Treatment strategy of rectal gastrointestinal stromal tumor (GIST)

J Surg Oncol. 2014 Jun;109(7):708-13. doi: 10.1002/jso.23562. Epub 2014 Feb 10.

Abstract

Background: Rectal gastrointestinal stromal tumor (GIST) is a rare entity. A retrospective analysis of outcomes from a single institution to identify treatment strategies associated with improved outcomes.

Methods: Records of patients with GIST of the rectum were retrospectively reviewed. Patient and tumor characteristics, treatment details, and outcome were evaluated.

Results: Compared with the trans-abdominal approach group, the local excision group patients had smaller size and lower location tumors (P < 0.05). Positive resection margin was an important hazard factor for DFS (OR, 7.63; P = 0.015). Among the patients with the tumor size >5 cm, those with preoperative Imatinib therapy had higher rate of a negative resection margin than those without (100% vs. 20%, P = 0.048). Among the patients with intermediate and high-risk tumors, those who received peri-operative Imatinib therapy had longer DFS compared with those without (61.3 ± 6.1 months vs. 20.2 ± 4.4 months, P = 0.030).

Conclusions: The location of rectal GIST impacts the choice of resection type. Most patients with tumors within 5 cm of the anal verge can be treated with local excision. Positive resection margin is the independent hazard factor for poorer survival. Peri-operative Imatinib therapy is associated with a prolonged DFS in patients with intermediate and high-risk tumors.

Keywords: gastrointestinal stromal tumor; imatinib mesylate; rectum; surgery.

MeSH terms

  • Adult
  • Aged
  • Benzamides / therapeutic use
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Gastrointestinal Stromal Tumors / mortality
  • Gastrointestinal Stromal Tumors / pathology
  • Gastrointestinal Stromal Tumors / therapy*
  • Humans
  • Imatinib Mesylate
  • Male
  • Middle Aged
  • Piperazines / therapeutic use
  • Proportional Hazards Models
  • Pyrimidines / therapeutic use
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / therapy*
  • Retrospective Studies

Substances

  • Benzamides
  • Piperazines
  • Pyrimidines
  • Imatinib Mesylate