metricas
covid
Buscar en
Clinics
Toda la web
Inicio Clinics Downstaging of a Rectal Gastrointestinal Stromal Tumor by Neoadjuvant Imatinib T...
Journal Information

Statistics

Follow this link to access the full text of the article

Letter to the Editor
Downstaging of a Rectal Gastrointestinal Stromal Tumor by Neoadjuvant Imatinib Therapy Allowing for a Conservative Surgical Approach
Gustavo dos Santos FernandesI, Guilherme Cutait de Castro CottiI, Daniela FreitasI, Raul CutaitII, Paulo M. HoffI,III
I Hospital Sírio Libanês, Centro de Oncologia - São Paulo/SP, Brazil
II Department of Radiology, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
III Department of Oncology, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil, Tel: 55 61 3377.0281,
Read
527
Times
was read the article
246
Total PDF
281
Total HTML
Share statistics
 array:24 [
  "pii" => "S1807593222025844"
  "issn" => "18075932"
  "doi" => "10.1590/S1807-59322009000800018"
  "estado" => "S300"
  "fechaPublicacion" => "2009-08-01"
  "aid" => "20222584"
  "copyright" => "CLINICS"
  "copyrightAnyo" => "2009"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
  "subdocumento" => "cor"
  "cita" => "Clinics. 2009;64:819-21"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1807593222025856"
    "issn" => "18075932"
    "doi" => "10.1590/S1807-59322009000800019"
    "estado" => "S300"
    "fechaPublicacion" => "2009-08-01"
    "aid" => "20222585"
    "copyright" => "CLINICS"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
    "subdocumento" => "cor"
    "cita" => "Clinics. 2009;64:822-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Coronary Artery Bypass Surgery&#44; Angioplasty and Long Term Anti-Platelet Treatment in a Type B Hemophilia Patient"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "822"
          "paginaFinal" => "823"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "f1-cln64_8p822"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1159
              "Ancho" => 992
              "Tamanyo" => 72391
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">A&#46; Circumflex coronary artery with 95&#37; obstruction&#46; B&#46; Anterior descending coronary artery with 70&#37; obstruction&#46; C&#46; Right coronary artery with a 100&#37; distal occlusion</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Antonio Eduardo Pesaro, Marcus Vinicius Gaz, Ralf Karbstein, Marco Perin, Carlos Vicente Serrano, &#201;lbio Damico"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Antonio Eduardo"
              "apellidos" => "Pesaro"
            ]
            1 => array:2 [
              "nombre" => "Marcus Vinicius"
              "apellidos" => "Gaz"
            ]
            2 => array:2 [
              "nombre" => "Ralf"
              "apellidos" => "Karbstein"
            ]
            3 => array:2 [
              "nombre" => "Marco"
              "apellidos" => "Perin"
            ]
            4 => array:3 [
              "nombre" => "Carlos Vicente"
              "apellidos" => "Serrano"
              "sufijo" => "Jr&#46;"
            ]
            5 => array:2 [
              "nombre" => "&#201;lbio"
              "apellidos" => "Damico"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222025856?idApp=UINPBA00004N"
    "url" => "/18075932/0000006400000008/v1_202212060853/S1807593222025856/v1_202212060853/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1807593222025832"
    "issn" => "18075932"
    "doi" => "10.1590/S1807-59322009000800017"
    "estado" => "S300"
    "fechaPublicacion" => "2009-08-01"
    "aid" => "20222583"
    "copyright" => "CLINICS"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
    "subdocumento" => "sco"
    "cita" => "Clinics. 2009;64:815-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Rapid Communication</span>"
      "titulo" => "The Composite Aortic Wall Graft Technique&#58; An Option for a Short Coronary Artery Bypass Graft"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "815"
          "paginaFinal" => "818"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "f2-cln64_8p815"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 789
              "Ancho" => 993
              "Tamanyo" => 161272
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Distal end of graft&#44; ready for anastomosis with bridging vessel</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jo&#227;o Bosco de Oliveira, Roberto Rocha e Silva, Dennys Marcel Sanches Martins, Ricardo De Mola, Marcos Vinicius Henriques de Carvalho"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Jo&#227;o Bosco"
              "apellidos" => "de Oliveira"
            ]
            1 => array:2 [
              "nombre" => "Roberto"
              "apellidos" => "Rocha e Silva"
            ]
            2 => array:2 [
              "nombre" => "Dennys Marcel Sanches"
              "apellidos" => "Martins"
            ]
            3 => array:2 [
              "nombre" => "Ricardo"
              "apellidos" => "De Mola"
            ]
            4 => array:2 [
              "nombre" => "Marcos Vinicius Henriques"
              "apellidos" => "de Carvalho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222025832?idApp=UINPBA00004N"
    "url" => "/18075932/0000006400000008/v1_202212060853/S1807593222025832/v1_202212060853/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Downstaging of a Rectal Gastrointestinal Stromal Tumor by Neoadjuvant Imatinib Therapy Allowing for a Conservative Surgical Approach"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "819"
        "paginaFinal" => "821"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Gustavo dos Santos Fernandes, Guilherme Cutait de Castro Cotti, Daniela Freitas, Raul Cutait, Paulo M&#46; Hoff"
        "autores" => array:5 [
          0 => array:3 [
            "nombre" => "Gustavo dos Santos"
            "apellidos" => "Fernandes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "afI-cln64_8p819"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Guilherme Cutait"
            "apellidos" => "de Castro Cotti"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "afI-cln64_8p819"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Daniela"
            "apellidos" => "Freitas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "afI-cln64_8p819"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Raul"
            "apellidos" => "Cutait"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">II</span>"
                "identificador" => "afII-cln64_8p819"
              ]
            ]
          ]
          4 => array:4 [
            "nombre" => "Paulo M&#46;"
            "apellidos" => "Hoff"
            "email" => array:1 [
              0 => "gustavo.onco@terra.com.br"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "afI-cln64_8p819"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">III</span>"
                "identificador" => "afIII-cln64_8p819"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Hospital S&#237;rio Liban&#234;s&#44; Centro de Oncologia - S&#227;o Paulo&#47;SP&#44; Brazil"
            "etiqueta" => "I"
            "identificador" => "afI-cln64_8p819"
          ]
          1 => array:3 [
            "entidad" => "Department of Radiology&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo - S&#227;o Paulo&#47;SP&#44; Brazil"
            "etiqueta" => "II"
            "identificador" => "afII-cln64_8p819"
          ]
          2 => array:3 [
            "entidad" => "Department of Oncology&#44; Faculdade de Medicina da Universidade de S&#227;o Paulo - S&#227;o Paulo&#47;SP&#44; Brazil&#44; Tel&#58; 55 61 3377&#46;0281&#44;"
            "etiqueta" => "III"
            "identificador" => "afIII-cln64_8p819"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "f2-cln64_8p819"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 628
            "Ancho" => 993
            "Tamanyo" => 68903
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-treatment MRI illustrating the reduction in tumor size</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Gastrointestinal stromal tumor &#40;GIST&#41; is a recently recognized pathology that originates from the interstitial cells of Cajal<a class="elsevierStyleCrossRef" href="#bib1">1</a> and is the most common mesenchymal neoplasm of the gastrointestinal tract&#46; Although surgery is the only treatment available&#44; it is only possible in approximately half of the cases<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#46; This malignancy is characterized by a high risk of metastatic relapse&#44; specifically in the liver and peritoneum&#46; Imatinib mesylate&#44; a tyrosine kinase inhibitor that inhibits c-kit signal transduction&#44; is often used as a treatment for metastatic GIST&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">Neoadjuvant therapy is defined as a treatment administered prior to the main &#40;usually surgical&#41; treatment for a particular neoplasm&#46; It is used not only to eliminate circulating tumor cells but also to reduce the size of the tumor&#44; thereby facilitating surgery and perhaps increasing the chance of organ preservation&#46; Since imatinib results in significant tumor shrinkage in at least 50&#37; of treated patients&#44;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;4</a> its use as a neoadjuvant treatment is logical&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE REPORT</span><p id="para30" class="elsevierStylePara elsevierViewall">A 32-year-old man&#44; otherwise fit and healthy&#44; underwent medical evaluation for hematochezia lasting a month&#46; A complete proctological examination revealed a bulge in the anterior rectal wall&#44; approximately 5 cm above the dentate line&#46; The rectal mucosa was normal upon digital examination and rigid proctoscopy&#44; which confirmed the rectal bulge&#46; A complete colonoscopy was unremarkable except for the findings described in the proctological examination&#46; Routine laboratory tests and tumor markers were normal &#40;CEA &#61; 0&#46;6&#59; CA 19-9 &#61; 8&#46;1&#41;&#46; An MRI of the abdomen and pelvis demonstrated a well-demarcated solid pelvic mass &#40;9&#46;3 cm x 8&#46;3 cm x 6&#46;5 cm&#59; 257 cc&#41; &#40;<a class="elsevierStyleCrossRefs" href="#f1-cln64_8p819">Figures 1 and 2</a>&#41; compressing the bladder&#44; prostate and rectum&#46; While the tumor appeared to have infiltrated the muscular wall of the rectum&#44; no other unusual findings were observed&#46; A chest X-ray was normal&#44; but a transperineal CT-guided biopsy was positive for a GIST&#46; After a multidisciplinary discussion regarding the known risk of incomplete surgical resection&#44; the patient was treated with 400 mg&#47;d imatinib mesylate for 6 weeks in order to reduce the size of the tumor and increase the likelihood of curative surgery&#46; An MRI after 6 weeks of imatinib mesylate treatment demonstrated a marked reduction in tumor size &#40;6&#46;3 cm x 5&#46;6 cm x 4&#46;7 cm&#59; 86 cc&#41; &#40;<a class="elsevierStyleCrossRefs" href="#f1-cln64_8p819">Figure 1 and 2</a>&#41;&#46; The patient was maintained on imatinib mesylate for another 4 weeks&#44; after which a second MRI revealed no further decrease in the size of the lesion&#44; and the patient was referred for surgery&#46;</p><elsevierMultimedia ident="f2-cln64_8p819"></elsevierMultimedia><elsevierMultimedia ident="f1-cln64_8p819"></elsevierMultimedia><p id="para40" class="elsevierStylePara elsevierViewall">The patient underwent laparoscopic-assisted resection of the rectal GIST with partial removal of the anterior rectal wall&#44; which was reconstructed using a manual suture&#46; Frozen sections of the margins were negative&#46; Since the suture was located 3 cm above the dentate line&#44; a temporary loop ileostomy was made&#46; Pathological examination confirmed a GIST &#40;CD117 positive&#44; CD34 positive&#41; that was 6&#46;5 cm x 5&#46;0 cm x 2&#46;0 cm in size with a low mitotic rate&#46; The patient&#8217;s recovery was uneventful&#44; and he was discharged on postoperative day 4&#46; He was advised to continue with imatinib mesylate treatment for another 9 months&#44; completing one year of treatment&#46; The loop ileostomy was closed 12 weeks after the tumor was removed with no complications&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para50" class="elsevierStylePara elsevierViewall">GISTs can be unresectable or&#44; as in our report&#44; resectable tumors requiring extensive organ disruption in order to achieve complete resection&#46; Therefore&#44; the use of imatinib prior to surgical resectioning to reduce the tumor size is an attractive approach&#46; Since 2003&#44; several case reports regarding the use of neoadjuvant treatment for GIST have been published&#44; and one phase II trial has been completed&#46; The usual therapeutic regimen involves a course of imatinib&#44; commonly administered for 3 to 12 months&#44; with frequent imaging studies and a re-evaluation of the best time for surgery&#46; The decision regarding the best time to operate&#44; which should take into account both resectability and the maximum therapeutic effect remains controversial&#44; particularly since tumor progression can occur rapidly even after a substantial tumor shrinkage&#46; Progression of the tumor establishes a clinical dilemma&#58; if radical salvage surgery is possible&#44; it remains a reasonable therapeutic option as opposed to performing salvage systemic therapy&#44; which would likely have little chance of achieving a substantial reduction in tumor size&#46; Unfortunately&#44; the long-term results for surgery performed on refractory tumors are typically worse&#46; The resectioning of progressive disease appears to benefit only those patients with focal progression and has little to offer to those who experience generalized disease progression while receiving imatinib&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib9">9</a></p><p id="para60" class="elsevierStylePara elsevierViewall">The preliminary data suggesting the benefits of neoadjuvant treatment with imatinib were obtained in a phase II trial &#40;RTGO 0132&#41; carried out by the Radiation Therapy Oncology Group &#40;RTOG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a> This study included patients with biopsy-proven GIST that was classified as either potentially resectable primary disease &#40;&#8805;5 cm&#41; or potentially resectable locally recurrent or metastatic disease &#40;&#8805; 2 cm&#41;&#46; Between February and June of 2006&#44; 63 patients from 18 institutions were treated with imatinib &#40;600 mg&#47;day&#41; for 8 to 12 weeks prior to surgical resection and two additional years of imatinib treatment&#46; Among the 52 patients analyzed&#44; 30 patients had locally advanced disease&#44; and 22 patients had recurrent&#47;metastatic disease&#46; Surgery was performed in 45 of the 52 cases&#44; and one patient died due to an infectious complication&#46; A response to pre-operatory imatinib &#40;RECIST&#41; was observed in 2 patients &#40;7&#37;&#41; with locally advanced disease and 25 patients &#40;83&#37;&#41; with stable disease&#46; None of these tumors progressed during treatment&#46; Within 2 years of the termination of treatment&#44; the progression free survival and overall survival for those patients who presented with locally advanced disease were 82&#37; and 93&#37;&#44; respectively&#46; This trial demonstrated that pre-operative treatment with imatinib is safe with minimal drug-related toxicity and surgical morbidity&#46; The PFS and OS are favorable for this group with high-risk GIST&#46; Despite these promising results&#44; this strategy is currently not recommended for use outside of a clinical trial&#46; The only reasonable exception would be the use of imatinib mesylate by an experienced multidisciplinary team when an objective response could result in organ preservation&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
        ]
        1 => array:2 [
          "identificador" => "cesec20"
          "titulo" => "CASE REPORT"
        ]
        2 => array:2 [
          "identificador" => "cesec30"
          "titulo" => "DISCUSSION"
        ]
        3 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "f1-cln64_8p819"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 630
            "Ancho" => 985
            "Tamanyo" => 80463
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-treatment MRI &#40;sagittal&#41; illustrating the reduction in tumor size</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "f2-cln64_8p819"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 628
            "Ancho" => 993
            "Tamanyo" => 68903
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-treatment MRI illustrating the reduction in tumor size</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:12 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of gastrointestinal stromal tumors&#58; a consensus approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              CD Fletcher \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JJ Berman \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              C Corless \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              F Gorstein \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              J Lasota \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              BJ Longley \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/106689690201000201"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Surg Pathol"
                        "fecha" => "2002"
                        "volumen" => "10"
                        "paginaInicial" => "81"
                        "paginaFinal" => "89"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12075401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two hundred gastrointestinal stromal tumors&#58; recurrence patterns and prognostic factors for survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              RP DeMatteo \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JJ Lewis \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Leung \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              SS Mudan \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JM Woodruff \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              MF Brennan \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2002"
                        "volumen" => "31"
                        "paginaInicial" => "51"
                        "paginaFinal" => "58"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety and efficacy of imatinib &#40;STI571&#41; in metastatic gastrointestinal stromal tumours&#58; a phase I study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              AT van Oosterom \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              I Judson \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Verweij \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              S Stroobants \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              E Donato di Paola \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              S Dimitrijevic \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0140-6736(01)06535-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2001"
                        "volumen" => "358"
                        "paginaInicial" => "1421"
                        "paginaFinal" => "1423"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11705489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neoadjuvant therapy for gastrointestinal stromal tumor &#40;GIST&#41;&#58; racing against resistance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              JS Gold \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RP Dematteo \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1245/s10434-006-9291-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg Oncol"
                        "fecha" => "2007"
                        "volumen" => "14"
                        "paginaInicial" => "1247"
                        "paginaFinal" => "1248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17265116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical interventions for focal progression of advanced gastrointestinal stromal tumors during imatinib therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              J Hasegawa \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              T Kanda \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              S Hirota \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Fukuda \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Nishitani \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              T Takahashi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10147-007-0657-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Oncol"
                        "fecha" => "2007"
                        "volumen" => "12"
                        "paginaInicial" => "212"
                        "paginaFinal" => "217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17566845"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of tyrosine kinase inhibitor therapy followed by surgical resection for metastatic gastrointestinal stromal tumor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              RP DeMatteo \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RG Maki \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              S Singer \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Gonen \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MF Brennan \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              CR Antonescu \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.sla.0000236630.93587.59"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2007"
                        "volumen" => "245"
                        "paginaInicial" => "347"
                        "paginaFinal" => "352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17435539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical treatment of patients with initially inoperable and&#47;or metastatic gastrointestinal stromal tumors &#40;GIST&#41; during therapy with imatinib mesylate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              P Rutkowski \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              Z Nowecki \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              P Nyckowski \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              W Dziewirski \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              U Grzesiakowska \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              A Nasierowska-Guttmejer \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jso.20466"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Surg Oncol"
                        "fecha" => "2006"
                        "volumen" => "93"
                        "paginaInicial" => "304"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16496358"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              CP Raut \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Posner \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Desai \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JA Morgan \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              S George \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              D Zahrieh \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2005.05.3439"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "2325"
                        "paginaFinal" => "2331"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16710031"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focal progression in patients with gastrointestinal stromal tumors after initial response to imatinib mesylate&#58; a three-center-based study of 38 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              SE Al-Batran \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JT Hartmann \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              F Heidel \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              J Stoehlmacher \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              E Wardelmann \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              C Dechow \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10120-007-0425-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastric Cancer"
                        "fecha" => "2007"
                        "volumen" => "10"
                        "paginaInicial" => "145"
                        "paginaFinal" => "152"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17922091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Phase III randomized&#44; intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase&#58; S0033"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              CD Blanke \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              C Rankin \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              GD Demetri \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              CW Ryan \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              M von Mehren \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RS Benjamin \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2007.13.4452"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2008"
                        "volumen" => "26"
                        "paginaInicial" => "626"
                        "paginaFinal" => "632"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18235122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular correlates of imatinib resistance in gastrointestinal stromal tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              MC Heinrich \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              CL Corless \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              CD Blanke \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              GD Demetri \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              H Joensuu \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              PJ Roberts \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2006.06.2265"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "4764"
                        "paginaFinal" => "4774"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16954519"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Phase II trial of neoadjuvant&#47;adjuvant imatinib mesylate &#40;IM&#41; for advanced primary and metastatic&#47;recurrent operable gastrointestinal stromal tumor &#40;GIST&#41;&#58; early results of RTOG 0132&#47;ACRIN 6665"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              BL Eisenberg \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Harris \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              CD Blanke \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              GD Demetri \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MC Heinrich \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              JC Watson \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jso.21160"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Surg Oncol"
                        "fecha" => "2009"
                        "volumen" => "99"
                        "paginaInicial" => "42"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18942073"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18075932/0000006400000008/v1_202212060853/S1807593222025844/v1_202212060853/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006400000008/v1_202212060853/S1807593222025844/v1_202212060853/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222025844?idApp=UINPBA00004N"
]
Article information
ISSN: 18075932
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 2 0 2
2024 October 29 19 48
2024 September 25 15 40
2024 August 24 19 43
2024 July 15 11 26
2024 June 18 14 32
2024 May 18 17 35
2024 April 12 6 18
2024 March 20 12 32
2024 February 22 15 37
2024 January 13 13 26
2023 December 10 20 30
2023 November 15 19 34
2023 October 10 20 30
2023 September 9 14 23
2023 August 8 4 12
2023 July 7 8 15
2023 June 6 4 10
2023 May 1 0 1
2023 April 1 3 4
2023 March 2 4 6
2023 February 1 8 9
2023 January 1 1 2
2022 December 12 0 12
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos