Department of Hematology, Oncology and Palliative Medicine, HELIOS Klinikum Bad Saarow, Pieskower Strasse 33, D-15526 Bad Saarow, Germany.
Expert Rev Anticancer Ther. 2010 Feb;10(2):221-32. doi: 10.1586/era.09.171.
The contemporary clinical landscape of gastrointestinal stromal tumor (GIST) has evolved rapidly over the past several years. Widely used treatment guidelines--from the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network--have recently been updated and represent the most up-to-date, comprehensive tools guiding the optimal management of GIST. In these, and in other published guidelines, close alignment among recommendations now exists for many of the clinical issues relevant to GIST management--surgery, use of the tyrosine kinase inhibitors imatinib and sunitinib and the role of pre- and post-operative imatinib, among others. This trend towards a global consensus in the treatment of GIST is the result of a relatively large amount of new data across the spectrum of its management. However, for some clinical considerations, recommendations still partially deviate. This review examines clinical recommendations and opinions on the management of GIST in the context of the latest data in the field and with an eye towards a multidisciplinary approach including surgical oncology, medical oncology, pathology and diagnostic radiology. Points of consensus are highlighted. Expert opinion is presented on management areas where no scientific evidence or firm recommendations currently exist; lingering and unresolved questions or issues are included. Within this framework, we present an evaluation of current global guidelines on the following areas in GIST management: surgery in the metastatic setting; neoadjuvant therapy; adjuvant therapy; mutational analysis; maintenance tyrosine kinase inhibitor therapy; and radiological imaging in GIST. A summary of consensus across these guidelines based on clinical trial data is juxtaposed with expert opinion where gaps in data still remain.
在过去的几年中，胃肠道间质瘤（GIST）的当代临床领域迅速发展。广泛使用的治疗指南——来自欧洲肿瘤内科学会（ESMO）和美国国家综合癌症网络（NCCN）——最近已经更新，代表了指导 GIST 最佳管理的最新、最全面的工具。在这些指南和其他已发表的指南中，现在对于与 GIST 管理相关的许多临床问题，建议之间非常一致——手术、使用酪氨酸激酶抑制剂伊马替尼和舒尼替尼以及手术前后伊马替尼的作用等。这种在 GIST 治疗中达成全球共识的趋势是其管理各个方面大量新数据的结果。然而，对于一些临床考虑因素，建议仍然存在部分差异。本综述在该领域的最新数据背景下，针对 GIST 管理的临床建议和意见进行了审查，并着眼于包括手术肿瘤学、肿瘤内科、病理学和诊断放射学在内的多学科方法。突出了共识点。就目前尚无科学证据或明确建议的管理领域提出了专家意见；包括悬而未决和未解决的问题或问题。在此框架内，我们评估了当前关于 GIST 管理的以下领域的全球指南：转移性疾病中的手术；新辅助治疗；辅助治疗；突变分析；维持性酪氨酸激酶抑制剂治疗；以及 GIST 的影像学。根据临床试验数据，对这些指南中基于共识的内容进行了总结，并结合了数据仍然存在差距的专家意见。
