GIST imaging surveillance: a simplified, practical protocol

  • Alessandrino F & al.
  • Clin Radiol
  • 22 Jul 2019

  • Oncology guidelines update
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Takeaway

  • A simplified protocol has been suggested for image-based follow-up of patients with resected gastrointestinal stromal tumors (GISTs).

Why this matters

  • No consensus exists on the optimal surveillance approach.
  • The authors focused on National Comprehensive Cancer Network (NCCN) and European Society of Medical Oncology-European Network for Rare Adult Solid Cancers (ESMO-EURACAN) guidelines.

Key points

  • With the exception of tumors with high mitotic counts, the authors do not recommend adjuvant imatinib for patients with very low or low-risk GISTs.
  • For very low risk tumors and resected tumors ≤2 cm, follow-up at 12-month intervals is sufficient.
  • For low-risk tumors >2 cm and ≤5 cm, the authors recommend CT imaging every 5 months for 5 years.
  • For tumors >5 cm and tumors of intermediate or high risk, the authors suggest adjuvant imatinib for a minimum of 3 years. Intermediate- and high-risk patients should be imaged every 3 months for the first year and every 6 months for the next 2 years.
  • After adjuvant imatinib, intermediate-risk patients should be seen annually for 10 years, and high-risk patients every 6 months for 10 years.
  • Indolent GISTs such as those that are succinate dehydrogenase deficient or associated with syndromes need longer and less frequent (annual) follow-up imaging.