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M. Schuler, M. Zeile, D. Pink, P. Tunn, A. Kretzschmar, B. Rau, P. Reichardt
Abstract:
Background: Gastrointestinal stromal tumors (GISTs) are rare tumors and account for 0.1-0.3% of all gastrointestinal cancers and 5% of all soft tissue sarcomas. The most common sites are stomach (60%) and small intestine (20-30%), but they can also arise from colon and rectum (10%). The most frequent metastatic sites are liver (65%) and peritoneum (21%). Lymph node (6%), bone (6%) and lung metastases (2%) are uncommon. Methods: In a single center retrospective analysis we evaluated patients (pts.) between Jan. 2000 and Oct. 2007 with the diagnosis of metastatic GIST. Patient, tumor and metastatic variables were analyzed for their relation to outcome. No routine bone scans were applied. All times were calculated until the last day of follow-up or death. Results: Out of the 309 consecutive patients with metastatic GIST 17 (5.5%) were identified to have bone metastases. Those were either found due to symptomatic disease (7/19 pts.) or in the course of routine diagnostic procedures (12/19 pts.). Median age was 54.5 years and 5/17 pts. Had synchronous metastatic disease. In one case bone metastases were the first manifestation of a late relapse eight years after primary curative resection. 6 of 17 pts. Had unilocular and 11/17 pts. Multilocular disease with a focus on spine bone lesions (10/17 pts.) with multilocular metastases (7/10 pts.). All patients also had other typical manifestations (17/17 hepatic, 10/17 peritoneal), but we also observed a coincidence with other rare manifestations (pulmonary/pleural [4], epidural [2], retroorbital [1]) in 7/17 pts. Palliative treatment consisted of bisphophonates, radiation and orthopedic surgery. In this group of pts. With bone metastases median survival was 325 weeks (w) (SD 59) from time of diagnosis, 252 w (SD 22) from diagnosis of distant metastases and 135 w (SD 24) from the time of occurrence of bone metastases. Conclusions: In a large series of unselected, consecutive pts. With metastatic GIST 5.5% were found to have bone metastases. Commonly those pts. Suffered from other rare metastatic localizations. The incidence of bone metastases may be underestimated due to the fact that especially bone lesions of the extremities were mainly found due to clinical symptoms. We should be aware of this in the long term follow-up.
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Associated Presentation(s):
1. Incidence of bone metastases in GIST: A single center analysis of 307 patients with metastatic disease.
Associated Presentation(s):