Gastrointestinal stromal tumors:a multidisciplinary challenge

作     者：Juan Manuel Sanchez-Hidalgo Manuel Duran-Martinez Rafael Molero-Payan Sebastian Rufian-Pena Alvaro Arjona-Sanchez Angela Casado-Adam Antonio Cosano-Alvarez Javier Briceno-Delgado 

作者机构：Department of General and Digestive SurgeryReina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Department of Intern MedicineReina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Lipids and Atherosclerosis Research UnitIMIBIC/Hospital Universitario Reina Sofía/Universidad de CórdobaCordoba 14004Spain 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第18期

页      面：1925-1941页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Gastrointestinal stromal tumors Surgery Oncology Radiology Endoscopy Nuclear medicine Pathology Disease management Tyrosine kinase inhibitors Gastroenterology 

摘      要：Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs( 95%) are positive for the KIT protein(CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis(the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvantImatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.