60 Neoadjuvant Imatinib Mesylate – an Ace of Spaces for Surgical Management of an Oesophago-Gastric Junction Gastro-Intestinal Stromal Tumour

Abstract Introduction Oesophageal gastro-intestinal stromal tumours (GISTs) are rare, accounting for less than five percent of all GIST, with the majority these occurring at oesophago-gastric junction (OGJ). Due to anatomical location and size presentation, surgical resection is often a major undertaking. Neoadjuvant treatment tyrosine kinase inhibitors, such as Imatinib mesylate, have potential downstage tumours, thereby limiting extent subsequent resection. This may therefore reduce any potentially associated morbidity mortality. Case Description We report case 75-year-old gentleman who presented large OGJ which dysphagia. The tumour was deemed too local excision due risk compromising lumen in attempting obtain clear margin. Given patient’s co-morbidity, oesophagectomy or total gastrectomy an Therefore, endoscopic biopsies were obtained view possible neoadjuvant therapy. These confirmed DOG-1 Exon-11 mutations, suggesting sensitivity mesylate. A standard dose regime 400mg daily planned 36-month course commenced. Subsequent imaging showed substantial decrease bulk decision made perform excision. enucleation procedure performed, patient sound recovery. Post-operative histology resected almost complete regression. Discussion significant response mesylate therapy demonstrates its use similar cases, where radical would cause