Yonsei Med J.  2009 Jun;50(3):437-440. 10.3349/ymj.2009.50.3.437.

Long-Surviving Patients with Recurrent GIST after Receiving Cytoreductive Surgery with Imatinib Therapy

• Choi WH
• Kim S
• Hyung WJ
• Yu JS
• Park CI
• Choi SH
• Noh SH

• KMID: 1758574
• DOI: http://doi.org/10.3349/ymj.2009.50.3.437

Abstract

In the treatment of recurrent or metastatic gastrointestinal stromal tumors (GIST), good prognoses may not be expected by surgery alone. Recently, imatinib has been applied for the treatment of GISTs, resulting in improved patient survival. However, long-term success is limited due to the development of resistance. Herein, we report two cases of long-surviving patients with recurrent GIST after receiving cytoreductive surgery with imatinib therapy. A 49 year-old man was diagnosed to a duodenal GIST with single hepatic metastasis, and an antrectomy including the duodenal lesion with intraoperative radiofrequency ablation were performed in April, 2002. After four months, a new metastatic hepatic lesion was identified. Percutaneous radiofrequency ablation was done, and imatinib therapy was started. A 56 year-old man underwent laparoscopic segmental resection of the distal ileum and partial excision of parietal peritoneum in March, 2001 to treat a malignant GIST of the distal ileum that was attached to parietal peritoneum. After six months, recurrence of GIST with peritoneal seeding and hepatic metastasis was found, and he underwent cytoreductive surgery including right hemicolectomy and wedge resection of liver. After surgery, there was no residual tumor grossly and imatinib therapy was started. In both cases, they were doing well with no evidence of recurrence for 5 years with imatinib therapy. Therefore, in patients with a recurrent GIST, improved survival can be expected with imatinib therapy after cytoreductive surgery.

Keyword

Gastrointestinal stromal tumors; recurrence; cytoreductive surgery; Imatinib

MeSH Terms

Gastrointestinal Stromal Tumors/*drug therapy/*surgery
Humans
Male
Middle Aged
Piperazines/*therapeutic use
Protein Kinase Inhibitors/*therapeutic use
Pyrimidines/*therapeutic use
Treatment Outcome

Figure

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  Fig. 1 Post-contrast CT. About a 1.3 cm round focal lesion with low attenuation density (arrow) showing a target-like appearance of mild contrast enhancement with centrally non-enhancing necrotic area in the right lobe of the liver suggests a single hepatic metastasis.

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  Fig. 2 The histologic picture of duodenal tumor shows the bundles of spindle cells (hematoxylin and eosin staining).

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  Fig. 3 Four-month follow-up CT shows a newly developed metastasis (arrow) in the posterior segment of right lobe of the liver.

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  Fig. 4 Post-contrast CT. About 3 cm low attenuation density lesion (arrowheads) in left lobe of the liver suggests a metastatic malignancy.

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  Fig. 5 The mesenteric tumors are composed of spindle cells (hematoxylin and eosin staining).

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  Fig. 6 Immunohistochemically, the cytoplasm of tumor cells tests diffusely positive for c-kit.

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