Ahmed Kensarah

Six months neoadjuvant imatinib improves resectability potential of gastric stromal tumors in Egyptian patients

OBJECTIVES Though recurrence is high, local excision is the preferred approach for dealing with gastric stromal tumors. Achieving negative margins is mandatory, sometimes requiring subtotal gastrectomy. Adjuvant imatinib is essential for advanced cases and prolonging survival; however, there is not enough data to recommend its use before surgery to increase resectability. The current study aims at investigating this concept in Egyptian patients. PATIENTS AND METHODS The study included 16 patients (13 males, 3 females, mean age 60 years) presenting with gastrointestinal stromal tumors (GISTs) who were candidates for emergency (n = 3) or elective (n = 13) surgery. Investigations included endoscopy (+biopsy), sonography, and computed tomography (CT). Patients were enrolled in two groups: A (n = 6: projected to planned surgery) and B (n = 7: harboring c-kit +ve tumors). Each B patient received imatinib (400 mg/day) for 6 months before surgery. Clinical and radiological evaluation was at day 100. The Chi-square test was used to check size changes, and p at <0.02535 was considered significant. RESULTS All patients had abdominal discomfort, while 62.5% had epigastric pain, and 12.5% had hematemesis. Tumor sizes ranged from 8.4 to 20 cm 2/3 were located in the upper stomach. Five patients (31.3%) harbored lesions with low risk malignancy, eight (50%) with moderate risk and three (18.8%) with high risk. Wedge gastrectomy was the most common operation performed (81.25%) while partial gastrectomy was carried out in the rest, reporting no recurrence for 6 months. Not determined in group A patients, c-kit status was strongly positive in all members of group B; in two of them treatment was suspended due to poor response. CONCLUSION Imatinib has an acceptable safety profile and can be considered as a neoadjuvant therapy in GISTs. Until clear guidelines have been developed, we report that a 6 month intake may noticeably increase their resectability potential and improve prognosis.