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Radiation Oncology

, 8:274

Clinical Radiation Oncology


BackgroundThe role of radiation therapy RT in the management of gastrointestinal stromal tumors GIST is not well described. Here we report our institutional experience for patients with locally advanced or metastatic GIST treated with RT.

MethodsBetween 1997 and 2012, 15 patients with 22 GISTs were treated with RT at our center. The median age was 68 range, 41–86. Fourteen patients had stage IV disease and 1 patient had stage IIIB disease, per the American Joint Committee on Cancer AJCC, 7th Edition staging. Tumors were in a variety of locations, and were most commonly referred for palliative treatment. Eighteen of 22 tumors were symptomatic. Prior to RT, 14 of 15 patients received systemic therapy in the form of tyrosine kinase inhibitors TKIs n = 11, chemotherapy n = 4, or both n = 1. TKIs were used concurrently for nine tumors 40.9%. No tumors were treated with concurrent chemotherapy. Several fractionation schemes were used, most commonly 3 Gy × 10 n = 8. Local progression-free survival and overall survival were estimated using the Kaplan-Meier method. Acute toxicity was graded per Common Terminology Criteria for Adverse Events CTCAE v4.0.

ResultsThe median follow-up was 5.1 months range, 1.3-28.3. At the time of analysis, 12 patients have died 80%. The estimated 6-month local progression-free survival and overall survival were 57.0% and 57.8%, respectively. Among the 18 symptomatic tumors, at least partial palliation was achieved in 17 94.4%, and symptoms were completely palliated in eight 44.4%. Treatment was well tolerated, with no Grade 4 or 5 toxicities. There was no Grade ≥3 toxicity associated with concurrent TKI use.

ConclusionsIn this largest series to date of GISTs treated with RT, a high rate of palliation was achieved for symptomatic tumors in a cohort of advanced stage, heavily pretreated patients. Treatment was well tolerated, and concurrent use of tyrosine kinase inhibitor therapy was not associated with additional toxicity. While follow-up was short, durable control is possible for some patients, providing evidence that GIST is not universally radioresistant and that RT can provide an important benefit in patients with progressive or metastatic disease.

KeywordsGastrointestinal stromal tumor Radiation therapy Palliation Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-8-274 contains supplementary material, which is available to authorized users.

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Autor: John J Cuaron - Karyn A Goodman - Nancy Lee - Abraham J Wu

Fuente: https://link.springer.com/

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