1492P - Monitoring of patients with gastrointestinal stromal tumour: should the chest be scanned?

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics GIST
Imaging, Diagnosis and Staging
Presenter Alice Findlay
Authors A.R. Findlay1, T. Ishfaq2, A. Raja2, A. Thacoor2, P. Hall3, M. Marples4
  • 1University of Leeds, LS2 9JT - Leeds/UK
  • 2School Of Medicine, University of Leeds, LS2 9JT - Leeds/UK
  • 3Leeds Institute Of Health Sciences, University of Leeds, LS2 9LJ - Leeds/UK
  • 4St James's University Hospital, LS9 7TF - Leeds/UK

Abstract

Introduction

Thoracic CT scanning is often used for monitoring patients with sarcoma and upper gastrointestinal carcinoma, but its role in monitoring gastrointestinal stromal tumour (GIST) is variably defined in guidelines. In line with study protocols, it has been our practice to include chest CT for monitoring patients with GIST, and we now report the role of these scans.

Method

We reviewed the electronic records of all patients diagnosed with GIST at St James's Institute of Oncology, Leeds, UK, between 1 January 2001 and 1 January 2011. Primary site, stage at diagnosis, pattern of metastatic disease and frequency of CT scans were recorded.

Results

We identified 176 patients diagnosed with GIST. All patients had CT scans of the chest, abdomen and pelvis performed at intervals agreed by the Yorkshire Sarcoma Network. Primary site was stomach in 96 patients (55%), small bowel in 27 (15%), rectum in 5 (3%), other sites in 38 (22%), and unknown in 10 (6%). Median follow-up was 34.3 months. Of the 139 patients who had no metastases at presentation, five developed local recurrence and 11 developed metastases. 27 patients had metastases at presentation, and the status of 10 was unknown. All patients with metastases had disease below the diaphragm, and only two had lung involvement as well (one at recurrence, one at initial presentation). Thirty-seven patients with metastatic disease were treated with imatinib. Of the 31 patients who progressed on imatinib, all had progression below the diaphragm; the patient with lung and abdominal metastases progressed in both areas. Four of these patients also developed lung metastases at the time of progression elsewhere.

Conclusions

We observed synchronous progression in lungs and abdomen in 5/31 patients progressing on imatinib (16%), but no patients in our cohort relapsed or progressed in the lungs alone. We conclude that progression confined to the lungs is rare in GIST. Patients being monitored for recurrence or progression should have CT scans of the abdomen and pelvis only, with completion CT of the thorax being reserved for baseline and progression of disease.

Disclosure

M. Marples: Dr Marples has accepted sponsorship to research meetings from Novartis. Novartis support mutation testing for GIST at Dr Marples' institution.

All other authors have declared no conflicts of interest.