Preoperative imatinib for patients with primary unresectable or metastatic/recurrent gastrointestinal stromal tumor

OBJECTIVES: Despite its rising popularity, reports on the use of preoperative imatinib mesylate (IM) in patients with advanced gastrointestinal stromal tumor (GIST) are limited. This study aims to explore the clinical efficacy of preoperative IM in patients with primarily unresectable or metastatic/recurrent GIST. METHODS: Between September 2009 and February 2014, patients with primarily unresectable or metastatic/recurrent GIST treated by a single medical team were recruited and considered for preoperative IM therapy. Re-examination was conducted regularly and abdominal enhanced CT data, blood biochemistry and responses to IM were recorded. RESULTS: A total of 18 patients were enrolled, including 13 with a primary tumor (7 stomach, 3 small bowel, 2 rectal and 1 pelvic tumor) and 5 with recurrent or metastatic GIST (2 with liver metastasis, 2 with anastomotic recurrence and 1 with pelvic GIST). The median follow-up time was 9.5 months (range of 3-63). The median tumor sizes before and after initiation of IM treatment were 9.1 cm and 6.0 cm (p = 0.003) based on the CT findings, respectively. All patients showed a decrease in tumor burden and the median tumor size reduction was 35%. Sixteen of the 18 patients showed a partial response to IM and two possessed stable disease. Nine of the 18 patients (50%) underwent surgical resection of primary or metastatic/recurrent tumors, with a median of 7 months of IM therapy. One case each of multivisceral resection and tumor recurrence were noted. CONCLUSIONS: IM as a preoperative therapy is feasible and safe for unresectable or metastatic/recurrent GIST that can effectively decrease tumor size, facilitating resection. .

Advances in clinical investigation of adjuvant radiotherapy in rectal cancer / 中国癌症杂志

Surgery has remained the mainstay of treatment of rectal cancer but due to high local recurrence rates,adjuvant chemoradiation has become standard practice for advanced rectal cancer.In 1990,postoperative chemoradiation has been established by NCI based on the results of GITSG,NCCTG and intergroup studies.However,the German CAO/ARO/AIO 94 study showed that preoperative chemoradition is better than postoperative in terms of local control and acute toxicity.The 5-year cumulative incidence of local relapse was lower in patients assigned to pre-operative chemoradiation vs postoperative treatment Grade 3 or 4 acute toxic effects occurred in 27% of patients in pre-op group vs 40% in post-op group.The corresponding rates of long-term toxic effects were 14% and 24%,respectively.Preoperative chemoradiation has been the trend of treatment of advanced rectal cancer.