Annals of Oncology Advance Access published online on July 23, 2009
Annals of Oncology, doi:10.1093/annonc/mdp310
Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients?
1 Melanoma and Sarcoma Unit, Department of Surgery, Istituto Nazionale Tumori, Milan, Italy
2 Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital Mannheim, University of Heidelberg, Germany
3 Experimental Molecular Pathology, Department of Pathology, Istituto Nazionale Tumori, Milan, Italy
4 Department of Hematology, Oncology and Palliative Care, HELIOS Medical Center, Bad Saarow, Germany
5 Department of Cancer Medicine, Istituto Nazionale Tumori, Milan, Italy
* Correspondence to: Dr A. Gronchi, Melanoma and Sarcoma Unit, Department of Surgery, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy. Tel: +39-02-23903234; Fax: +39-02-23902404; E-mail: alessandro.gronchi{at}istitutotumori.mi.it
Background: Surgical indication for metastatic gastrointestinal stromal tumor (GIST) treated with imatinib is not yet established.
Materials and methods: We analyzed 80 patients who underwent surgery for metastatic GIST after imatinib therapy from July 2002 to October 2007. Patients were divided into those with surgery at best clinical response (group A, n = 49) and those with surgery at focal progression (group B, n = 31). Primary end points were progression-free survival (PFS) and disease-specific survival (DSS).
Results: Two-year postoperative PFS was 64.4% in group A and 9.7% in group B (P < 0.01). In group A, median PFS was not reached; in group B, it was 8 months. Median DSS from the time of imatinib onset was not reached in either group. Five-year DSS was 82.9% in group A and 67.6% in group B (P < 0.01). Multivariate analysis confirmed a significantly shorter PFS and DSS in group B. Surgical morbidity occurred in 13 patients (16.3%).
Conclusions: Surgery for focal progressive lesions could be considered as part of the second-line/third-line armamentarium in selected cases. Surgery of residual disease upon best clinical response seems associated with survival benefit compared with historical controls in similar patient collectives treated with imatinib alone. However, evidence from prospective randomized trials is needed to make definite recommendations.
gastrointestinal stromal tumors, imatinib, prognosis, sarcoma, surgery
Both authors contributed equally to the paper. Received for publication February 1, 2009. Revision received May 8, 2009. Accepted for publication May 12, 2009.