Small intestine gastrointestinal stromal tumors

Current Opinion in Gastroenterology, 03/02/2012

Advances in the last decade have dramatically changed the management and prognosis of patients with primary and advanced gastrointestinal stromal tumor (GIST).

  • Tumor size, mitotic count, and site of origin are the three key prognostic factors, with mitotic count being the single strongest predictor of recurrence.
  • Tumors arising in the small bowel have worse prognosis than those of comparable size and mitotic count arising in other organs.
  • Endoscopy and endoscopic ultrasound-guided, fine-needle aspiration are key components in the diagnosis of GIST.
  • The role of endoscopy in surveillance and resection remain investigational.
  • Surgery, either open or laparoscopic, remains the only curative option, but recurrence rates are high.
  • Adjuvant therapy with imatinib mesylate improves recurrence-free survival rates and may improve overall survival (OS) with longer duration of treatment.
  • Neoadjuvant imatinib may play an important role in the management of patients with locally advanced disease.
  • For patients with advanced disease, first-line imatinib and second-line sunitinib malate have improved progression-free and OS rates.
  • Systemic treatment should be continued life-long or until treatment failure.

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