Gastrointestinal stromal tumours at Inkosi Albert Luthuli Central Hospital from 2005 to 2015

Abstract

Background: Gastrointestinal stromal tumour (GIST) is the commonest mesenchymal malignancy of the gastrointestinal tract. Patient demographics and outcomes following imatinib therapy in South Africa are unknown.

Aim: To establish the patient demographics of GIST and the clinical outcomes following imatinib therapy.

Setting: Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa.

Methods: A quantitative, retrospective, descriptive chart review study was conducted. The study population included patients with a histologic diagnosis of GIST who presented between January 2005 and December 2015 to the facility. Only patients who received imatinib were included in the clinical outcome analysis.

Results: Sixty-nine patients were seen during the study period. The mean (SD) age at diagnosis was 57.3 (13.5) years. The male gender (53.6%) was predominant, the black ethnic group (53.6%) was the commonest and the stomach (69.6%) was the most common disease site. Localised disease (53.6%) was the commonest disease category, while high risk (29.7%) and intermediate risk (29.7%) were the majority risk categories. Thirty-six (52.2%) patients received imatinib with a median (IQR) follow-up time of 20.5 (38) months. Eighty-one per cent of patients with localised disease remained in remission after adjuvant imatinib, and 18.2% developed metastatic recurrence. Among patients with locally advanced disease, 81.8% attained partial response on neoadjuvant imatinib, while 9.1% had stable disease. Most (75%) patients with metastatic disease attained partial response as the best response to imatinib. The most common adverse effects were anaemia and fluid overload.

Conclusion: At IALCH, GIST is more common in the male gender, black ethnic group and in the stomach. The majority of localised and locally advanced GIST patients have favourable outcomes on imatinib. However, most metastatic GIST patients eventually develop resistance to imatinib necessitating further treatment options.