[Gastrointestinal stromal tumors: diagnostics and therapy]

Area of Science:

• Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the digestive system.

Context:

• Standard treatment for GIST involves complete surgical resection with 1-2 cm margins, emphasizing the critical need to avoid intraoperative tumor capsule rupture due to high risks of metastasis.
• Laparoscopic resection is feasible for smaller GISTs, adhering to oncological principles. Lymph node dissection is generally not indicated due to the rarity of lymph node involvement in GIST.

Purpose:

• To outline the current management strategies for gastrointestinal stromal tumors (GIST), including surgical approaches and adjuvant therapies.
• To highlight risk stratification for GIST recurrence and the role of imatinib therapy based on European Society for Medical Oncology (ESMO) guidelines.

Summary:

• Complete surgical resection is the primary treatment for GIST. Post-operative adjuvant therapy with imatinib for 3 years is recommended for patients with intermediate and high risk of recurrence, based on tumor size, mitosis index, and location.
• Adjuvant imatinib therapy significantly enhances progression-free and overall survival compared to shorter treatment durations.
• Patients with the D842V mutation in the PDGFRA gene exon 18 are exceptions and do not benefit from imatinib therapy.

Impact:

• This approach optimizes patient outcomes by reducing recurrence rates and improving survival in high-risk GIST cases.
• Adherence to ESMO guidelines for adjuvant imatinib therapy duration can lead to substantial improvements in patient survival.
• Accurate risk stratification and identification of specific mutations are crucial for tailoring GIST treatment effectively.