Strategies for care of patients with gastrointestinal stromal tumor or soft tissue sarcoma during COVID‐19 pandemic: A guide for surgical oncologists

Callegaro, Dario; Raut, Chandrajit P.; Keung, Emily Z.; Kim, Teresa S.; Péchoux, C. Le; Martin‐Broto, Javier; Gronchi, Alessandro; Swallow, Carol J.; Gladdy, Rebecca A.

doi:10.1002/jso.26246

Cited by 8 publications

(8 citation statements)

References 77 publications

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“…Nevertheless, particular cases such as elderly people with co-morbidities, strong wishes for "wait-and-see", or in long surgery waiting lists could affect treatment decisions and warrant more precise and concise in risk prediction [37,38]. Intriguingly, callegaro et al [39] recommended that a watchful waiting strategy might be extended for gastric GISTs more than 2 cm or small GISTs in other locations, offering priority to cancer patients to surgery in the COVID-19 pandemic. While question remained unanswered regarding the due time of waiting in this serious situation.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography in the size measurement of gastric gastrointestinal stromal tumors: Implication to risk stratification and “wait-and-see” tactics

Chen

et al. 2022

European Journal of Surgical Oncology

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Introduction: This study aimed to compare the radiologic size of gastric gastrointestinal stromal tumors (GISTs) on computed tomography (CT) with the pathologic size in a Chinese population, and elucidate the potential significance of the CT size in the preoperative risk stratification. Materials and methods: The study enrolled 314 patients treated by endoscopic/surgical resection of gastric lesions that proved postoperatively to be GISTs. Bland-Altman analysis and intraclass correlation coefficient (ICC) were adopted to assess the size agreement between CT and pathology. Independent predictors of risk category underestimation and the optimal cut-off value of CT size were determined by logistic regression analysis and the receiver operating characteristic (ROC) curve. Results: CT underestimated gastric GISTs size by 0.30 cm [95% confidence interval (CI): (À0.42, -0.19); p < 0.001]. In the subgroup analysis, the size underestimation was 0.10 cm in GISTs 5 cm [95% CI: (À0.19, À0.01); p ¼ 0.024]; and 0.75 cm in GISTs >5 cm [95% CI: (À1.05, 0.45), p < 0.001]. Though ICC values showed well reliability for the corresponding pathologic size, with 0.95 in all size, 0.86 in size 5 cm, and 0.92 in size >5 cm respectively. Risk underestimation by CT imaging mainly occurred in gastric GISTs with smaller size ( 5 cm; p ¼ 0.010) and lower mitotic index ( 5 per 50 high-power fields; p ¼ 0.011). CT size of 3.65 cm was defined as an absolute cut-off to differentiate intermediate/ high-risk patients from low-risk group, with 87.5% sensitivity at a specificity of 57.8%. Conclusion: Preoperative CT underestimated the mean size by 0.30 cm in gastric GISTs. A CT size of 3.65 cm would facilitate the selection of potential intermediate/high-risk patients, instant intervention should be encouraged in the absence of contraindications.

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Section: Discussionmentioning

confidence: 99%

Computed tomography in the size measurement of gastric gastrointestinal stromal tumors: Implication to risk stratification and “wait-and-see” tactics

Chen

et al. 2022

European Journal of Surgical Oncology

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“…A triage model was applied by Olshinka et al in a quaternary-referral musculoskeletal oncology center in Quebec with the implementation of telemedicine in managing patients with low-grade malignancy or benign cases, which proved to be an efficient redirection of resources toward prioritizing malignant cases [13]. In some other cases, new strategies regarding sarcoma patients' management have utilized non-surgical therapies in an attempt to better stratify the need for surgical intervention and respond to the new frame caused by the COVID-19 outbreak [40]. Despite the storm of COVID-19, which changed the approach in many cancers, high-malignancy sarcomas were given the utmost priority in the reviewed literature [41,42].…”

Section: Telemedicine and Surgerymentioning

confidence: 99%

Telemedicine in Care of Sarcoma Patients beyond the COVID-19 Pandemic: Challenges and Opportunities

Tsagkaris

Trygonis

Spyrou

et al. 2023

Cancers

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Background: The COVID-19 pandemic has created a challenging environment for sarcoma patients. Most oncology societies published guidelines or recommendations prioritizing sarcoma patients and established telehealth as an efficient method of approaching them. The aim of this review is the assessment of current evidence regarding the utilization of telemedicine in diagnosis, treatment modalities, telerehabilitation and satisfaction among sarcoma patients and healthcare providers (HP). Methods: This systematic review was carried out using the databases PubMed and Ovid MEDLINE according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: The application of telemedicine to the management of sarcoma has yielded improved clinical and psychological outcomes. Specifically, significant progress has been demonstrated in the areas of tele-oncology and telerehabilitation during the last decade, and the COVID-19 outbreak has accelerated this transition toward them. Telehealth has been proven efficient in a wide spectrum of applications from consultations on physical therapy and psychological support to virtual care symptom management. Both HP and patients reported satisfaction with telehealth services at levels comparable to in-person visits. Conclusions: Telehealth has already unveiled many opportunities in tailoring individualized care, and its role in the management of sarcoma patients has been established in the post-COVID-19 era, as well.

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“…Although the risk of SARS-CoV-2 infection is not increased in GIST patients, they may experience other consequences during the COVID-19 pandemic, such as delay in treatment, delayed surgery or long waiting period for elective surgery, a heavy burden on medical resources, and the need for emergency surgery[ 11 ]. Additionally, neoadjuvant imatinib is routinely used to shrink locally advanced GISTs and if there is a danger of positive margins, unresectable, or borderline resectable tumors[ 12 ]. Imatinib may be a beneficial alternative to minimize the possibility of tumors developing in intermediate or high-risk cancers bearing imatinib-sensitive mutations that would otherwise be excised during a time of limited access to surgical therapy[ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, neoadjuvant imatinib is routinely used to shrink locally advanced GISTs and if there is a danger of positive margins, unresectable, or borderline resectable tumors[ 12 ]. Imatinib may be a beneficial alternative to minimize the possibility of tumors developing in intermediate or high-risk cancers bearing imatinib-sensitive mutations that would otherwise be excised during a time of limited access to surgical therapy[ 12 ]. Even if imatinib is generally well tolerated, patients may develop adverse effects such as myelosuppression (grade 3 in up to one-fifth of all patients), which might be concerning if the patient becomes infected with SARS-CoV-2[ 13 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 in patients with gastrointestinal stromal tumors: Recommendations for management and vaccination

Snegarova¹,

Miteva²,

Gulinac³

et al. 2022

World J Gastrointest Pathophysiol

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The coronavirus disease 2019 (COVID-19) pandemic profoundly affected the management and treatment of patients with malignancies. Based on the progress reported in the literature, we reviewed the recommendations for treatment and vaccination in patients with gastrointestinal stromal tumor (GIST) during COVID-19. We focus on whether there is a risk and what could be the possible effects of vaccinating patients with GIST/cancer. Since the situation is quickly changing, and the health services have been severely disrupted, the diagnosis, treatment and recommendations for vaccination of these patients against COVID-19 are still not updated. The approval of vaccines in the pandemic gave hope that we would soon be able to return to a more normal life. However, the oncology community needs to adapt and provide the most effective treatment and care models for patients with rare cancer, such as GIST. Collecting data on the impact of vaccination in patients with GIST/cancer also will be beneficial in expanding knowledge about the future planning of treatment strategies and optimizing care in the event of a subsequent pandemic.

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Strategies for care of patients with gastrointestinal stromal tumor or soft tissue sarcoma during COVID‐19 pandemic: A guide for surgical oncologists

Cited by 8 publications

References 77 publications

Computed tomography in the size measurement of gastric gastrointestinal stromal tumors: Implication to risk stratification and “wait-and-see” tactics

Computed tomography in the size measurement of gastric gastrointestinal stromal tumors: Implication to risk stratification and “wait-and-see” tactics

Telemedicine in Care of Sarcoma Patients beyond the COVID-19 Pandemic: Challenges and Opportunities

COVID-19 in patients with gastrointestinal stromal tumors: Recommendations for management and vaccination

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