Small intestine gastrointestinal stromal tumors
Current Opinion in Gastroenterology, 03/02/2012
Grover S et al. – 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.