Recurrent Gastrointestinal Stromal Tumors in the Imatinib Mesylate Era: Treatment Strategies for an Incurable Disease

Table 2

Institutional studies demonstrating benefit of surgery for recurrent GIST.

	Study design	Number of patients	Primary endpoint	R0 resection	Main findings
Bischof et al. [1]	Multi-institutional retrospective cohort	158 (87 locally advanced, 71 recurrent/metastatic)	RFS, OS	69% (recurrent/metastatic) versus 87.4% (locally advanced)	TKI-sensitive recurrent/metastatic disease—improved RFS, OS after surgery
Du et al. [43]	Phase III multicenter trial for recurrent/metastatic on IM +/− surgery for residual disease	41 (19 IM + surgery, 22 IM alone)	PFS	73.6%	Trend towards improved PFS in surgery group
Tan et al. [13]	Retrospective cohort—upfront surgery versus TKI for recurrence	186 (56 recurrent—30 resectable, 24 underwent surgery for recurrence)	DFS, OS	75% (18 of 24) in upfront surgery group	Improved OS and DFS with surgery
Chang et al. [17]	Prospectively collected retrospective review—imatinib + surgery (early versus late groups) versus IM only	182 (89 metastatic, 93 recurrent, 76 underwent surgery)	Clinical response, PFS, OS	31.5% (early surgery) versus 59.1% (late surgery)	Improved CR, PR, PFS, OS in early surgery group; improved CR, PR, OS in late surgery group
Sato et al. [25]	Retrospective cohort comparing IM + surgery to surgery only	737 (93 recurrent/metastatic—50 surgery + TKI therapy, 43 TKI therapy alone)	DFI, OS	58% (29 of 50)	Improved survival from surgery + TKI after complete resection, response to TKI, < 4 metastatic lesions, lesions < 100 mm total

TKI = tyrosine kinase inhibitor, IM = imatinib mesylate, OS = overall survival, DFS = disease-free survival, PFS = progression-free survival, CR = complete response, PR = partial response, RFS = recurrence-free survival, DFI = disease-free interval.