cm)revealed hyaline degeneration in most tumor cells and positive ckit expression in only some proportion of tumor cells. Based on histopathological evaluation, the tumor was diagnosed as Grade 2b. The patient showed an uneventful postoperative course. After discharge, she received imatinib as adjuvant chemotherapy and is progressing well without recurrence. Taken together, we reported the case of a huge gastric GIST in a patient who showed significant tumor shrinkage following preoperative neoadjuvant chemotherapy and successfully underwent laparoscopic radical resection.
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Affiliation(s)
- Kota Kawabata
- Dept. of Gastroenterological Surgery, Osaka University Graduate School of Medicine
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Wang J, Yin Y, Shen C, Yin X, Cai Z, Pu L, Fu W, Wang Y, Zhang B. Preoperative imatinib treatment in patients with locally advanced and metastatic/recurrent gastrointestinal stromal tumors: A single-center analysis. Medicine (Baltimore) 2020; 99:e19275. [PMID: 32118738 PMCID: PMC7478449 DOI: 10.1097/md.0000000000019275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The advent of imatinib mesylate (IM) has dramatically revolutionized the prognosis of advanced and metastatic/recurrent gastrointestinal stromal tumors (GISTs). The objective of this retrospective study is to investigate the safety and efficacy of combination of surgery following IM treatment in the management of advanced and metastatic/recurrent GISTs. We further explore the long-term clinical outcomes in these who underwent therapy of preoperative IM.Eligible patients with GISTs before the onset of the IM therapy and were periodically followed up in the outpatient clinic were included in this study. Detailed clinical and pathologic characteristics were obtained from the medical records of our institution. Univariate and multivariate regression analyses were performed to use for the evaluation of potential prognostic factors.A total of 51 patients were included in the study, of these patients, 36 patients underwent surgery and median duration of preoperative IM is 8.2months (range 3.5-85 months). Significant median tumor shrinkage rate was 29.27% (95% confidence interval 21.00%-34.00%) observed in these patients who responded to IM, and partial response and stable disease were achieved in 24 patients (47.06%) and 23 patients (45.10%), respectively, in light of the RECIST guideline (version 1.1). After the median follow-up of 43.70 months (range 14.2-131.1 months), 1- and 3-year overall survival (OS) were estimated to be 96.1% and 94.0%, respectively, and there was a significant improvement in OS for patients who received surgical intervention versus those who did not.Our study consolidates that patients were received preoperative IM therapy could shrink the size of tumors and facilitate organ-function preservation. The long-term analysis on this study supports that surgical intervention following IM therapy benefits for patients with primary advanced and recurrent or metastatic GISTs on long-term prognosis.
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Kado T, Kishi K, Saito T, Mikamori M, Furukawa K, Ohtsuka M, Suzuki Y, Imasato M, Tanemura M, Akamatsu H. [A Case of Multidisciplinary Treatment for a Recurrent Gastrointestinal Stromal Tumor of the Stomach]. Gan To Kagaku Ryoho 2020; 47:334-336. [PMID: 32381980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The standard treatment for unresectable or recurrent gastrointestinal stromal tumor(GIST)is tyrosine kinase inhibitor(TKI). It is reported that resection of metastatic lesions after TKI administration prolongs progression free survival, but its influence on overall survival is not clarified. We experienced a case of GIST with peritoneal dissemination for which TKI administration and 2 local resections were effective. The patient was a man in his 70's. We started chemotherapy with imatinib for GIST with peritoneal dissemination. However, it was discontinued due to the occurrence of interstitial pneumonia. Dissemination was evaluated as radically resectable on the images. After the interstitial pneumonia was alleviated, surgery was performed. Although sunitinib was introduced at 2 months postoperatively, recurrent peritoneal dissemination was detected at 32 months postoperatively, and treatment was then changed to regorafenib. Regorafenib treatment reduced the tumor size; however, Grade 3 albuminuria was detected 16 months after treatment initiation and, thus, this treatment was discontinued. Subsequently, the tumor enlarged again. Because there was only 1 recurrent lesion, we performed radical resection. Postoperatively, a reduced dose of regorafenib was re-administered. At present, 9 months after the re-surgery, the patient is alive without recurrence.
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Kashu N, Yasuda K, Yoshitake H, Takami T, Kataoka N, Yamaguchi T, Tomita M, Shono Y, Makimoto S. [A Case of Gastrointestinal Stromal Tumor in the Rectum with Preservation of Anal Function after Neoadjuvant Chemotherapy UsingImatinib]. Gan To Kagaku Ryoho 2019; 46:2383-2385. [PMID: 32156939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A n 81-year-old woman was admitted to our institution. Computed tomography performed before transcatheter aortic valve implantation(TAVI)for aortic stenosis revealed a tumor in the rectum. Lower endoscopy revealed that the tumor was a 60mm submucosal tumor and located 2 cm from the anal verge. Abiopsy revealed the diagnosis to be gastrointestinal stromal tumor(GIST). Although the tumor was located near the anal verge and might have invaded the surrounding organs, neoadjuvant chemotherapy(NAC) with 400mg/day of imatinib was initiated to preserve anal function as requested by the patient and her family. After 3 months, the tumor size decreased by 36.6% and there was a decrease in rate of tumor shrinkage. We performed transanal tumor resection and temporary colostomy. After 6 months, we performed colostomy closure, and the patient has remained recurrence-free and is continuing chemotherapy.
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Sakurai T, Enomoto M, Wada T, Mazaki J, Ishizaki T, Nagakawa Y, Katsumata K, Tsuchida A. [Rectal Gastrointestinal Stromal Tumor(GIST)Excised by Two Teams Following Neoadjuvant Chemotherapy-A Case Report]. Gan To Kagaku Ryoho 2019; 46:2580-2582. [PMID: 32157005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 67-year-old man presented with bloody stools. Colonoscopy showed a small submucosal tumor in the lower rectum. As the tumor was small, follow-up was chosen. Although he was instructed to undergo reexamination 1 year later, he did not comply. Four years later, he was reexamined by the previous doctor for disorders of defecation. He was admitted to our hospital for examination and treatment, as the tumor was growing. The mass measured 87×69 mm. The tumor was found on the dorsal side of the rectum with well-circumscribed, smooth margins. Trans-anal biopsy showed rectal GIST. The tumor seemed difficult to resect, and hence, imatinib mesylate(400mg/day)was administered as neoadjuvant chemotherapy for tumor reduction. After 4 months, the maximum tumor diameter was reduced by 60%, and arthroscopic surgery was performed by 2 teams. In the trans-anal arthroscopic operation, partial resection of the levator ani muscle was performed, and complete excision was achieved by securing the excision margin. The operation time was 341 min, and the hemorrhage volume was 422 mL. Postoperatively, a Grade 2 suture failure occurred at the anastomotic site, but no further complications were observed.
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Affiliation(s)
- Toru Sakurai
- Dept. of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
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Florou V, Trent JC, Wilky BA. Precision medicine in gastrointestinal stromal tumors. Discov Med 2019; 28:267-276. [PMID: 32053767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are rare soft tissue sarcomas of the gastrointestinal tract, with most carrying conserved driver mutations in the tyrosine kinase receptors KIT or PDGFRα. The use of targeted therapy against these mutations in GISTs is one of the most successful examples of precision medicine in solid tumors, beginning in 2002 with the development of imatinib, a small molecule tyrosine kinase inhibitor (TKI) of KIT. In recent years, much progress has been made in understanding the molecular mechanisms of GISTs while unveiling their genetic heterogeneity. Since development of secondary mutations leads to imatinib resistance, the majority of research efforts have focused on identification of novel inhibitors to improve outcomes in imatinib-resistant GISTs. Sunitinib and regorafenib are two TKIs with demonstrated activity after failure of imatinib, which led to the U.S. FDA approval. Pivotal phase 3 clinical trials are ongoing with two novel agents, avapritinib and ripretinib, based on their remarkable activities in the 4th or greater line settings in phase 1/2 studies of these drugs. In this review, we will outline the remarkable diversity of genetic mutations in GISTs, and review the evidence for treatment options of genomic medicine in locally advanced or metastatic gastrointestinal stromal tumors.
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Affiliation(s)
- Vaia Florou
- Department of Medicine, Division of Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jonathan C Trent
- Department of Medicine, Division of Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Breelyn A Wilky
- Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Carney D, Clark CE, Chase A, Oprea-Ilies G, Turner J. Gastrointestinal Stromal Tumors Presenting as Vaginal Bleeding. Am Surg 2019; 85:e485-e487. [PMID: 31638548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Oguri Y, Cho H, Oohinata R, Onoyama H, Horiguchi S. [A Large Gastric Gastrointestinal Stromal Tumor Successfully Treated with Neoadjuvant Imatinib Followed by Surgery-A Case Report]. Gan To Kagaku Ryoho 2019; 46:1307-1309. [PMID: 31501376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Neoadjuvant imatinib may prevent tumor rupture and the need for extended surgery by reducing the tumor size by approximately 35%, especially for large gastric gastrointestinal stromal tumors(GISTs), as shown in a previous phase Ⅱ study (Kurokawa et al. BJC 2017); however, the use ofneoadjuvant imatinib is not prevalent in clinical practice. Herein, we report a large gastric GIST that was successfully treated with neoadjuvant imatinib. A 74-year-old woman complained ofabdominal pain, and abdominal computed tomography(CT)revealed a 14 cm oval tumor in the left upper abdominal cavity. Gastric biopsy revealed that the tumor was a GIST. The patient also had a small lung tumor that was diagnosed as a primary lung carcinoma in the right upper lobe. We performed neoadjuvant imatinib for 6 months as the primary treatment. After 7 months ofimatinib administration, CT revealed that the GIST decreased in size but the lung cancer was slightly enlarged. Therefore, we performed right upper lung lobectomy and continued imatinib therapy for an additional 3 months. After a total of9 months ofneoadjuvant imatinib treatment, we performed partial gastrectomy combined with splenectomy without tumor rupture. The patient is scheduled to continue imatinib therapy for a total of 3 years.
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Affiliation(s)
- Yohei Oguri
- Dept. of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital
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Affiliation(s)
- Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Sichuan Province, China
| | - Yi-Yun Fu
- Department of Pathology, West China Hospital of Sichuan University, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital of Sichuan University, Sichuan Province, China
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Abstract
Diagnostics and treatment of mesenchymal tumors (i.e. soft tissue sarcomas, gastrointestinal stromal tumors, and bone sarcomas) have changed dramatically in the past few years. Molecular and immunohistochemical biomarkers contribute significantly to improved diagnostics. They also play an increasing role in terms of clinical treatment decisions.Grading and tumor type-specific outcome data provide the basis for adjuvant chemotherapy of localized sarcomas. Recurrent gene fusions become more important as predictive biomarkers for targeted therapies in the context of systemic treatments. Immuno-oncology-based approaches are currently being studied in clinical trials, and the first responses of selected patients have been demonstrated. However, the role of predictive biomarkers in this field, such as PD-L1, still needs to be elucidated. Comprehensive genetic analyses of metastatic sarcomas will continue to identify additional therapeutic targets and the corresponding biomarkers.
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Affiliation(s)
- S Bauer
- Sarkomzentrum am Westdeutschen Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
- Innere Klinik/Tumorforschung, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - U Dirksen
- Sarkomzentrum am Westdeutschen Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
- Klinik für Kinderheilkunde III, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - H-U Schildhaus
- Sarkomzentrum am Westdeutschen Tumorzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
- Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
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Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) arising from the gynecological tract are extremely rare. A case of GIST with an unusual presentation as a vaginal mass is presented with comprehensive literature review, aiming to gain a better understanding of the diagnostic and treatment strategy of the disease. PATIENT CONCERNS A 78-year-old woman presented with persistent vaginal bleeding and difficulty in micturition. Although the tumor mass was diagnosed, the results of preoperative evaluations are uncertain. DIAGNOSIS Preoperative evaluation included the computed tomography examination (a 6.3×5.3 cm cervical mass lesion with rectal and vaginal invasion), colonoscopy (an external compression with an intact mucosa), tumor markers, and biopsy (spindle cell tumor). Postoperative histopathology confirmed the diagnosis of GIST. INTERVENTIONS Posterior exenteration with complete resection was performed. The patient received postoperative adjuvant imatinib therapy. OUTCOMES The patient has survived without the disease for more than 3 years. CONCLUSION It is still a challenge to diagnose GISTs in women with rectovaginal mass preoperatively. Efforts should be made, including a high suspicion and an assistance of immunohistochemistry. A precise diagnosis may offer a better surgical and treatment plan, especially on the preservation of reproductive organs and accessibility of targeted therapy.
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Affiliation(s)
- Min Cheng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
| | - Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
| | - Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
| | - Pei-Fen Lo
- Department of Nursing, Taipei Veterans General Hospital
| | - Wen-Ling Lee
- Department of Nursing, Oriental Institute of Technology, New Taipei City
- Department of Medicine, Cheng-Hsin General Hospital
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Goto T, Sendo H, Yamazaki T, Ishida R, Yasuda T, Muramatsu S, Tsukamoto Y, Miyashita M, Ku Y. [Hepatic and Pancreatic Metastases of a Rectal Gastrointestinal Stromal Tumor in a Patient with Long-Term Survival following Combined Therapy-ACase Report]. Gan To Kagaku Ryoho 2019; 46:300-302. [PMID: 30914540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 68-year-old woman underwent Miles' surgery with a diagnosis of a rectalgastrointestinalstromaltumor (GIST)in 2004. In 2005 and 2006, she developed liver metastases that were surgically removed, but once again in June 2006, she presented with liver metastasis, and imatinib therapy(400mg/day)was administered. In October 2016, she was diagnosed with progression of liver metastasis, and a tumor in the pancreatic body was identified on a CT scan. The patient was referred to our institution for treatment. We performed right hepatectomy and distalpancreatectomy in January 2017. Immunohistochemically, the recurrent tumor was positive for c-kit and CD34, and the diagnosis of GIST was confirmed. The pathological diagno- sis was a high-risk GIST showing 43mitoses per 50 high-power fields. Imatinib therapy(400mg/day)was administered after surgery. She is currently alive without recurrence.
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Geramizadeh B, Kashkooe A, Nikeghbalian S, Malek-Hosseini SA. Metastatic Tumors to the Pancreas, a Single Center Study. Arch Iran Med 2019; 22:50-52. [PMID: 30821161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Most pancreatic masses are primary ductal adenocarcinomas; however, with the advent of new imaging studies and increasing survival of cancer patients, there are more cases with the diagnosis of secondary metastatic cancer to the pancreas. There is no study regarding cancer metastases to the pancreas from Iran. In this study, we retrieved all of the cases with the diagnosis of secondary cancer of pancreas in the affiliated hospitals of Shiraz University of Medical Sciences. METHODS In 5 years (2012-2017), we evaluated all cases with the diagnosis of any pancreatic tumors and extracted all of the demographic and clinicopathologic findings of the cases with the diagnosis of metastatic pancreatic tumors from the clinical charts and pathology reports. RESULTS For the duration of 5 years in our center, there were 131 cases of pancreatic tumors with different diagnoses, 9 of which were diagnosed as metastatic cancers from other organs. Two cases were diagnosed with gastric adenocarcinoma, 2 cases were colonic adenocarcinoma, one case was lung small cell carcinoma, 2 cases were renal cell carcinoma (RCC) and one case was gastrointestinal stromal tumor (GIST). The mesenchymal metastatic cancer to the pancreas has been a case of pleomorphic sarcoma of retroperitoneum. CONCLUSION Pancreas is not a common location for metastases; however, colon, stomach, kidney and lung seem to be the most common primary tumors with metastases to the pancreas. Our report is the first study about pancreatic metastatic tumors from Iran.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Nikeghbalian
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Tendo M, Hori T, Iimori N, Deguchi S, Sakimura C, Masuda G, Nakao S, Nakata B, Ohira M, Ishikawa T, Hirakawa K. [A Case of Rectal Gastrointestinal Stromal Tumor(GIST)with Long-Term Survival Treated with Multidisciplinary Therapy]. Gan To Kagaku Ryoho 2018; 45:2288-2290. [PMID: 30692440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report a case of gastrointestinal stromal tumor(GIST)with long-term survival treated by multidisciplinary therapy, including surgery and imatinib to prevent repeated recurrence. A 76-year-old woman visited our hospital with difficulty in defecation and bloody bowel discharge. She was diagnosed with rectal GIST and underwent transanal partial resection of the rectum. Local recurrence occurred 1 year after the operation, and the tumor was resected transanally. Hepatic metastasis occurred 8 months after the second operation. The patient was administered imatinib for 2 months, which caused the tumor to shrink, and extended left lobectomy was performed. Imatinib was administered for 2 years after hepatectomy. After another 2 years, metastasis to the liver and thoracic and lumbar vertebrae occurred. The recurrent tumors reverted to cystic lesions after 6 months of imatinib treatment. She has been alive without tumor progression during re-treatment with imatinib for 7 years(13 years after the first surgery).
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Li Y, Tan B, Wu H, Xin H, Fan L, Zhao Q, Ma Z, Liu Y. The risk factors about prognosis of 142 GIST patients with recurrence or metastasis: A retrospective study of single centre in Northern China. J BUON 2018; 23:1855-1861. [PMID: 30610813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE In this retrospective study, we investigated the clinicopathologic features, prognosis as well as the factors contributing to prognosis of patients with metastatic or recurrent gastrointestinal stromal tumors (GISTs). METHODS A total 142 GIST patients with confirmed metastasis or recurrence with complete clinicopathologic and prognostic data were enrolled as research group, and 278 GISTs patients without metastasis or recurrence as control group between June 2003 and June 2013. RESULTS Significant differences between research group and control group were revealed, including gender, age, primary tumor sites, tumor diameter, mitosis rate, CD117 expression, risk level, treatment methods and surgical types (p<0.05). Univariate survival analysis suggested that factors with significant influence on prognosis were tumor primary site, tumor diameter, mitosis rate, tumor progression (recurrence or metastasis), and treatment methods (p<0.05). Multivariate survival analysis demonstrated that mitosis and treatment methods were independent prognostic factors for GIST patients with metastatis or recurrence. CONCLUSION Some factors contributed significantly to the prognosis of GIST patients with metastatis or recurrence, and the combination of surgery and targeted agent should be selected for these patients to improve prognosis.
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Affiliation(s)
- Yong Li
- Department of General Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R.China
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Hompland I, Hølmebakk T, Boye K, Stoldt S, Bjerkehagen B, Berner JM, Wiedswang AM, Revheim ME, Poulsen JP, Hall KS, Bruland ØS. Multimodal kreftbehandling av gastrointestinal stromal tumor. Tidsskr Nor Laegeforen 2018; 138:18-0200. [PMID: 30277049 DOI: 10.4045/tidsskr.18.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Gastrointestinal stromal tumour (GIST) is a subtype of sarcoma that may occur in any part of the gastrointestinal system, most frequently in the stomach and small intestine. The most common symptoms are bleeding and abdominal pain. In this clinical review, we summarise the progress made with this condition and discuss the recommended diagnostics and treatment of GIST.
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv68-iv78. [PMID: 29846513 DOI: 10.1093/annonc/mdy095] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso 'S.Maria di Cà Foncello', Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals, London, UK
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Institute of Scientific Hospital Care (IRCCS), Regina Elena National Cancer Institute, Rome
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Issels
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Whelan
- University College Hospital, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol 2018; 24:2806-2817. [PMID: 30018476 PMCID: PMC6048423 DOI: 10.3748/wjg.v24.i26.2806] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.
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Affiliation(s)
- Kazuya Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Masafumi Oya
- Department of Pathology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Tadashi Koga
- Department of Surgery, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Yuki Shiratsuchi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
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Ma C, Tsai H, Su W, Sun L, Shih Y, Wang J. Combination of arginine, glutamine, and omega-3 fatty acid supplements for perioperative enteral nutrition in surgical patients with gastric adenocarcinoma or gastrointestinal stromal tumor (GIST): A prospective, randomized, double-blind study. J Postgrad Med 2018; 64:155-163. [PMID: 29848836 PMCID: PMC6066627 DOI: 10.4103/jpgm.jpgm_693_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/16/2018] [Accepted: 04/03/2018] [Indexed: 01/01/2023] Open
Abstract
Background Perioperative enteral nutrition (EN) enriched with immune-modulating substrates is preferable for patients undergoing major abdominal cancer surgery. In this study, perioperative EN enriched with immune-modulating nutrients such as arginine, glutamine, and omega-3 fatty acids was evaluated for its anti-inflammatory efficacy in patients with gastric adenocarcinoma or gastrointestinal stromal tumor (GIST) receiving curative surgery. Materials and Methods This prospective, randomized, double-blind study recruited 34 patients with gastric adenocarcinoma or gastric GIST undergoing elective curative surgery. These patients were randomly assigned to the study group, receiving immune-modulating nutrient-enriched EN, or the control group, receiving standard EN from 3 days before surgery (preoperative day 3) to up to postoperative day 14 or discharge. Laboratory and inflammatory parameters were assessed on preoperative day 3 and postoperative day 14 or at discharge. Adverse events (AEs) and clinical outcomes were documented daily and compared between groups. Results No significant differences were observed between the two groups in selected laboratory and inflammatory parameters, or in their net change, before and after treatment. AEs and clinical outcomes, including infectious complications, overall complications, time to first bowel action, and length of hospital stay after surgery, were comparable between treatment groups (all P > 0.05). Conclusion Immune-modulating nutrient-enriched EN had no prominent immunomodulation effect compared with that of standard EN.
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Affiliation(s)
- C Ma
- Division of Digestive and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - H Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of General Medicine Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - W Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of General Medicine Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - L Sun
- Nutrition Service Team, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Y Shih
- Nutrition Service Team, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - J Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Nutrition Service Team, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Rufian-Peña S, Arjona-Sanchez A, Casado-Adam A, Cosano-Alvarez A, Briceño-Delgado J. Gastrointestinal stromal tumors: A multidisciplinary challenge. World J Gastroenterol 2018; 24:1925-1941. [PMID: 29760538 PMCID: PMC5949708 DOI: 10.3748/wjg.v24.i18.1925] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/27/2018] [Accepted: 05/06/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.
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Affiliation(s)
- Juan Manuel Sanchez-Hidalgo
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Manuel Duran-Martinez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Rafael Molero-Payan
- Department of Intern Medicine, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
- Lipids and Atherosclerosis Research Unit, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Córdoba, Cordoba 14004, Spain
| | - Sebastian Rufian-Peña
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Alvaro Arjona-Sanchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Angela Casado-Adam
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Antonio Cosano-Alvarez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Javier Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
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Cipolla C, Fulfaro F, Sandonato L, Fricano S, Pantuso G, Grassi N, Vieni S, Valerio MR, Lo Dico R, Gebbia N, Latteri MA. Clinical Presentation and Treatment of Gastrointestinal Stromal Tumors. Tumori 2018; 92:279-84. [PMID: 17036516 DOI: 10.1177/030089160609200403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Aims and background Gastrointestinal stromal tumors (GISTs), although rare, are the most common mesenchymal neoplasms affecting the gastrointestinal tract. We present our experience in the treatment of localized and metastatic disease and a review of literature. Patients and methods Nine patients were observed from April 2002 to July 2004. Eight tumors were in the gastric area and J was in the small bowel. In 5 cases, complete surgical removal was performed, and none of these patients underwent adjuvant therapy. The remaining 4 cases, with locally advanced or recurrent disease, were treated with imatinib. Results The patients with localized disease treated only by surgery did not relapse. In the patients with locally advanced or metastatic disease treated by imatinib, we observed 3 partial responses, and one case was not assessable because he had no measurable disease. In 2 of 3 responders, it was possible to perform a new radical surgery. Conclusions Our series is too small to draw any conclusion. According to our review of the literature, surgery remains the standard treatment for non-metastatic GISTs. Imatinib mesylate represents a major breakthrough in the treatment of advanced GISTs and is the first effective systemic therapy for the disease.
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Affiliation(s)
- Calogero Cipolla
- University of Palermo, Department of Oncology, Division of General and Oncological Surgery, Italy.
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Shi X, Yu S, Wang F, Zhao Q, Xu H, Li B. A gastrointestinal stromal tumor with acute bleeding: Management and nursing. Medicine (Baltimore) 2018; 97:e9874. [PMID: 29489686 PMCID: PMC5851723 DOI: 10.1097/md.0000000000009874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract. A small percentage of GISTs may cause acute gastrointestinal bleeding, which requires urgent surgical intervention. PATIENT CONCERNS In this case report, we present a 62-year-old male patient with who was hospitalized due to acute bleeding. DIAGNOSES The patient was diagnosed as GIST with low risk. INTERVENTIONS The patient was treated endoscopically with polidocanol sclerotherapy. OUTCOMES The mass was removed completely, and the patient was discharged at day 9 after operation. LESSONS This case indicates that GIST can present as massive upper gastrointestinal bleeding and urgent endoscopic sclerotherapy can be life-saving. The endoscopical intervention may be a good alternative for emergency.
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Affiliation(s)
- Xiuju Shi
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Shuxia Yu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Fenyan Wang
- Department of Gastroenterology, Qianfo Mountain Hospital, Jinan, China
| | - Qi Zhao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Hongwei Xu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Bin Li
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University
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Ishigame T, Kimura T, Kase K, Muto M, Watanabe J, Sato N, Kofunato Y, Okada R, Kenjo A, Shimura T, Marubashi S. [A Case of Long-Term Survival of Metastatic and Recurrent Duodenal Gastrointestinal Stromal Tumor Treated with Multimodality Managements]. Gan To Kagaku Ryoho 2018; 45:527-529. [PMID: 29650927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We hereby report a case of long-term survival of metastatic and recurrent duodenal gastrointestinal stromal tumor(GIST) treated with multimodality managements. A 59-year-old man was diagnosed with duodenal GIST and underwent surgical resection of a primary lesion of the duodenum. Since the pathological findings on mitotic rate indicated its high risk of recurrence, the systemic treatment by imatinib mesylate was given shortly after the surgery. Six months later, metastatic lesions being considered to be imatinib-resistant were observed in the remnant liver. Since there were no other drugs available for GISTs in clinic at that time, surgery of central bisegmentectomy with partial resection of the liver was performed to eliminate all metastatic lesions. However, recurrences had been repeatedly diagnosed afterward. In response to them, four more surgery for recurrent liver or peritoneal tumors, two transcatheter arterial chemoembolizations(TACE)and one radiofrequency ablation(RFA)were performed on the basis of its resectability. Sunitinib malate had been given since it was approved for imatinib-resistant GISTs in clinic. Eventually, as long as 99 months had passed since we observed the first evidence of the resistance to imatinib mesylate when he died from the GIST.
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Affiliation(s)
- Teruhide Ishigame
- Dept. of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University
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Gopie P, Mei L, Faber AC, Grossman SR, Smith SC, Boikos SA. Classification of gastrointestinal stromal tumor syndromes. Endocr Relat Cancer 2018; 25:R49-R58. [PMID: 29170162 DOI: 10.1530/erc-17-0329] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 12/12/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, thought to derive from neoplastic outgrowth of the interstitial cells of Cajal. Building on recent advances in recognition, classification and diagnosis, the past two decades have seen a changing paradigm with molecular diagnostics and targeted therapies. KIT and PDGFRA mutations account for 85-90% of GIST carcinogenesis. However, the remaining 10-15% of GISTs, which until recently were called KIT/PDGFRA wild-type GISTs, have been found to have one of the several mutations, including in the SDHA, B, C, D, BRAF and NF1 genes. Though most of such GISTs are sporadic, a number of families with high incidence rates of GISTs and other associated clinical manifestations have been reported and found to harbor germline mutations in KIT, PDGFRA, SDH subunits and NF1 The goal of this review is to describe the mutations, clinical manifestations and therapeutic implications of syndromic and inherited GISTs in light of recent studies of their clinicopathologic range and pathogenesis.
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Affiliation(s)
- Priya Gopie
- Massey Cancer CenterVCU School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lin Mei
- Massey Cancer CenterVCU School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anthony C Faber
- Phillips Institute for Oral Health ResearchVCU School of Dentistry and Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Steven R Grossman
- Massey Cancer CenterVCU School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Steven C Smith
- Departments of Pathology and SurgeryVCU School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sosipatros A Boikos
- Massey Cancer CenterVCU School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Lewitowicz P, Matykiewicz J, Chrapek M, Koziel D, Horecka-Lewitowicz A, Gluszek-Osuch M, Wawrzycka I, Gluszek S. Tumor Digital Masking Allows Precise Patient Triaging: A Study Based on Ki-67 Scoring in Gastrointestinal Stromal Tumors. Scanning 2018; 2018:7807416. [PMID: 30245762 PMCID: PMC6139189 DOI: 10.1155/2018/7807416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/28/2018] [Accepted: 08/05/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND Technological advances constantly provide cutting-edge tools that enhance the progress of diagnostic capabilities. Gastrointestinal stromal tumors belong to a family of mesenchymal tumors where patient triaging is still based on traditional criteria such as mitotic count, tumor size, and tumor location. Limitations of the human eye and randomness in choice of area for mitotic figure counting compel us to seek more objective solutions such as digital image analysis. Presently, the labelling of proliferative activity is becoming a routine task amidst many cancers. The purpose of the present study was to compare the traditional method of prediction based on mitotic ratio with digital image analysis of cell cycle-dependent proteins. METHODS Fifty-seven eligible cases were enrolled. Furthermore, a digital analysis of previously performed whole tissue section immunohistochemical assays was executed. Digital labelling covered both hotspots and not-hotspots equally. RESULTS We noted a significant diversity of proliferative activities, and consequently, the results pointed to 6.5% of Ki-67, counted in hotspots, as the optimal cut-off for low-high-grade GIST. ROC analysis (AUC = 0.913; 95% CI: 0.828-0.997, p < 0.00001) and odds ratio (OR = 40.0, 95% CI: 6.7-237.3, p < 0.0001) pointed to Ki-67 16% as the cut-off for very high-grade (groups 5-6) cases. With help of a tumor digital map, we revealed possible errors resulting from a wrong choice of field for analysis. We confirmed that Ki-67 scores are in line with the level of intracellular metabolism that could be used as the additional biomarker. CONCLUSIONS Tumor digital masking is very promising solution for repeatable and objective labelling. Software adjustments of nuclear shape, outlines, size, etc. are helpful to omit other Ki-67-positive cells especially small lymphocytes. Our results pointed to Ki-67 as a good biomarker in GIST, but concurrently, we noted significant differences in used digital approaches which could lead to unequivocal results.
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Affiliation(s)
- Piotr Lewitowicz
- Department of Pathology, Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Jaroslaw Matykiewicz
- Department of Surgery and Surgical Nursing, Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
- Department of General, Oncological and Endocrine Surgery, The Voivodship Hospital in Kielce, Kielce, Poland
| | - Magdalena Chrapek
- Department of Probability Theory and Statistics, Institute of Mathematics, The Faculty of Mathematics and Natural Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Dorota Koziel
- Department of Surgery and Surgical Nursing, Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Agata Horecka-Lewitowicz
- Department of Public Health, Faculty of Medicine and Heath Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Martyna Gluszek-Osuch
- Department of Public Health, Faculty of Medicine and Heath Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Iwona Wawrzycka
- Department of Surgery and Surgical Nursing, Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
- Department of General, Oncological and Endocrine Surgery, The Voivodship Hospital in Kielce, Kielce, Poland
| | - Stanisław Gluszek
- Department of Surgery and Surgical Nursing, Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
- Department of General, Oncological and Endocrine Surgery, The Voivodship Hospital in Kielce, Kielce, Poland
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50
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Li G, Dai J. [Current research status and progress of primary esophageal gastrointestinal stromal tumors in China]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:1087-1090. [PMID: 28901002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary esophageal gastrointestinal stromal tumors (GIST) is a rare independent disease with clinicopathological and molecular features different from other mesenchymal tumors. Authors searched and reviewed associated reports and summarized the morbidity trends, characteristics, diagnosis and treatment of esophageal GIST in China. Data show that the incidence and detection rate of esophageal GIST presents the rising trend. Imaging has some characteristics. Ultrasonography and CT are main methods and effective examinations to detect and prompt diagnosis of esophageal GIST. Pathology and immunohistochemistry are the evidence for a definite diagnosis. Risk classification is the important basis for selecting surgical methods and predicting prognosis. Surgery is the mainstay treatment. Very low and low risk patients with tumors less than 3 cm can choose endoscopic resection. For tumors of 3 to 5 cm, tumor resection must be considered. Thoracoscopy appears to be the first choice for surgery. Medium and high risk patients with tumors >5 cm should be treated with partial resection of esophagus. Surgery combined with targeted therapy and neoadjuvant therapy is the main treatment pattern and research direction.
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Affiliation(s)
- Guoren Li
- Department of Thoracic Surgery, The First People's Hospital of Lianyungang, Jiangsu Lianyungang 222002, China.
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