Radiotherapy in the management of gist: state of the art and new potential scenarios

Gatto, Lidia; Nannini, Margherita; Saponara, Maristella; Scioscio, Valerio Di; Beltramo, G.; Frezza, G.P.; Ercolani, Giorgio; Pinna, Antonio Daniele; Astolfi, Annalisa; Urbini, Milena; Brandi, Giovanni; Biasco, Guido; Pantaleo, Maria Abbondanza

doi:10.1186/s13569-016-0065-z

Cited by 32 publications

(23 citation statements)

References 22 publications

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“…A similar approach (i.e., SBRT delivered during regorafenib treatment to treat metastases) has been previously described only in 2 patients affected by metastatic gastrointestinal stromal tumor, achieving an objective response in the first case and a significant clinical benefit associated with a local tumor control in the second case. [ 16 ] Also, in our case, we obtained encouraging results, with an unexpected PFS of 36 months and a good tolerability of the combined treatment. This good response to regorafenib and SBRT in a late-stage mCRC suggests that radiotherapy can be used to treat focally progressing lesions in combination with systemic therapy, not only with a palliative intent but also to control the disease.…”

Section: Discussionsupporting

confidence: 57%

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

et al. 2017

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Rationale:Regorafenib is the new standard third-line therapy in metastatic colorectal cancer (mCRC). However, the reported 1-year overall survival rate does not exceed 25%.Patient concerns:A 55-year-old man affected by mCRC, treated with regorafenib combined with stereotactic body radiotherapy (SBRT), showing a durable response.Interventions:After 6 months of regorafenib, a PET/CT scan revealed a focal uptake in a solid lung nodule which was treated with SBRT, whereas continuing regorafenib administration. Fourteen months later, the patient had further progression in a parasternal lymph node, but treatment with regorafenib was continued. The regorafenib-associated side effects, such us the hand-foot syndrome, were favorable managed by reducing the dose from 160 to 120 mg/day.Outcomes:Patient-reported outcome was characterized by a progression-free survival of approximately 3 years.Lessons:in presence of oligometastatic progression, a local SBRT while retaining the same systemic therapy may be a better multidisciplinary approach. Moreover, disease progression is no longer an absolute contraindication for continuing the regorafenib treatment.

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Section: Discussionsupporting

confidence: 57%

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

et al. 2017

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“…In general, radiotherapy is restricted to symptomatic palliation patient with GIST (65). However, the efficacy of radiotherapy in combination with tyrosine kinase inhibitors for metastatic or advanced GIST has been reported by some researchers (65,66). Ciresa et al described that the introduction of molecularly targeted therapy combined with radiation therapy could improve the outcomes of patients with GIST (65), but the role of radiotherapy for GIST is controversial.…”

Section: Combined Modality Therapy For Rectal Gistmentioning

confidence: 99%

Management of rectal gastrointestinal stromal tumor

Kameyama¹,

Kanda²,

Tajima³

et al. 2018

Transl. Gastroenterol. Hepatol.

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Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. However, rectal GIST is rare, the incident rate of it is approximately 5% of all GISTs. Rectal GIST symptoms generally include bleeding and/or pain and occasionally, urinary symptoms. Immunohistochemical evaluation finds that most rectal GIST tumors are CD117 (KIT) positive, and are sometimes CD34, platelet-derived growth factor receptor alpha (PDGFRA), smooth muscle actin, S-100, or vimentin positive. The National Institutes of Health (NIH) classifies rectal GIST as very-low risk, low risk, intermediate risk, or high risk, and the frequencies have been estimated as 0-23.8% for very-low risk, 0-45% for low risk, 0-34% for intermediate risk, and 21-100% for high risk tumors. The first-line treatment for localized GIST is curative resection, but is difficult in rectal GIST because of anatomical characteristics such as the deep, narrow pelvis and proximity to the sphincter muscle or other organs. Several studies noted the efficacy of the minimally invasive surgery, such as trans-anal, trans-sacral, trans-vaginal resection, or laparoscopic resection. The appropriate surgical procedure should be selected depending on the case. Imatinib mesylate (IM) is indicated as first-line treatment of metastatic or unresectable GIST, and clinical outcomes are correlated with mutation genotype. However, the mutation genotypes in rectal GIST are not well known. In this review, as in other GISTs, a large proportion (59-100%) of rectal GISTs carry exon 11 mutations. Although curative resection is indicated for localized rectal GIST, a high rate of local recurrence is a problem. Multimodal therapy including perioperative IM may improve postoperative outcomes, contributing to anus-preserving surgery. Moreover, mutation analysis before IM treatment is important. This review summarizes current treatment strategies for rectal GIST.

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“…It is unclear if this biomarker feature is specific to SDH-deficient GIST, or if the presence of somatostatin receptors is a common finding in all types of GIST, which seems very plausible. Lastly, the inclusion of radiotherapy in the management of GIST is considered mostly for palliation, and there is emerging recent data suggestive that the concomitant use of TKIs may improve its efficacy, such as in the present case [ 9 - 10 ]; this was further demonstrated by the significant response to stereotactic body radiation therapy (SBRT) in the liver and the retropharyngeal mass sites reported by 18F-FDG PET/CT.…”

Section: Discussionmentioning

confidence: 59%

Somatostatin Receptor Avidity in Gastrointestinal Stromal Tumors: Theranostic Implications of Gallium-68 Scan and Eligibility for Peptide Receptor Radionuclide Therapy

Loaiza‐Bonilla

Bonilla-Reyes

2017

Cureus

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This manuscript reports on a patient with a metastatic gastrointestinal stromal tumor (GIST) refractory to standard first-line treatment, who underwent a gallium-68 scan based on pre-clinical data of somatostatin receptor (SSTR) expression in such tumors. The gallium-68 DOTATATE scan determined significant somatostatin receptor avidity as hypothesized, suggesting that this imaging modality may be used as an option for diagnostic and follow-up purposes in GIST patients. In addition, peptide receptor-mediated radiotherapy (177Lu-PPRT) via SSTR may provide a novel treatment strategy in carefully selected SSTR-avid GIST patients with thyrosine kinase inhibitor (TKI)-resistant tumors such as this case, and this warrants further investigation in novel clinical trial concepts.

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Radiotherapy in the management of gist: state of the art and new potential scenarios

Cited by 32 publications

References 22 publications

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

Management of rectal gastrointestinal stromal tumor

Somatostatin Receptor Avidity in Gastrointestinal Stromal Tumors: Theranostic Implications of Gallium-68 Scan and Eligibility for Peptide Receptor Radionuclide Therapy

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