Imatinib as preoperative therapy in Chinese patients with recurrent or metastatic GISTs

Objective： Imatinib has dramatically altered the options for management of patients with gastrointestinal stromal turnouts. However, it has become clear that secondary resistance to the drug develops during long- term therapy. The purpose of our study was to retrospectively analyze safety and long-term outcomes in Chinese patients with recurrent or metastatic GISTs treated with imatinib preoperatively. Methods： Between June 2003 and June 2011, 22 patients underwent surgery for recurrent or metastatic GISTs after preoperative treatment with imatinib. Results： Complete resection was accomplished in 8 of the 10 responsive disease （RD） patients （80%）, and in 3 of the 12 patients （25%） who had progression disease （PD）. The amount of blood loss during the operation in PD patients was higher than in RD patients. There was 1 hospital death in PD group related to surgery, while the other patients recovered with conservative therapy because complications were mild. The difference in median PFS between patients with RD and those with PD was significant （24.8 vs. 2.81 months, P〈0.001）. The difference in 2-year OS rate between patients with RE） and those with PD was not significant （100% vs. 87.5%, P〉0.05）. Conclusions： Our study indicates that surgical intervention can improve the PFS of Chinese patients with recurrent or metastatic GISTs responsive to imatinib, but does not prolong OS as well as in patients who develop imatinib resistance. Surgical resection following imatinib treatment is feasible and can be considered for patients with advanced GISTs responsive to imatinib.

Treatment and prognosis of iliac fossa soft tissue sarcoma: A single-center study

Dear Editor,Primary iliac fossa sarcoma(IFS)is a special type of retroperitoneal sarcoma(RPS),accounting for∼15%of all RPS cases[1].The deep location,large size,and invasion to surrounding tissues and organs are the main causes of unresectability of IFS.All these characteristics are associated with an increased risk of positive surgical margin and a decreased feasibility of adjuvant therapy.In patients with multivisceral and/or vascular involvement,a multivisceral en bloc approach[2]with blood vessel replacement may be required to achieve a negative margin and to improve the quality of resection[3].However,whether these surgical procedures improve prognosis in patients with IFS remain undefined.Moreover,whether aggressive procedures lead to acceptable functional impairment requires validation.In addition,previous studies have reported inconsistent results regarding the role of adjuvant radiotherapy in the treatment of RPS[4].To date,the role of radiotherapy in the local control of IFS remains to be determined.Therefore,we analyzed the clinical features,treatment,and outcomes of IFS patients in an attempt to determine the significant prognostic factors and efficient therapeutics in real clinical practice.