PRE-OPERATIVE GASTRIC GIST DOWNSIZING: THE IMPORTANCE OF NEOADJUVANT THERAPY.

INTRODUCTION: Gastric gastrointestinal tumors (GIST) are a rare and usually asymptomatic neoplasm that can present as abdominal mass in more advanced scenarios. Since surgical resection is the main aspect of the treatment, locally advanced tumors require multivisceral resection and, therefore, higher postoperative morbidity and mortality. OBJECTIVE: To perform a review the literature on the topic, with emphasis on the neoadjuvant therapy. METHODS: Literature review on the Medline database using the following descriptors: gastrointestinal stromal tumors, neoadjuvant therapy, imatinib mesylate and molecular targeted therapy. RESULTS: Surgical resection remains the cornerstone for the treatment of GISTs; however, tyrosine kinase inhibitors have improved survival as an adjuvant therapy. More recently, neoadjuvant therapy have been described in the treatment of locally advanced tumors in order to avoid multivisceral resection. CONCLUSION: Despite surgical resection remains as the most important aspect of the treatment of GISTs, adjuvant and neoadjuvant therapy with tyrosine kinase inhibitors have shown to both improve survival and resectability, respectively.

Pre-operative gastric gist downsizing: the importance of neoadjuvant therapy / Redução tumoral pré-operatória do gist gástrico: a importância da terapia neoadjuvante

ABSTRACT Introduction: Gastric gastrointestinal tumors (GIST) are a rare and usually asymptomatic neoplasm that can present as abdominal mass in more advanced scenarios. Since surgical resection is the main aspect of the treatment, locally advanced tumors require multivisceral resection and, therefore, higher postoperative morbidity and mortality. Objective: To perform a review the literature on the topic, with emphasis on the neoadjuvant therapy. Methods: Literature review on the Medline database using the following descriptors: gastrointestinal stromal tumors, neoadjuvant therapy, imatinib mesylate and molecular targeted therapy. Results: Surgical resection remains the cornerstone for the treatment of GISTs; however, tyrosine kinase inhibitors have improved survival as an adjuvant therapy. More recently, neoadjuvant therapy have been described in the treatment of locally advanced tumors in order to avoid multivisceral resection. Conclusion: Despite surgical resection remains as the most important aspect of the treatment of GISTs, adjuvant and neoadjuvant therapy with tyrosine kinase inhibitors have shown to both improve survival and resectability, respectively.

RESUMO Introdução: O tumor estromal gastrintestinal (GIST) gástrico é neoplasia que cursa, por vezes, com apresentação assintomática, se manifestando como massa abdominal, relacionada a casos mais avançados. Esses, por sua vez, exigem tratamento com operações maiores e que cursam com mais alta morbimortalidade. Objetivo: Revisar e atualizar o tratamento do GIST gástrico, com enfoque na relevância do tratamento neoadjuvante. Método: Revisão da literatura utilizando a base de dados Medline/PubMed. Utilizaram-se os seguintes descritores: gastrointestinal stromal tumors, neoadjuvant therapy, imatinib mesylate e molecular targeted therapy. Dos artigos selecionados, 20 foram incluídos. Resultados: O tratamento cirúrgico é pilar fundamental para a cura do GIST. Entretanto, após a introdução do mesilato de imatinibe, classicamente utilizado como terapia adjuvante, houve mudança no manejo do GIST, permitindo aumento da sobrevida e diminuição da recorrência. A aplicação como terapia neoadjuvante é mais recente, e visa evitar procedimentos maiores sem, no entanto, prejudicar o resultado oncológico. Conclusão: A ressecção cirúrgica possui papel bem estabelecido no tratamento do GIST, inclusive com abordagem laparoscópica. O tratamento adjuvante com mesilato de imatinib, durante os primeiros três anos após a operação, mostra-se como opção segura para casos com elevado risco de recidiva. A terapia neoadjuvante é opção promissora para casos de tumor localmente avançado, permitindo ressecções menores e com menor morbimortalidade operatória.