Authors: M A Pantaleo M Di Battista F Catena M Astorino M Saponara V Di Scioscio D Santini G Piazzi P Castellucci G Brandi G Biasco
Publish Date: 2008/01/17
Volume: 134, Issue: 5, Pages: 625-630
Abstract
After imatinib treatment the surgical management of patients affected by gastrointestinal stromal tumor GIST has been widely reported and often considered by many oncologists in clinical practice Surgical results are correlated with disease responsiveness to tyrosine kinase inhibitors and with complete extirpation of all tumor sites By now no report specifically addressing surgical management after secondline treatment with sunitinib is still available Most patients have an unresectable disease and do not have any other therapeutical options except for clinical trialsBoth our patients had a long durable stable disease on sunitinib but one developed a chronic mild bleeding that does not call for emergency surgical interventions and the other one developed chronic heart toxicity They were proposed to undergo surgery despite the unresectable diseases and received an incomplete resection because of residual metastatic lesions They restarted sunitinib after surgeryThe poor prognosis after sunitinib treatment and the absence of alternative validated options open the debate on the assessment of surgical management of metastatic GISTs in this setting The role of surgery should be investigated in clinical trials however the enrollment may be difficult In clinical practice and after a multidisciplinary case patient discussion surgery could represent a reasonable choice for advanced GISTs especially if the risk of surgeryrelated death is not too high
Keywords: