Abstract

PURPOSE OF REVIEW
To review the contemporary management of gastrointestinal stromal tumor (GIST), including endoscopy, surgery, and systemic therapy, highlighting the aspects unique to small intestinal tumors.
RECENT FINDINGS
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.
SUMMARY
Advances in the last decade have dramatically changed the management and prognosis of patients with primary and advanced GIST.

Links

Publisher Full Text

Authors

Grover S, Ashley SW, Raut CP

Institution

Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Source

Current opinion in gastroenterology 28:2 2012 Mar pg 113-23

MeSH

Antineoplastic Agents
Chemotherapy, Adjuvant
Gastrointestinal Stromal Tumors
Humans
Indoles
Intestinal Neoplasms
Intestine, Small
Neoadjuvant Therapy
Neoplasm Metastasis
Piperazines
Prognosis
Pyrimidines
Pyrroles

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22157511