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Adjuvant and Neoadjuvant Treatment

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Gastrointestinal Stromal Tumor

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Abstract

Although surgical complete resection remains the only curative intervention for GIST, more than 40% of completely resected GISTs, especially those expressing high-risk features, such as large tumors or tumors with a high mitotic rate, are likely to develop recurrence with distant metastasis. In the past two decades, tyrosine kinase inhibitors were introduced for the treatment of GIST, and imatinib greatly prolonged the survival of metastatic or unresectable disease. This efficacy has encouraged the use of imatinib in perioperative settings; however, the staging system (risk estimation) is immature, and thus which patients need adjuvant or neoadjuvant therapy the most is unclear. A recent phase III trial revealed that adjuvant imatinib improves the recurrence-free survival of high-risk GISTs, but the optimum duration of imatinib and the impact on the overall survival remain controversial. Neoadjuvant treatment is a promising strategy for marginally resectable GISTs, but the prospective comparison of adjuvant and neoadjuvant therapy for such patients has not been performed. The further accumulation of evidence and the establishment of universal risk estimation and prevalence of genotyping are necessary in order to facilitate the perioperative treatment of GIST.

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Authors and Affiliations

  1. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan

    Haruhiko Cho

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  1. Haruhiko Cho
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Correspondence to Haruhiko Cho .

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Editors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Yukinori Kurokawa

  2. Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Hokkaido, Japan

    Yoshito Komatsu

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Cho, H. (2019). Adjuvant and Neoadjuvant Treatment. In: Kurokawa, Y., Komatsu, Y. (eds) Gastrointestinal Stromal Tumor. Springer, Singapore. https://doi.org/10.1007/978-981-13-3206-7_10

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  • DOI: https://doi.org/10.1007/978-981-13-3206-7_10

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  • Online ISBN: 978-981-13-3206-7

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