Recurrent gastrointestinal stromal sarcomas

Gastrointestinal stromal sarcomas, formerly categorized as leiomyosarcomas of gastrointestinal origin, have a common pattern of intraperitoneal dissem ination. Despite surgical resection with or without adjuvant systemic chemo therapy the vast majority of these patients succumb to intraperitoneal sarc omatosis and/or hepatic metastases. In an attempt to improve upon the morbi dity and mortality associated with this disease we and several other center s have begun treating these patients with intraperitoneal chemotherapy. We have found that aggressive surgical resection with postoperative intraperit oneal chemotherapy has significantly lowered the peritoneal recurrence rate in patients with recurrent gastrointestinal stromal sarcomas as compared t o those who have undergone surgical resection alone. However, this treatmen t approach has proven to be ineffective in preventing hepatic metastases, a nd thus has had little effect upon overall survival. With the treatment of primary rather than recurrent disease we hope to interrupt the disease proc ess at an earlier stage further decreasing peritoneal recurrences and poten tially improving survival. (C) 2000 Elsevier Science Ltd. All rights reserv ed.