Long-term survival after surgery and adjuvant imatinib in a patient with rectal GIST, local recurrence, liver metastases and mediastinal pleural metastasis

Imatinib is a standard treatment for metastatic GIST. Surgery is an optional treatment for local recurrence and resectable liver metastasis. We report a case of high risk group rectal GIST with local recurrence, liver metastases and mediastinal pleural metastasis. Long-term survival (7 years and 10 months) was achieved with imatinib after resection. A 63-year-old man underwent a surgery for undifferentiated esophageal cancer and simultaneously was diagnosed a rectal submucosal tumor of 3 cm by digital examination in 2001. After 2 years, he underwent Miles' operation because of an increase of the rectal submucosal tumor. The histological examination revealed a high risk group GIST. PET-CT and CT pointed out a local recurrence and liver metastases that were resected in 2004. Adjuvant imatinib at a dose of 300 mg/day was started but the dose was reduced to 300 mg/2 days due to a side effect. Resumption and discontinuation of imatinib had been repeated. In 2008, he received a resection of mediastinal pleural metastasis. Imatinib started again at a dose of 200 mg/2 days and no recurrence has been pointed out. Combined modality therapy with surgery and chemotherapy for the metastatic GIST may contribute to a long-term survival.