title: Optimizing surgical and imatinib therapy for the treatment of gastrointestinal stromal tumors.
abstract: BACKGROUND
  The discovery of activating KIT and PDGFRα mutations in gastrointestinal stromal tumors (GISTs) represented a milestone as it allowed clinicians to use tyrosine kinase inhibitors, like imatinib, to treat this sarcoma. Although surgery remains the only potentially curative treatment, patients who undergo complete resection may still experience local recurrence or distant metastases. Therapeutic strategies that combine surgical resection and adjuvant imatinib may represent the best treatment to maximize patient outcomes. In addition to the use of imatinib in the adjuvant and metastatic settings, neoadjuvant imatinib, employed as a cytoreductive therapy, can decrease tumor volume, increase the probability of complete resection, and may reduce surgery-related morbidities. Thus, selected patients with metastatic disease may be treated with a combination of preoperative imatinib and metastasectomy. However, it is critical that patients with GIST be evaluated by a multidisciplinary team to coordinate surgery and targeted therapy in order to maximize clinical outcomes.
  
  
  CONCLUSIONS
  Following a systematic literature review, we describe the presentation, diagnosis, and treatment of GIST, with a discussion of the risk assessment for imatinib therapy. The application of surgical options, combined with adjuvant/neoadjuvant or perioperative imatinib, and their potential impact on survival for patients with primary, recurrent, or metastatic GIST are discussed.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Moores UCSD Cancer Center, University of California, San Diego, UC San Diego Health System, 3855 Health Sciences Drive, Mail Code 0987, La Jolla, CA, 92093-0987, USA, jsicklick@ucsd.edu.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Sicklick
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Lopez
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D000068877:Imatinib Mesylate; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate