The role of
cytoreductive surgery with
hyperthermic intraperitoneal chemotherapy (CRS/
HIPEC) procedures in the management of patients with
gastrointestinal stromal tumor (GIST)-induced sarcomatosis that is refractory to
tyrosine kinase inhibitors (TKI) is not well defined. A retrospective analysis of a prospective database of 1070 CRS/
HIPEC procedures was performed. Demographics, Eastern Cooperative Oncology Group performance status, resection status, morbidity, mortality, perioperative use of targeted
therapies, and overall survival were analyzed. Since 1992, 18 CRS/
HIPEC procedures were performed for peritoneal dissemination of GIST. Fifty per cent of these cases were performed before the introduction of TKIs. R0/1 resection was achieved in 72 per cent, whereas 63 per cent of patients were treated with neoadjuvant and/or adjuvant targeted
therapy. Thirty-day morbidity and mortality were 33.3 and 5.6 per cent, respectively. Median overall survival after CRS/
HIPEC was 3.33 years with 3-year survival of 56 per cent. Median survival in those who did not receive targeted
therapy was 1.04 versus 7.9 years for those treated with TKI and cytoreduction. Median postsurgical survival for those treated preoperatively with progression on TKI treatment was 1.35 years versus not reached in those on TKI
therapy without progression. Primary
therapy for patients with disseminated GIST should be TKI
therapy. However, in patients with sarcomatosis from GIST, cytoreduction should be considered before developing TKI resistance. Progression on TKI is associated with poor outcomes even after complete cytoreduction.