Updates on the management of gastrointestinal stromal tumors

Abstract

Despite being the most common sarcoma of the gastrointestinal tract, gastrointestinal stromal tumor (GIST) has been widely recognized as a unique entity for just over a decade. The advent of tyrosine kinase inhibitors has revolutionized the diagnosis and treatment of GIST. Although surgery remains the only chance for cure, multimodal treatment that includes molecular therapy continues to develop. Optimal management of GIST requires careful radiographic, pathologic, medical, and surgical care, emphasizing the need for a multidisciplinary approach. This review highlights recent developments in the management of GIST.

Figure 1. Nomogram for predicting 2 and 5-year recurrence-free survival in patients with resected localized GIST

An upward vertical line is drawn from the 2^nd, 3^rd, and 4^th rows to the points line. The sum of points generated is marked on the total points line and a vertical line is drawn downward to determine the 2 and 5-year recurrence-free survival. From Gold JS, Gonen M, Gutierrez A, et al. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localized primary gastrointestinal stromal tumor: a retrospective analysis. Lancet Oncol 2009;10:1045–1052; with permission.

Figure 2. Recurrence-free survival in patients treated for 1 year with adjuvant imatinib or placebo following resection of localized, primary GIST (≥3cm)

From DeMatteo RP, Ballman KV et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 2009; 373(9669): 1097–1104; with permission.

Figure 3. Algorithm for the management of GIST

RFA = Radiofrequency ablation. * If all gross disease or all imatinib-resistant disease is treatable.