A Ruptured Metastatic Hepatic Gastrointestinal Stromal Tumor Treated by Angiographic Embolization

Radiotherapy in the management of rare gastrointestinal cancers: A systematic review

The aim of this analysis is to assess radiotherapy's role and technical aspects in an array of rare gastrointestinal (GI) cancers for adult patients. Collection data pertaining to radiotherapy and digestive rare cancers were sourced from Medline, EMBASE, and Cochrane Library. Preoperative chemoradiotherapy improved outcomes for patients with esophageal undifferentiated carcinoma compared with esophageal salivary gland types of carcinomas. For rare gastric epithelial carcinoma, perioperative chemotherapy is the common treatment. Adjuvant chemoradiotherapy showed no benefice compared with adjuvant chemotherapy for duodenal adenocarcinoma. Small bowel sarcomas respond well to radiotherapy. By analogy to anal squamous cell carcinoma, exclusive chemoradiotherapy provided better outcomes for patients with rectal squamous cell carcinoma. For anal adenocarcinoma, neoadjuvant chemoradiotherapy, followed by radical surgery, was the most effective regimen. For pancreatic neuroendocrine tumors, chemoradiotherapy can be a suitable option as postoperative or exclusive for unresectable/borderline disease. The stereotactic body radiotherapy (SBRT) is a promising approach for hepatobiliary malignancy. Radiotherapy is a valuable option in gastrointestinal stromal tumors (GIST) for palliative intent, tyrosine kinase inhibitors (TKIs) resistant disease, and unresectable or residual disease. Involved field (IF) radiotherapy for digestive lymphoma provides good results, especially for gastric extranodal marginal zone lymphoma (MALT). In conclusion, radiotherapy is not an uncommon indication in this context. A multidisciplinary approach is needed for better management of digestive rare cancers.

Radiotherapy in the Management of Gastrointestinal Stromal Tumors: A Systematic Review

Simple Summary

Gastrointestinal stromal tumors are considered to be insensitive to radiotherapy. However, with the development of radiation techniques and the accumulation of cases, some studies have indicated that radiotherapy could help achieve objective response in advanced or metastatic gastrointestinal stromal tumors. Therefore, it is necessary to conduct a systematic review to reassess the role of radiotherapy in gastrointestinal stromal tumors. The purpose of this study was to draw the attention of scholars and clinicians to radiotherapy and promote further research on radiotherapy in gastrointestinal stromal tumors.

Abstract

Gastrointestinal stromal tumors (GISTs) are considered insensitive to radiotherapy. However, a growing number of case reports and case series have shown that some lesions treated by radiotherapy achieved an objective response. The aim of the study was to perform a systematic review of all reported cases, case series, and clinical studies of GISTs treated with radiotherapy to reevaluate the role of radiotherapy in GISTs. A systematic search of the English-written literature was conducted using PubMed, Web of Science, and Embase databases. Overall, 41 articles describing 112 patients were retrieved. The included articles were of low to moderate quality. Bone was the most common site treated by radiotherapy, followed by the abdomen. In order to exclude the influence of effective tyrosine kinase inhibitors (TKIs), a subgroup analysis was conducted on whether and which TKIs were concurrently applied with radiotherapy. Results showed that radiotherapy alone or combined with resistant TKIs could help achieve objective response in selected patients with advanced or metastatic GISTs; however, survival benefits were not observed in the included studies. Pain was the most common symptom in symptomatic GISTs, followed by neurological dysfunction and bleeding. The symptom palliation rate was 78.6% after excluding the influence of effective TKIs. The adverse reactions were mainly graded 1–2. Radiotherapy was generally well-tolerated. Overall, radiotherapy may relieve symptoms for GIST patients with advanced or metastatic lesions and even help achieve objective response in selected patients without significantly reducing the quality of life. In addition to bone metastases, fixed abdominal lesions may be treated by radiotherapy. Publication bias and insufficient quality of included studies were the main limitations in this review. Further clinical studies are needed and justified.

Duodenojejunal intussusception secondary to primary gastrointestinal stromal tumor: A case report

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Gastrointestinal stromal tumor (GIST) in the third portion of the duodenum is rare.

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Intussusception and obstruction caused by GIST are uncommon.

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Adult intussusception usually requires surgical resection.

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If the location, tumor size, and resection margin of duodenal GIST are adequate for limited resection, it seems to be better than pancreaticoduodenectomy.

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Elderly patients can have improved quality of life with minimally invasive surgery.

Introduction

Gastrointestinal stromal tumors (GISTs) in the third portion of the duodenum are rare. Intussusception and obstruction are rarely caused by GISTs because of their tendency to grow in an extraluminal manner. Herein, we report a case involving segmental duodenectomy in a patient with duodenojejunal intussusception secondary to a primary GIST.

Presentation of case

A 91-year-old woman with a history of iron-deficiency anemia presented with vomiting and anorexia. Preoperative imaging suggested duodenojejunal intussusception secondary to a GIST in the third portion of the duodenum. Segmental duodenectomy with end-to-end duodenojejunostomy without reduction of the intussusception was performed. At 6 months after the surgery, the patient’s anemia had improved and she had no abdominal symptoms.

Discussion

Adult intussusception requires surgical resection because most of the patients have intraluminal lesions. The location in relation to the Vater papilla, tumor size, and resection margin should be considered when selecting the type of surgical resection for duodenal GIST. Limited resection appears to be better than pancreaticoduodenectomy with respect to postoperative complications. Considering the age and performance status of this patient, a less invasive maneuver was selected.

Conclusion

Duodenal GISTs can be a rare cause of intussusception. Thus, a limited surgical resection procedure should be considered in such cases.