Surgical intervention following imatinib treatment in patients with advanced gastrointestinal stromal tumors (GISTs)

Background: We investigated the role of surgical intervention for advanced GIST after imatinib. Methods: Among 256 patients treated with imatinib for advanced GIST, the medical records of the 34 patients who underwent surgery of residual tumors after imatinib treatment were reviewed. Results: Surgery was performed on 24 patients with responsive disease (RD) after imatinib, on 3 with focal progressive disease (FP), and on 7 with generalized progressive disease (GP). All gross tumors were completely resected in 19/24 (79%), 1/3 (33%), and 1/7 (14%) patients, respectively. Disease status at surgery was associated with prognosis after surgery; with a median follow-up of 25.7 months. the median progress ion-free survival of patients resected for RD, FP, and GP were 27.8 months (95% Cl, 17.8-37.8 months), 5.1 months (95% Cl, 4.7-5.6 months), and 3.3 months (95% Cl, 2.7-3.9 months), respectively (P < 0.001). Median overall survival was not reached in patients resected for RD, and was 22.5 months (95% Cl, 1.4-43.0 months) and 23.5 months (95% CI, 3.0-43.9) for patients resected for FP and GP, respectively (P < 0.001). Conclusion: Surgical resection of tumors responsive to imatinib may be beneficial in patients with advanced GIST. Debulking surgery, however, is not recommended for patients who have already developed imatinib resistance.