Long-term follow-up outcome of imatinib mesylate treatment for recurrent and unresectable gastrointestinal stromal tumors.

BACKGROUND: The follow-up study of up to 71 months of a randomized phase II B2222 trial has demonstrated a long-term survival in patients with recurrent or unresectable gastrointestinal stromal tumors (GISTs). One subset of the patients (17.7%) has been alive for over 9 years with continuous imatinib mesylate (imatinib) treatment. Here, we report the retrospective analysis of recurrent or unresectable GIST patients with imatinib treatment at our institution. METHODS: We summarized the data of 20 patients with recurrent or unresectable GIST treated with imatinib. RESULTS: Patients were followed for a median of 40 months (range 2.5-103) under imatinib treatment. The median progression-free survival (PFS) was 89 months and overall survival for 8 years was 67%. Fifteen patients showed continuous partial response or stable disease with imatinib treatment. The median PFS was 45 months and the median size of the primary tumor was 7.6 cm (range 2.8-18). Four patients showed progressive disease. The median PFS was 56 months and the median size of the primary tumor was 11.9 cm (range 6.7-19). Grade 3 or 4 adverse events occurred in neutropenia (10%), anemia (15%) and renal dysfunction (5%). However, all patients were well managed by supportive treatment and none were discontinued from imatinib treatment due to toxicity or adverse events. CONCLUSION: Imatinib had a high efficacy in patients with unresectable and recurrent GIST during long-term follow-up. All patients were well managed by supportive treatment against adverse events and they were able to take imatinib without discontinuation. The management of adverse events was a key factor for achieving a long-term survival. In addition, the potential risk of imatinib-resistant GISTs tends to depend on the size of the primary GISTs.

Damage to the left ventral, arcuate fasciculus and superior longitudinal fasciculus-related pathways induces deficits in object naming, phonological language function and writing, respectively.

The anatomic localization of brain functions can be characterized via diffusion tensor imaging in patients with brain tumors and neurological symptoms. The goal of the present study was to evaluate the function of the ventral, arcuate fasciculus (AF) and the superior longitudinal fasciculus (SLF)-related language pathways using these techniques by analyzing 9 patients treated in our hospital between 2007 and 2011. In cases 1-3, the left ventral pathways, namely, the inferior longitudinal fasciculus, uncinate fasciculus or inferior fronto-occipital fasciculus, were mainly damaged, and the common dysfunction experienced by these patients was a deficit in object naming. In cases 4-6, the left SLF was mainly damaged, and the common deficit was dysgraphia. In cases 7-9, the left AF was mainly damaged, and almost all language functions related to phonology were abnormal. These results suggest that the left ventral, AF and SLF-related pathways are closely related to visual, auditory and hand-related language function, respectively.

The right dorsal anterior cingulate cortex may play a role in anxiety disorder and visual function.

Recent investigation suggests that the dorsal anterior cingulate cortex (ACC) is involved in the interplay between cognition and emotion. The present study described three patients who underwent removal of brain tumors just above the right dorsal ACC. These patients had residual tumor following surgery and showed anxiety disorder (AD) both before and after surgery. Visual memory or attention was abnormal before surgery in these patients, but these deficits improved following surgery, possibly due to a decrease in compression of the right dorsal ACC. These results suggest that damage to the right dorsal ACC is involved in AD and well as in deficits in visual memory or attention. Therefore, the right dorsal ACC might play a role in vision-related cognition and emotion, such as anxiety.

[A case of gastrointestinal stromal tumor of the stomach mimicking a primary tumor of the omentum minus due to the extramural growth].

We report a case of gastrointestinal stromal tumor (GIST) of the stomach mimicking a primary tumor of the omentum minus. The tumor presented as an isolated mass in the omentum minus without any adhesion to the stomach. Microscopic examination revealed that the tumor pseudocapsule on the gastric side included a small smooth muscle tissue component. The patient was given a diagnosis of a gastric GIST that showed extensive extramural growth. GISTs should not be defined by the localization of the tumor.

The left superior longitudinal fasciculus within the primary sensory area of inferior parietal lobe plays a role in dysgraphia of kana omission within sentences.

Functional neurological changes after surgery combined with diffusion tensor imaging (DTI) tractography can directly provide evidence of anatomical localization of brain function. Using these techniques, a patient with dysgraphia before surgery was analyzed at our hospital in 2011. The patient showed omission of kana within sentences before surgery, which improved after surgery. The brain tumor was relatively small and was located within the primary sensory area (S1) of the inferior parietal lobe (IPL). DTI tractography before surgery revealed compression of the branch of the superior longitudinal fasciculus (SLF) by the brain tumor. These results suggest that the left SLF within the S1 of IPL plays a role in the development of dysgraphia of kana omission within sentences.

Irinotecan plus mitomycin C as second-line chemotherapy for advanced gastric cancer resistant to fluoropyrimidine and Cisplatin: a retrospective study.

Background. S-1 plus cisplatin has been established to be standard first-line chemotherapy for advanced gastric cancer in Japan. The optimal second-line treatment refractory to S-1 plus cisplatin remains unclear. Methods. We retrospectively studied the efficacy, toxicity, and survival of irinotecan plus mitomycin C in patients with advanced gastric cancer refractory to a fluoropyrimidine plus cisplatin. Results. Twenty-four patients were studied. Prior chemotherapy was S-1 plus cisplatin in 15 patients, S-1 plus cisplatin and docetaxel in 8, and 5-fluorouracil plus cisplatin with radiotherapy in 1. The overall response rate was 17.4%. The median overall survival was 8.6 months, and the median progression-free survival was 3.6 months. Grade 3 or 4 toxicities included leukopenia (33%), neutropenia (50%), anemia (33%), thrombocytopenia (4%), anorexia (13%), diarrhea (4%), and febrile neutropenia (13%). Conclusion. A combination of irinotecan and mitomycin C is potentially effective in patients with advanced gastric cancer refractory to a fluoropyrimidine plus cisplatin.

Epithelioid gastrointestinal stromal tumor of the stomach mimicking extragastrointestinal origin.

We report a case of gastrointestinal stromal tumor (GIST) of the stomach mimicking extragastrointestinal origin. The tumor presented as a large isolated mass in the transverse mesocolon with a minor adhesion to the stomach. Microscopic examination revealed c-kit gene protein product (KIT)-positive tumor cells with epithelioid features. The tumor pseudocapsule close to the adhesion site included a small smooth muscle tissue component, indicating a gastric origin. Furthermore, tumor cells at the adhesion site showed prominent hyalinization and calcification. The tumor was diagnosed as a gastric GIST showing extensive extramural growth. Thus, GIST of the stomach and other parts of the gastrointestinal tract can present as tumors localized in the soft tissues of the abdomen mimicking extragastrointestinal origin.

Right temporal lobe plays a role in verbal memory.

OBJECTIVES: Comparison of preoperative and postoperative neurological functions in patients undergoing resection of brain tumors, in combination with data from diffusion tensor imaging (DTI) studies, can provide direct evidence of anatomical localization of brain function. The goal of the present study was to use these techniques to characterize memory function of the right temporal lobe in five patients with right temporal lobe brain tumors. METHODS: Memory function was tested using the Wechsler Memory Scale-Revised (WMS-R) before and after surgery in five patients with right temporal lobe brain tumors. Preoperative DTI was performed in four of five cases. RESULTS: In all cases, general and verbal memory, including verbal paired association, significantly improved after surgery (P<0.05). The right inferior longitudinal fasciculus (ILF) was compressed by the tumor in all cases. CONCLUSION: These results suggest that the right temporal lobe plays a role in verbal memory and that this function may be associated with the right ILF.

Damage to the right dorsal anterior cingulate cortex induces panic disorder.

Brain imaging studies suggest that panic disorder (PD) is mediated by several brain regions, including the anterior cingulate cortex (ACC). In the present report we describe a patient who experienced a panic attack during awake surgery (case 1) and another patient who developed PD after surgery and radiotherapy (case 2). In case 1, the patient experienced repeated panic attacks when the tumor at the upper border of right dorsal ACC was removed during awake surgery. In case 2, the patient developed PD at six months after surgery and Cyberknife radiotherapy. MRI examination revealed that the dorsal ACC size was reduced at six months after surgery and that the dorsal ACC was absent at two years after surgery, possibly due to radiotherapy-induced damage by radiotherapy. Profile of mood states (POMS) testing characterized the presence of tension-anxiety as the common abnormal symptom in cases 1 and 2. In conclusion, these results suggest that damage to the right dorsal ACC can induce PD and that this structure likely plays a pathophysiologic role in PD.

Left or right temporal lesion might induce aggression or escape during awake surgery, respectively: role of the amygdala.

OBJECTIVE: Some patients with temporal lobe brain tumours show aggressive or escape behaviour during awake surgery. As the amygdala plays a critical role in coping with stress, we evaluated whether the left or right amygdala was involved in aggressive or escape behaviour in six patients undergoing awake surgery for temporal lobe brain tumours. METHODS: Brain tumours were located in the left temporal lobe in cases 1-3 and in the right temporal lobe in cases 4-6. In cases 1, 2, 4 and 5, the tumours invaded the amygdala. RESULTS: In case 1, the patient showed aggressive behaviour before partial removal of the left amygdala during awake surgery; just after partial removal of left amygdala, the patient was calm and cooperative. In case 2, the patient showed aggressive behaviour when the tumour near the left amygdala was removed. In case 3, the patient showed aggressive behaviour when awakening during awake surgery. In case 4, the patient showed escape behaviour when removal of the tumour near the right amygdala was initiated. In cases 5 and 6, patients showed escape behaviour upon awakening and upon initiation of tumour removal from the temporal lobe. CONCLUSION: In conclusion, these results suggest that left or right temporal lesions might induce aggressive or escape behaviour during awake surgery, respectively, and that the amygdala on the respective side may play a role in these behaviours.