1. RPS 2011-10924 ZU

2. 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 2011-10924 ZU

4. 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 2011-10924 ZU

6. 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? 2011-10924 ZU

7. November 2011 post RT 50.2 Gy

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

9. 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 2011-10924 ZU

10. 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 550 - 558) –No mutation in PDGFRA (exon 12 - 14 - 18) Diagnosis of gastric GIST

11. Risk of recurrence of GIST after surgery: an analysis of pooled population- based cohorts Joensuu H et al. Lancet Oncol. 2012; 13(3): 265-274 X Per operative biopsy X

13. March 2014 Patient received adjuvant IMATINIB 400mg/d

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

15. September 2014