Opinion on surgery for metastatic GIST

By Jerry Call

In this issue of the Newsletter we reported on several American Society of Clinical Oncology (ASCO) presentations dealing with surgery. A few comments about this important subject seem appropriate. These comments only apply to surgery for metastatic disease.

In the absence of clinical trial data about surgery for metastatic disease, there are 4 or 5 case series that have been published (at least in abstract form). For the most part, the data from these studies seems to be fairly consistent and some conclusions can be reached. One of the most solid conclusions seems to be that surgery is of little benefit for patients with widespread progression of metastatic disease. Surgery for limited progression (one or two tumors) appears to have some benefit. Few patients die as a result of surgery, but non-fatal complications can arise.

There are also some areas where it is difficult to reach any conclusions. From these studies we know that patients with stable disease do pretty well after surgery; but we do not know how well they would have done with Gleevec alone. It will probably be quite some time before any trial can answer that question (none are in progress).

Given the limited data available, the decision on whether or not to have surgery for metastatic disease after responding to Gleevec is a complex decision. It involves many factors such as:

1. Can all disease be removed?
2. How complicated is the surgery?
3. How likely are complications?

Given the complexity of these decisions and the limited data, it is recommended that patients be seen in a center with recognized GIST expertise. This type of evaluation should include a multidisciplinary review, including an oncologist and a surgeon.