Gastrointestinal stromal tumours at present: an approach to burning questions

Abstract

Because of their well known origin in gene mutations and a revolutionary therapy by means of molecular targets, gastrointestinal stromal tumours (GIST) constitute a plentiful and paradigmatic model of translational investigation, resulting in an avalanche of exponential growth data. In this article, we focus on what we consider to be hot spots in GIST at present. A wide spectrum of events is approached, extending from subtle pathogenic mechanisms at a molecular level (gene mutations and their implications for cell receptors with subsequent activation of signalling pathways) to more practical problems facing diagnosis (molecular markers, role of biopsy), prognosis (risk stratification systems) and different therapeutic aspects (laparoscopic surgery, role of surgery in advanced disease, response criteria, adjuvant and neoadjuvant therapy, treatment for progressing and recurrent disease, therapy directed on mutation analysis and new developments, among others). The review has been endorsed by level of evidence evaluation through a recognised pattern to assist in teaching, and a final summary of recommendations and a management algorithm are included.