Letter to the Editors · Brief an die Herausgeber Onkologie 2008;31:556 Published online: September 23, 2008 DOI: 10.1159/000151688 for 2 months. A control CT showed central necrosis of the le- sions which were essentially unchanged. However, the patient reported that the symptom of abdominal pain did no longer exist. The patient was advised to take imatinib mesylate for 2 more months. A subsequent CT scan again showed no change in the diameter of the mass, so the RECIST criteria again failed to meet our expectations. As a consequence, we suggested stopping imatinib. However, within 3 months of dis- continuing treatment, the patient was seen twice in the emer- gency room (ER) with gastric bleeding and abdominal pain. At the second ER visit, the patient insisted to start imatinib again and said ‘Please, desist RECIST criteria in GIST, at least in me. I was feeling well with no abdominal pain or gastric bleeding while using imatinib. Believe me, the size of the le- sion does not matter!’ The patient was restarted on imatinib. He was seen 2 years later in good condition but still without any change in the size of the mass. Hence, RECIST is a poor predictor of clinical benefit in GIST. Gastrointestinal stromal tumour (GIST) is an extraordinary and interesting disease both to physicians and patients. Every patient with GIST is a new experience for the medical oncologist [1–5]. The Response Evaluation Criteria in Solid Tumors (RECIST) are used in GIST. However, RECIST cri- teria show limitations in the response evaluation in imatinib- treated GIST [6, 7]. We report on an interesting patient with metastatic GIST in whom RECIST failed to show a re- sponse. A 63-year-old male patient presented with abdominal pain, and was diagnosed with metastatic GIST in March 2002. Ab- dominal computed tomography (CT) revealed a 5-cm mass in the lesser curvature of the stomach, and multiple metastatic lesions in the liver. As GIST is both chemo-and radioresistant, the patient was recommended to take imatinib mesylate. However, at that time, neither the drug nor positron emission tomography (PET)CT were available in Turkey. The patient obtained the drug from the United States himself, and used it Alper Sevinc, MD Gaziantep University, School of Medicine Department of Medical Oncology, Gaziantep Oncology Hospital Gaziantep, 27310, Turkey Tel. +90 342 472-0711/1320, Fax: -0718 sevinc@gantep.edu.tr ‘Please, Desist RECIST Criteria in GIST, At Least in Me’ Alper Sevinc a N. Serdar Turhal b a Department of Medical Oncology, Gaziantep Oncology Hospital, School of Medicine, Gaziantep University, b Department of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey © 2008 S. Karger GmbH, Freiburg Accessible online at: www.karger.com/onk Fax +49 761 4 52 07 14 Information@Karger.de www.karger.com References 1 Sevinc A, Camci C, Yilmaz M, Buyukhatipoglu H: The diagnosis of C-kit negative GIST by PDGFRA staining: clinical, pathological, and nuclear medicine perspective. Onkologie 2007;30:645–648. 2 Kalender ME, Sevinc A, Kucukdurmaz Z, Balik A, Sari I, Camci C: Gastric and prostate adenocarcino- ma in a patient with metastatic gastrointestinal stromal tumor. Onkologie 2007;30:568–570. 3 Zincirkeser S, Sevinc A, Kalender ME, Camci C: Early detection of response to imatinib therapy for gastrointestinal stromal tumor by using 18F-FDG- positron emission tomography and computed to- mography imaging. World J Gastroenterol 2007;13: 2261–2262. 4 Kalender ME, Sevinc A, Tutar E, Sirikci A, Camci C: Effect of sunitinib on metastatic gastrointestinal stromal tumor in patients with neurofibromatosis type 1: a case report. World J Gastroenterol 2007; 13:2629–2632. 5 Sevinc A, Camci C: ‘Times Is a GIFT in GIST’ – The Medical and Paramedical Perspective of a Case with Metastatic Gastrointestinal Stromal Tumor. Chemotherapy 2008;54, in press. 6 Burton A. RECIST: right time to renovate? Lancet Oncol 2007;8:464–465. 7 Benjamin RS, Choi H, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Charnsan- gavej C: We should desist using RECIST, at least in GIST. J Clin Oncol 2007;25:1760–1764.