Radiotherapy in the Management of Gastrointestinal Stromal Tumors: A Systematic Review

Abstract

Gastrointestinal stromal tumors (GISTs) are considered insensitive to radiotherapy. However, a growing number of case reports and case series have shown that some lesions treated by radiotherapy achieved an objective response. The aim of the study was to perform a systematic review of all reported cases, case series, and clinical studies of GISTs treated with radiotherapy to reevaluate the role of radiotherapy in GISTs. A systematic search of the English-written literature was conducted using PubMed, Web of Science, and Embase databases. Overall, 41 articles describing 112 patients were retrieved. The included articles were of low to moderate quality. Bone was the most common site treated by radiotherapy, followed by the abdomen. In order to exclude the influence of effective tyrosine kinase inhibitors (TKIs), a subgroup analysis was conducted on whether and which TKIs were concurrently applied with radiotherapy. Results showed that radiotherapy alone or combined with resistant TKIs could help achieve objective response in selected patients with advanced or metastatic GISTs; however, survival benefits were not observed in the included studies. Pain was the most common symptom in symptomatic GISTs, followed by neurological dysfunction and bleeding. The symptom palliation rate was 78.6% after excluding the influence of effective TKIs. The adverse reactions were mainly graded 1-2. Radiotherapy was generally well-tolerated. Overall, radiotherapy may relieve symptoms for GIST patients with advanced or metastatic lesions and even help achieve objective response in selected patients without significantly reducing the quality of life. In addition to bone metastases, fixed abdominal lesions may be treated by radiotherapy. Publication bias and insufficient quality of included studies were the main limitations in this review. Further clinical studies are needed and justified.

Keywords: GIST; adverse events; gastrointestinal stromal tumor; management; radiation therapy; radiotherapy; symptom palliation.

Figure 1

Flow diagram of the literature search and selection criteria.

Figure 2

Kaplan–Meier estimates of survival: (A) progression-free survival in the 6 patients treated by radiotherapy without any continued TKIs; (B) progression-free survival in the 8 patients treated by radiotherapy with previously resistant TKIs; (C) recurrence-free survival in the 7 patients treated by radiotherapy without continued TKIs after surgery; (D) overall survival in the 7 patients treated by radiotherapy without continued TKIs after surgery.