Successful radiotherapy for local control of progressively increasing metastasis of gastrointestinal stromal tumor

Abstract

Gastrointestinal stromal tumors (GISTs) are known to be poorly responsive to conventional chemotherapy and historically considered resistant to radiotherapy. In the past the mainstay of GIST treatment was surgery, but the introduction of tyrosine kinase inhibitors (TKIs) imatinib and sunitinib marked the beginning of a new era in the treatment of GIST patients. To date, radiotherapy for GIST has not been administered in clinical practice except for limited palliative settings and there are no clear data on the administration of radiotherapy, alone or in combination with TKIs, with a purely cytoreductive intent. We describe the clinical case of a 48-year-old woman with metastatic GIST treated with external radiotherapy in a critical supraclavicular tumor localization progressively increasing in size with several symptoms and not responsive to systemic TKI therapies. We obtained an initial shrinkage of the mass and subsequent stabilization with an immediate and clear clinical benefit. Although the historical medical literature considered GISTs resistant to radiation therapy, our clinical case suggests this treatment may be appropriate in selected patients.

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

“…However, to date some publications suggest the efficacy of radiation therapy in the management of GIST [10–12]. …”

Radioembolization in Patients with Progressive Gastrointestinal Stromal Tumor Liver Metastases Undergoing Treatment with Tyrosine Kinase Inhibitors

“…With more data on RE now available, patients with a mutational status as described earlier might be candidates for RE before second-, third-, and fourth-line drug therapy, which have little hope of success. One further aspect might be of interest insofar as GIST is thought to be resistant to radiation therapy (32). The results of the present series might be explained by the advantage of hypervascularized GIST metastases in accumulating 90 Y microspheres, and therefore a high local radiation dosage can be applied.…”

Treatments for Gastrointestinal Stromal Tumors that are Resistant to Standard Therapies

“…Thus, radiotherapy has been historically administered in GIST patients only with a palliative/antalgic aim and mainly for bone metastases. However, a few experiences show that selected patients could benefit from radiotherapy in specific sites, thus obtaining not only high rates of palliation for symptomatic tumors in a cohort of advanced-stage, heavily pretreated patients, but also initial tumor shrinkage and subsequent durable disease stabilization [71][72][73][74][75]. In this sense, radiotherapy integrated with systemic therapy could provide an important benefit in selected patients with progressive or metastatic disease.…”