Primary localized gastrointestinal stromal tumors (GIST) of the duodenum: Final results of a French Sarcoma Group (FSG) retrospective review of 110 patients (pts).

Medientyp: E-Artikel

Titel: Primary localized gastrointestinal stromal tumors (GIST) of the duodenum: Final results of a French Sarcoma Group (FSG) retrospective review of 110 patients (pts)

Beteiligte: Huynh, Thanh Khoa; Cassier, Philippe A; Bachet, Jean Baptiste; Boucher, Eveline; Bouche, Olivier; Le Cesne, Axel; Landi, Bruno; Mancini, Julien; Marchal, Frederic; Bay, Jacques-Olivier; Bertucci, François; Spano, Jean-Philippe; Italiano, Antoine; Collard, Olivier; Chaigneau, Loic; Isambert, Nicolas; Lebrun-Ly, Valerie; Blay, Jean-Yves; Duffaud, Florence

Erschienen: American Society of Clinical Oncology (ASCO), 2012

Sprache: Englisch

DOI: 10.1200/jco.2012.30.15_suppl.10078

ISSN: 0732-183X; 1527-7755

Schlagwörter: Cancer Research ; Oncology

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Beschreibung: 10078 Background: Duodenal GISTs represent 3-5% of all GISTs with limited understanding of patient outcomes from small series. We conducted a retrospective analysis of primary localized duodenal GISTs over the past 18 years. Methods: Pts were identified in two ways: a group of 101 pts reported via survey from 20 FSG centers, and a group of 9 pts enrolled in the BFR14 trial. Results: Pts were:55 females, 55 males, with a median age of 57 years (30-84), and median ECOG 0 (0-3). Abdominal pain, anemia, and GI bleeding were the most common symptoms. Tumors (T) originated mainly in D2 (41%), or D3 (27%), with a median size of 5 cm (1.5-30). All pts except four had resection of the primary T. Surgical procedures were: local resection (LR) [segmental duodenectomy (n=31), wedge local resection (n=31), local excision (n=6)], and duodenopancreatectomy (DP, n=20). Resections were R0 in 84 pts (79%), R1 in 6 pts (6%). T characteristics included: KIT+ (n=100), CD34 + (n= 54), mitoses/50 HPF ≤ 5 (n= 70), or > 5 (n=24), Miettinen low-risk (n=37), and high-risk (n=19), necrosis (n=29), spindle cell (n=84). Genotype was evaluated in 36 cases: KIT exon 11 mutant (n=30), no mutation (n=4), and KIT exon 9 mutant (n=2). 12 pts received neoadjuvant imatinib (IM) therapy resulting in 6 PR, 3 SD, 1 PD. 17 pts received adjuvant IM therapy. With a median FU of 32 months (1-250), 95 pts (86%) are alive. Twenty-eight (26%) pts relapsed: 6 LR, and 26 metastases. The 4-year OS and EFS rates were 89.5% and 68.2 %. The 6-year OS and EFS rates were 89.5% and 36.5%. Univariate analysis showed that: age and ECOG PS have an impact on OS (p= 0.008, p <0.001), necrosis, spindle-cell type, T size, mitoses/50 HPF, and Miettinen risk were predictive of relapse (p< 0.001). In multivariate analysis tumor size and mitoses/ 50 HPF only were predictive of relapse (p< 0.001). Conclusions: Pts with resected duodenal GIST have a reasonably favourable prognosis. LR rather than DP should be pursued if possible to preserve optimal pancreas function. Neoadjuvant IM may potentially allow a proportion of patients requiring DP to undergo LR. Adjuvant IM should be systematically discussed with a patient based on the individual-risk of recurrence.

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