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Better Survival With Complete Resection, Presurgery Imatinib for Giant GIST
Preoperative imatinib therapy plus surgery or R0 resection plus imatinib therapy were the best treatment options for gastrointestinal stromal tumors (GIST) in a recent retrospective study (ANZ J Surg. 2020 Mar 11. Epub ahead of print).
“Controversy persists about the best treatment for giant gastrointestinal stromal tumours,” explained F Wang, MD, Department of General Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China and colleagues on the purpose of investigating different treatments options for giant GISTs and the effect on outcomes.
A total of 71 patients with GIST ≥10 cm in diameterwere assigned to four arms based on treatment: emergency surgery (n=17), preoperative targeted (imatinib) therapy (n=12), palliative resection (n=17), and R0 resection (n=25).
Researchers compared baseline conditions, intraoperative and post-operative findings betweens the treatment arms. Outcomes were assessed through long-term follow-up.
In the emergency surgery arm, preoperative gastrointestinal bleeding was significantly higher (P = 0.003)and hemoglobin level significantly lower (P < 0.05)than in other arms. Mean tumor diameter was significantly higher in the palliative resection group than in other groups (P= 0.023).
Overall survival was significantly higher in the R0 resection and preoperative targeting imatinib therapy arms than the emergency surgery and palliative resection arms (P < 0.05).
“In patients with giant GISTs, the best outcomes appear to be achieved with preoperative imatinib therapy plus surgery or R0 resection followed by imatinib therapy,” concluded Dr Wang et al.—Kaitlyn Manasterski
