Initial management of localized gastrointestinal stromal tumors

While some patients with GIST are candidates for observation, most are treated with primary surgical resection. Systemic therapy may be offered either in the adjuvant setting to decrease recurrence risk or in the neoadjuvant setting to decrease tumor burden prior to surgical resection. Refer to UpToDate content on neoadjuvant and systemic therapy for GIST, which are discussed separately.

EUS: endoscopic ultrasound; GIST: gastrointestinal stromal tumor.

* EUS surveillance may be offered after a risk-benefit discussion with the patient. Data are limited for the optimal interval between surveillance studies. One approach is to have a short-term initial assessment (eg, within three to six months). If the tumor remains stable, then the follow-up interval can be lengthened. The tumor should be resected if it cannot be assessed endoscopically, becomes symptomatic (eg, dysphagia), increases in size, or shows structural changes or high-risk endoscopic features on EUS. Refer to UpToDate content on local treatment for GIST.

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Initial management of localized gastrointestinal stromal tumors