‘Please, Desist RECIST Criteria in GIST, At Least in Me’

for 2 months. A control CT showed central necrosis of the le-sions which were essentially unchanged. However, the patientreported that the symptom of abdominal pain did no longerexist. The patient was advised to take imatinib mesylate for 2 more months. A subsequent CT scan again showed nochange in the diameter of the mass, so the RECIST criteriaagain failed to meet our expectations. As a consequence, wesuggested 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 imatinibagain and said ‘Please, desist RECIST criteria in GIST, at leastin me. I was feeling well with no abdominal pain or gastricbleeding 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 withoutany change in the size of the mass. Hence, RECIST is a poorpredictor of clinical benefit in GIST.Gastrointestinal stromal tumour (GIST) is an extraordinaryand interesting disease both to physicians and patients.Every patient with GIST is a new experience for the medicaloncologist [1–5]. The Response Evaluation Criteria in SolidTumors (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 withmetastatic 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 inthe lesser curvature of the stomach, and multiple metastaticlesions 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 emissiontomography (PET) CT were available in Turkey. The patientobtained the drug from the United States himself, and used it