RPS ZU

Mrs. Liliane D…., 72 year-old No past medical history Mai 2011 – Loss of weight (4kg in 6 months) – Asthenia Thoraco-abdomino pelvic scanner CT-scanner ZU

July 2011 : Surgery in general hospital –Median laparotomy –Tumor considered per operatively unresectable –Surgical biopsies Histological results –Solitary Fibrous Tumor –Reviewed in a French Cancer Center –No molecular analysis ZU

August 2011 : First consultation at Gustave Roussy Clinical examination OMS 2 /3 The patient is bedridden Median scar 25 cm Drip What can we propose?? Surgery? Chemotherapy? Anti angiogenic? Radiotherapy? Best supportive care? ZU

November 2011 post RT 50.2 Gy

What can we propose?? Surgery? Wait and see? Clinical examination OMS 1 Much more better!

Operated December 2011 Histo-pathological analysis – 18 x 14 x 9 cm – Fusiform cell sarcoma – Undifferentiated – 6 mitosis / 10 field – Less than 50% necrosis – Residual tumor cells after radiotherapy : 60% – Invasion of the the stomach and the spleen – Pressing the kidney, the adrenal, the colon and the psoas muscle fascia without invading them ZU

h- caldesmondesminCD34 CD117 (KIT) A new histo-pathological analysis was performed - Immunochemistry - Gene analysis April 2012 –C-Kit (+++), CD34 (+++), DOG1 (+++) –Caldesmone (+++), Actin (+ to ++) –MDM2 (-), CDK4 (-), PS100 (-), Desmine (-) –C-Kit gene mutation (deletion in exon 11, codon ) –No mutation in PDGFRA (exon ) Diagnosis of gastric GIST

Risk of recurrence of GIST after surgery: an analysis of pooled population- based cohorts Joensuu H et al. Lancet Oncol. 2012; 13(3): X Per operative biopsy X

March 2014 Patient received adjuvant IMATINIB 400mg/d

August 2014 (+ 2 years and 8 months after surgery )

September 2014