Prolonged Therapy with Imatinib Mesylate before Surgery for Advanced Gastrointestinal Stromal Tumor Results of a Phase II Trial.

Purpose. Proven efficacy of imatinib mesylate in gastrointestinal stromal tumour (GIST) has led to its use in advanced disease and, more recently, in adjuvant and neoadjuvant settings. The purpose of this study was to evaluate the optimal neoadjuvant imatinib duration to reduce the morbidity of surgery and increase the possibility of resection completeness in advanced tumours. Patients and Method. Patients with advanced GIST were enrolled into a registered open-label multicenter trial and received imatinib daily for a maximum of 12 months, followed by en bloc resection. Data were prospectively collected regarding tumour assessment, response rate, surgical characteristics, recurrence, and survival. Results. Fourteen patients with advanced GIST were enrolled. According to RECIST criteria, 6 patients had partial response and 8 had stable disease. The overall tumour size reduction was 25% (0-62.5%), and there was no tumour progression. Eleven patients underwent tumour resection, and all had R0 resection. After a median followup of 48 months, 4-year OS and DFS were 100% and 64%, respectively. Conclusion. This prospective trial showed that one year of neoadjuvant imatinib in advanced GIST is safe and associated with high rate of complete microscopic resection. It is not associated with increased resistance, progression, or complication rates.

Implantable device for venous access.

This paper reports the experience at the Royal Victoria Hospital in Montreal with the first 50 Port-A-Cath devices implanted for venous access in patients requiring long-term chemotherapy. There were 25 women and 22 men, ranging in age from 18 to 85 years. Twenty-two devices were implanted for hematologic malignant disease, 26 for solid tumours and 2 for benign disease. The mean operative time was 46.3 minutes, using a percutaneous subclavian stick technique in 94% of insertions. Blood sampling and infusions were easy in 88% and 92% respectively. Seventy-eight percent of the patients accepted the device well. Nine devices were removed, four at the end of therapy (median functioning time of 208.5 days) and five because of sepsis (median time 18 days). The median time of the still-functioning devices in live patients is 141.5 days. Septic complications were seen in 12%, blockage in 6% and skin necrosis in 2%. One death occurred from sepsis in a poor-performance patient with stage IV breast cancer and hypercalcemia. We breast cancer and hypercalcemia. We believe that the Port-A-Cath is efficient, safe and easily accessible for patients on long-term chemotherapy.

Carcinoma of the tongue: the Montreal General Hospital experience from 1979 to 1984.

In a retrospective study of 54 patients with primary carcinoma of the tongue seen at the Montreal General Hospital from 1979 to 1984, the overall 2-year survival for those with stage I disease was 92%. Surgery alone was the initial treatment in 84% of these patients. Disease recurred in 36%. In stage II patients, 8 of 12 had surgery followed by radiotherapy; 37% had recurrent disease. Surgery alone was used in 4 of 12 and with recurrence in 3. Overall survival in stage II was 83% at 2 years. In cases of localized disease, the survival rate for surgery alone was not significantly different from that after surgery plus radiotherapy. Combined surgery plus radiotherapy might offer better regional control in stage II disease. Of 18 stage III patients, 7 were treated by surgery followed by radiotherapy; 3 died and 4 are disease free. All had commando procedures. Radiotherapy alone was used in seven and six of them had recurrences. Overall, the 2-year survival for stage III was 61%. Control of regional disease was achieved in 57% of those who had surgery plus radiotherapy as opposed to 39% overall. Stage IV patients had a 2-year survival of 10%. Nine of the 11 received chemotherapy followed by radiotherapy. This combination did not improve survival and most of these patients died within 1 year.