Modern treatment of gastric gastrointestinal stromal tumors

• Published in: World journal of gastroenterology : WJG 2012-12, Vol.18 (46), p.6720-6728
• Main Authors: Roggin, Kevin K, Posner, Mitchell C
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - therapeutic use; Benzamides - therapeutic use; Endoscopy; Gastrointestinal Stromal Tumors - diagnosis; Gastrointestinal Stromal Tumors - therapy; Humans; Imatinib Mesylate; Minimally Invasive Surgical Procedures; Neoadjuvant Therapy; Piperazines - therapeutic use; Prognosis; Pyrimidines - therapeutic use; Recurrence; Sarcoma - diagnosis; Sarcoma - therapy; Stomach Neoplasms - diagnosis; Stomach Neoplasms - therapy; Tomography, X-Ray Computed; Topic Highlight; Treatment Outcome; 恶性肿瘤; 磁共振成像; 突变事件; 胃肠道; 辅助治疗; 酪氨酸激酶受体; 酪氨酸激酶抑制剂; 间质
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i46.6720

Gastrointestinal stromal tumors （GIST） are rare mesenchymal smooth muscle sarcomas that can arise anywhere within the gastrointestinal tract. Sporadic mutations within the tyrosine kinase receptors of the interstitial cells of Cajal have been identified as the key molecular step in GIST carcinogenesis. Although many patients are asymptomatic, the most common associated symptoms include： abdominal pain, dyspepsia, gastric outlet obstruction, and anorexia. Rarely, GIST can perforate causing life-threatening hemoperitoneum. Most are ultimately diagnosed on cross-sectional imaging studies （i.e., computed tomography and/or magnetic resonance imaging in combination with upper endoscopy. Endoscopic ultrasonographic localization of these tumors within the smooth muscle layer and acquisition of neoplastic spindle cells harboring mutations in the c-KIT gene is pathognomonic. Curative treatment requires a complete gross resection of the tumor. Both open and minimally invasive operations have been shown to reduce recurrence rates and improve long-term survival. While there is considerable debate over whether GIST can be benign neoplasms, we believe that all GIST have malignant potential, but vary in their propensity to recur after resection and metastasize to distant organ sites. Prognostic factors include location, size （i.e., 〉 5 cm）, grade （〉 5-10 mitoses per 50 high power fields and specific mutational events that are still being defined. Adjuvant therapy with tyrosine kinase inhibitors, such as imatinib mesylate, has been shown to reduce the risk of recurrence after one year of therapy. Treatment of locally-advanced or borderline resectable gastric GIST with neoadjuvant imatinib has been shown to induce regression in a minority of patients and stabilization in the majority of cases. This treatment strategy potentially reduces the need for more extensive surgical resections and increases the number of patients eligible for curative therapy. The modern surgical treatment of gastric GIST combines the novel use of targeted therapy and aggressive minimally invasive surgical procedures to provide effective treatment for this lethal, but rare gastrointestinal malignancy.