Current clinical management of gastrointestinal stromal tumor

Abstract

Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.

Renal Clearable Theranostic Nanoplatforms for Gastrointestinal Stromal Tumors

“…Despite advances in imaging techniques and the development of new localization procedures, tumors less than 1 cm in size remain difficult to localize by conventional means because of the difficulty in specific delivery of contrast agents to the tumor site and a low tumor‐to‐background ratio (TBR) resulting from high nonspecific uptake and background retention. Chemotherapeutic agents such as imatinib (IM) can be used to treat GIST with locally advanced, recurrent, primary unresectable, and metastasized tumors . IM is the first approved selective tyrosine kinase inhibitor for KIT (also known as mast/stem cell growth factor receptor Kit, receptor tyrosine kinase Kit, proto‐oncogene c‐Kit, or CD117) and platelet derived growth factor receptor alpha (PDGFRA) in GIST .…”

Surgical treatment of gastric GIST with acute bleeding using laparoscopic sleeve gastrectomy: A report of two cases

“…Nevertheless recent studies show the safety and feasibility of laparoscopic resection in large (>5 cm) and giant (>10 cm) GISTs with oncologic results comparable to those of open surgery . Other minimally invasive techniques such as submucosal tunneling endoscopic resection, endoscopic full thickness resection, and laparoscopic endoscopic cooperative surgery have recently shown good clinical outcomes; however, more studies and randomized clinical trials are necessary for a better definition of their long‐term safety . In contrast, open surgery remains an acceptable option in case of GISTs requiring complex multivisceral resection or large lesions that need delicate tissue handling to minimize the risk of tumor rupture and seeding especially when the specimen is removed .…”

“…13 Other minimally invasive techniques such as submucosal tunneling endoscopic resection, endoscopic full thickness resection, and laparoscopic endoscopic cooperative surgery have recently shown good clinical outcomes; however, more studies and randomized clinical trials are necessary for a better definition of their long-term safety. 8 In contrast, open surgery remains an acceptable option in case of GISTs requiring complex multivisceral resection or large lesions that need delicate tissue handling to minimize the risk of tumor rupture and seeding especially when the specimen is removed. 14 In writing about indications to laparoscopy in approaching gastric GISTs, it is of the utmost importance keep in mind their emergency presentations which often pose a challenge to the general surgeon both in terms of diagnosis and treatment.…”

Urgent Surgical Treatment of GIST of Esophago-Gastric Junction in a Patient with Giant Hiatal Hernia

“…GISTs are 4 times more likely to recur if the primary site is the intestine compared to stomach. These data should be considered when evaluating success of surgical resection of recurrent tumors since the primary site could potentially condition the ultimate outcome in form of overall survival and recurrence-free survival [10][11][12][13][14][15].…”