title: Radiotherapy in the management of gist: state of the art and new potential scenarios.
abstract: BACKGROUND
  Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. The main treatment for localized gastrointestinal stromal tumors is surgical resection. Unresectable or advanced GIST are poorly responsive to conventional cytotoxic chemotherapy but the introduction of tyrosine kinase inhibitors (TKIs) marked a revolutionary step in the treatment of these patients, radically improving prognosis and clinical benefit. Historically GIST has been considered radiation-resistant, and the role of radiotherapy in the management of patients with GIST is currently restricted to symptomatic palliation in current treatment guidelines.
  
  
  METHODS
  Here we report two patients affected by metastatic GIST, treated with radiotherapy and radiosurgery in combination with TKIs, achieving an unexpected objective response in the first case and a significant clinical benefit associated with a local tumor control of several months in the second case.
  
  
  CONCLUSIONS
  These and other successful experiences that are progressively accumulating, open up new scenarios of use of radiation therapy in various settings of treatment. GIST is not universally radioresistant and radiotherapy, especially if combined with molecularly targeted therapy, can improve the outcomes for patients diagnosed with GIST.
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Gatto
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Nannini
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Saponara
authors.affiliation: Department of Radiology, S. Orsola Malpighi Hospital, Bologna University, Bologna, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Di Scioscio
authors.affiliation: Centro Diagnostico Italiano, Reparto Cyberknife, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Beltramo
authors.affiliation: Radiation Oncology Unit, Bellaria Hospital, Bologna, Italy.
authors.forename: G P
authors.initials: GP
authors.lastname: Frezza
authors.affiliation: Department of General and Emergency Surgery and Organ Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Department of General and Emergency Surgery and Organ Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Astolfi
authors.affiliation: Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Urbini
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy ; Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Brandi
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy ; Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Biasco
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy ; Interdepartmental Centre of Cancer Research "G. Prodi", University of Bologna, Bologna, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Pantaleo
keywords: GIST; Radiotherapy; Treatment