Resection of residual disease in patients with metastatic gastrointestinal stromal tumors responding to treatment with imatinib

Authors

  • Sebastian Bauer,

    Corresponding author
    1. Department of Internal Medicine (Cancer Research), University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
    • Dept. of Pathology, Brigham & Women's Hospital, 75 Francis Street, Thorn 521, Boston, MA, USA
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    • Fax: +1-617-278-6921.

  • Jörg Thomas Hartmann,

    1. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
    2. Department of Hematology/Oncology/Immunology/Rheumatology/Pneumology, University Medical Center,Eberhard-Karls-University, Tuebingen, Germany
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  • Maike de Wit,

    1. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
    2. Department of Oncology and Haematology, University Hospital Eppendorf, Hamburg, Germany
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  • Hauke Lang,

    1. Department of General and Transplantation Surgery, University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Florian Grabellus,

    1. Department of Pathology, University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Gerald Antoch,

    1. Department of Diagnostic and Interventional Radiology, University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Wolfgang Niebel,

    1. Department of General and Transplantation Surgery, University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Jochen Erhard,

    1. Department of Visceral and Vascular Surgery, Evangelisches Krankenhaus, Dinslaken, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Peter Ebeling,

    1. Department of Internal Medicine (Cancer Research), University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Matthias Zeth,

    1. Department of Internal Medicine (Cancer Research), University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Georg Taeger,

    1. Department of Diagnostic and Interventional Radiology, University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Siegfried Seeber,

    1. Department of Internal Medicine (Cancer Research), University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Michael Flasshove,

    1. Department of Internal Medicine (Cancer Research), University of Essen Medical School, Essen, Germany
    2. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
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  • Jochen Schütte

    1. Department of Traumasurgery, University of Essen Medical School, Essen, Germany
    2. Department of Oncology/Hematology, Marien Hospital, Düsseldorf, Germany
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  • This work was in part presented at the American Society of Clinical Oncology meeting in New Orleans 2004.

Abstract

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Long-term survival of patients with metastatic disease has only been observed in patients with completely resected disease. Recently, the tyrosine kinase inhibitor imatinib has been found to yield responses in the majority of patients with metastatic GIST suggesting improved resectability in responding patients. Combined treatment approaches including resective surgery after imatinib treatment in patients with advanced metastatic disease have rarely been explored. We report a series of 90 patients with metastatic GIST in whom treatment with imatinib enabled 12 patients with mostly recurrent and extensive disease to be considered for resection of residual disease. In 11 of these patients, complete resection could be achieved. Viable tumor cells were found in all but one resected specimens suggesting that despite favorable radiological or clinical responses, imatinib is unlikely to induce pathological complete responses. Until more mature data from prospective trials are available, these data suggest that an early aggressive surgical approach should be considered for all patients with metastatic GIST. Further trials investigating a combined surgical and pre/postoperative treatment with imatinib in patients with advanced metastatic GIST are warranted. © 2005 Wiley-Liss, Inc.

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