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Gastrointestinal stromal tumors
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of gastrointestinal stromal tumors are prepared by our editorial team based on guidelines from the British Sarcoma Group (BSG 2025), the Spanish Group for Research on Sarcomas (GEIS/SEOM 2023), the European Reference Network on Rare Adult Solid Cancers (EURACAN/ESMO/ERN GENTURIS 2022), and the American Society for Gastrointestinal Endoscopy (ASGE 2017,2015).
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Diagnostic investigations
Imaging for staging: as per GEIS/SEOM 2023 guidelines, obtain contrast-enhanced abdominopelvic CT with image acquisitions of the arterial and portal phases for evaluating tumor extension.
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Circulating tumor DNA
Diagnostic procedures
EUS: as per BSG 2025 guidelines, perform EUS biopsy in patients with suspected GISTs > 2 cm in diameter, provided the lesion is in the stomach, duodenum, or rectum.
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Core-needle biopsy
Excisional biopsy
Mutational analysis
Medical management
General principles: as per BSG 2025 guidelines, manage patients with GISTs by an experienced multidisciplinary team in a specialist center.
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Management of local/locoregional disease (neoadjuvant therapy)
Management of local/locoregional disease (surgical excision)
Management of local/locoregional disease (adjuvant therapy)
Management of advanced/metastatic disease (systemic therapy, first-line)
Management of advanced/metastatic disease (systemic therapy, second-line)
Management of advanced/metastatic disease (systemic therapy, third- and fourth-lines)
Management of advanced/metastatic disease (surgical excision)
Management of advanced/metastatic disease (radiotherapy)
Follow-up and surveillance
Surveillance imaging: as per BSG 2025 guidelines, obtain cross-sectional imaging every 3-6 months in the first 3 years of treatment in patients with high-risk disease on adjuvant therapy, 3 monthly for 2 years following discontinuation of treatment, and thereafter every 6 months for 3 years and then annually for at least 5 years.
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