Manageme
Management
of gastrointestinal stromal tumors: Five years period, Tanta experience
Mohamed
El-Shebiney1, Alaa Maria1 and Emad Sadaka1 and
Ayman El-Namer2
1Clinical Oncology department, Faculty of
Medicine, Tanta University, Egypt
2General Surgery department, Faculty of
Medicine, Tanta University, Egypt
Abstract: Background: Gastrointestinal
stromal tumors (GISTs) are the most common mesenchymal neoplasm of the
gastrointestinal (GI) tract. Surgical resection has remained the mainstay of
treatment of GISTs with a 5-year survival of 29–35%. Gastrointestinal stromal
tumors have only been described based on their specific immunohistochemistry
and the presence of particular KIT-related mutations which potentially make
them targets for tyrosine kinase inhibition. We
present our experience of managing GISTs, 5-years period. Methods:We
reviewed clinical, pathological records and treatment outcome of 22 patients
(14 men and 8 women) with GISTs treated at General Surgical and Clinical
Oncology Departments, Tanta University Hospital during the period from Jan 2007
to Dec 2011. Results: The stomach was the most common site of
origin (45.45%). The mean tumor diameter was 7±3.1 (range 4–18) cm. We detected
advanced-stage tumors in 18.18% of patients. Complete resection was performed
in 77.27% of patients. Mitotic count was greater than 5 high-power field (HPF)
in 31.82 % patients. Immunohistochemical staining for CD117 was positive in 90.91%
patients. The mean follow-up period was 26.7±15.1 (range 7–55) months. Distant
metastases developed in 18.18% of all patients within an average of 14.5 (range
7–21) months. Local recurrence had occurred in 29.41% of patients who underwent
complete surgical resection within an average of 11.4 (range 4–18) months.
Imatinib mesylate therapy was administered for 11 patients (4 patients hade
positive margins, 3 patients had locally recurrent disease and 4 patients had
distant metastases) with a median survival of 21 (range 7-37) months. The
median length of survival for all patients was 29 months and the 3-year overall
survival (OS) and disease free survival (DFS) rates were 54.55% and 45.45%
respectively. Three-year OS rates were 58.82 % versus 40% for
patients who underwent complete surgical excision versus those who underwent
incomplete surgical excision respectively (p=0.61). The 3-year OS rates
were 76.92% versus 22.22% for low & intermediate versus high
malignant risk patients respectively (p=0.008). Conclusion: Treatment
of GISTs should be made on an individual basis. Surgical resection is
considered the gold standard therapy for resectable GISTs and the completeness
of the resection with negative margins is the main goal of surgery. Large
multi-centers studies with large number of patients are needed for further
insight into issues of tyrosine kinase inhibitors dosage, treatment duration
and the selection, timing and monitoring of further therapeutic interventions.
[Mohamed El-Shebiney, Alaa Maria, Emad Sadaka and
Ayman El-Namer. Management of gastrointestinal stromal tumors: Five
years period, Tanta experience. Life Sci J 2013;10(1):1729-1735]
(ISSN:1097-8135).http://www.lifesciencesite.com.
Key words: Gastrointestinal stromal tumors, c-KIT protein, Imatinib mesylate.
