Modern treatment of gastric gastrointestinal stromal tumors

Figure 5 Neoadjuvant treatment of a locally-advanced gastrointestinal stromal tumors with imatinib mesylate. A: This woman presented with abdominal pain and fullness. A computed tomography (CT) scan identified a massive (> 30 cm), homogeneous tumor in the gastric fundus that was exophytic and extending caudally towards the pelvic inlet; B: After tissue diagnosis confirmed a gastric gastrointestinal stromal tumor (GIST), the patient was treated with six months of low-dose imatinib mesylate (400 mg/d) until a maximal response was achieved. The coronal views of this interval CT scan demonstrated a much smaller, well-encapsulated, homogenous tumor (solid white arrowhead). She had a radical resection of the gastric GIST and was free of disease until 24 mo when she developed a metastatic lesion in the left lateral segment of the liver. Following complete metastectomy, she was treated with several targeted tyrosine kinase inhibitors until she ultimately succumbed from her metastatic disease 19 mo from her second operation and 43 mo from her initial operation.