Gastrointestinal%20stromal%20tumor Management
Follow Up
- Relapses affect the liver & peritoneum & rarely the bone
- Risk of relapse is high w/ ruptured tumors
- Evaluate tumor response by checking for tumor shrinkage, tumor density changes on computed tomography (CT) scan, & absence of tumor progression
- For gastrointestinal stromal tumors (GISTs) <2 cm w/o high-risk endoscopic ultrasound (EUS) features, consider endoscopic surveillance every 6-12 months
Post-surgery
Completely Resected Tumors w/ or w/o Pre-operative Imatinib
- Clinical evaluation every 3-6 months x 5 years, then annually
- May be less frequent for small tumors (<2 cm)
- Abdominal/Pelvic CT every 3-6 months x 3-5 years, then annually
Metastatic Disease or Persistent Gross Residual Disease w/ or w/o Pre-op Imatinib
- Clinical evaluation & abdominal/pelvic CT every 3-6 months
- May be less frequent for small tumors (<2 cm)
Management of Disease Progression
Limited Disease Progression
- Continue or increase Imatinib dose as tolerated or may change to Sunitinib & reassess tumor response via positron emission tomography (PET) or CT
- For progressing lesions while continuing Imatinib, consider surgical resection if still feasible, radiofrequency ablation or embolization, or palliative radiation therapy for bone metastases
Systemic Disease Progression
- Increase Imatinib dose as tolerated or may change to Sunitinib & assess response via PET or CT
- If still w/ limited or systemic disease progression, consider Regorafenib, a clinical trial or supportive care