Neoadjuvant Treatment Strategies in Gastrointestinal Stromal Tumors

Area of Science:

• Gastrointestinal Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the GI tract.
• Neoadjuvant therapy (NAT) is increasingly utilized in GIST management.
• Optimal treatment strategies for GISTs are continually evolving.

Purpose of the Study:

• To outline the current paradigm for neoadjuvant therapy in GIST management.
• To emphasize the importance of genetic testing prior to NAT.
• To describe the response assessment and duration of therapy for GISTs.

Main Methods:

• Review of current clinical practices and literature regarding GIST NAT.
• Genetic testing protocols for GIST patients undergoing NAT.
• Radiological assessment methods (CT/MRI) for monitoring NAT response.
• Systemic treatment protocols post-GIST resection.

Main Results:

• NAT in GISTs primarily aims to reduce operative morbidity.
• Response to NAT is typically assessed using contrast-enhanced CT or MRI.
• Maximal response to NAT is generally achieved within 8-12 months.
• Post-resection systemic therapy is recommended for selected patients for 3 years.

Conclusions:

• Neoadjuvant therapy represents a significant advancement in GIST management.
• Pre-treatment genetic testing is essential for guiding GIST therapy.
• A structured approach to NAT response assessment and duration is critical for optimal outcomes.
• Long-term systemic treatment and surveillance are integral components of comprehensive GIST care.