Korean J Radiol.  2015 Apr;16(2):304-313. 10.3348/kjr.2015.16.2.304.

Fluid Retention Associated with Imatinib Treatment in Patients with Gastrointestinal Stromal Tumor: Quantitative Radiologic Assessment and Implications for Management

Affiliations
  • 1Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. medimash@gmail.com
  • 2Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
  • 3The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA.

Abstract


OBJECTIVE
We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management.
MATERIALS AND METHODS
In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores.
RESULTS
The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction.
CONCLUSION
Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.

Keyword

Imatinib; Fluid retention; Subcutaneous edema; Ascites; Computed tomography

MeSH Terms

Adult
Aged
Aged, 80 and over
Antineoplastic Agents/*adverse effects/therapeutic use
Ascites/pathology/radiography
Benzamides/*adverse effects/therapeutic use
Echocardiography/methods
Edema/pathology/radiography
Female
Gastrointestinal Stromal Tumors/drug therapy/pathology/*radiography
Gastrointestinal Tract/pathology/*radiography
Heart Failure/radiography
Humans
Male
Middle Aged
Molecular Targeted Therapy/*adverse effects
Pericardial Effusion/pathology/radiography
Peritoneal Neoplasms/diagnosis/radiography/secondary
Piperazines/*adverse effects/therapeutic use
Pleural Effusion/pathology/radiography
Pyrimidines/*adverse effects/therapeutic use
Radiology
Retrospective Studies
Tomography, X-Ray Computed
Antineoplastic Agents
Benzamides
Piperazines
Pyrimidines
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