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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2018; 24(18): 1925-1941
Published online May 14, 2018. doi: 10.3748/wjg.v24.i18.1925
Gastrointestinal stromal tumors: A multidisciplinary challenge
Juan Manuel Sanchez-Hidalgo, Manuel Duran-Martinez, Rafael Molero-Payan, Sebastian Rufian-Peña, Alvaro Arjona-Sanchez, Angela Casado-Adam, Antonio Cosano-Alvarez, Javier Briceño-Delgado
Juan Manuel Sanchez-Hidalgo, Manuel Duran-Martinez, Sebastian Rufian-Peña, Alvaro Arjona-Sanchez, Angela Casado-Adam, Antonio Cosano-Alvarez, Javier Briceño-Delgado, Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
Rafael Molero-Payan, Department of Intern Medicine, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
Rafael Molero-Payan, Lipids and Atherosclerosis Research Unit, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Córdoba, Cordoba 14004, Spain
Author contributions: Sanchez-Hidalgo JM, Duran-Martinez M and Molero-Payan R contributed to the conception and design of the review; Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Casado-Adam A and Cosano-Alvarez A contributed to literature review and analysis; Sanchez-Hidalgo JM, Duran-Martinez M and Arjona-Sanchez A contributed to drafting and critical revision and editing; Sanchez-Hidalgo JM, Rufian-Peña S and Briceño-Delgado J approved the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Juan Manuel Sanchez-Hidalgo, MD, PhD, Doctor, Surgical Oncologist, Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain. juanmanuelsanchezhidalgo@hotmail.com
Telephone: +34-957-010000
Received: March 27, 2018
Peer-review started: March 28, 2018
First decision: April 19, 2018
Revised: April 27, 2018
Accepted: May 6, 2018
Article in press: May 6, 2018
Published online: May 14, 2018
Processing time: 44 Days and 16.9 Hours
Abstract

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 adjuvant Imatinib-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.

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

Core tip: The treatment of gastrointestinal stromal tumors with tyrosine kinase inhibitors represents the paradigm of the new era of molecular targeted therapy against cancer. During the last years, there have been improvements in the control of this disease and in the prognosis of these patients, deriving in hopeful perspectives in the management of these tumors partly thanks to the numerous specialists. In this work, we define the role of each specialist in the different clinical scenarios.