Gastrointestinal Stromal Tumor: Experience in the Treatment of Localized and Advanced Disease at the Clinical Hospital of Parana Federal University

Abstract

Introduction: Gastrointestinal stromal tumors (GIST ) are rare neoplasms that originate from interstitial cells of Cajal. Objectives: To describe the experience at the Curitiba Clinical Hospital in the treatment of both localized and advanced GIST, with analysis of clinical and anatomical and pathological characteristics and use of imatinib. Methodology: A retrospective study of 32 patients diagnosed for immunohistochemistry, c-Kit positive, from 2003 to 2008. Results: The median age was 66 years, the median tumor size was 8.4 cm and the most common sites were the tomach in 46.9% and the small intestine in 40.9%. Patients at high risk of progressive disease: 37.5%. 23 patients had localized disease at diagnosis, 39.1% relapsed, and 9 patients had advanced disease. The median follow up was 43.7 months, overall survival at 5 years for the total group of 56.2%. In localized disease, overall survival at 5 years was 73.8% and 37.5% in advanced disease (p=0.03). There was no impact of prognostic factors on survival. The use of imatinib occurred in 16 patients, 43.8% due to initial metastasis, 37.5% disease progression, 12.5% local recurrence and 6.2% compromised margins. The median overall survival with the use of imatinib was 53 months and the first progression-free survival of 32.9 months. There was good tolerance to imatinib and only two patients received sunitinib. Conclusion: Predominant tumors were large, gastric-sited and of high risk of progression. The relapse rate was high in localized disease. And overall survival of patients with localized disease and who used the imatinib was considered satisfactory.