The effectiveness and role of radiotherapy for patients with gastrointestinal stromal tumors (GISTs) may need to be reevaluated, according to findings that were recently published in Cancers.
GISTs are believed to be resistant to radiotherapy and their use is primarily for palliative care. However, because patients with GISTs are expected to live longer compared with those with other malignant tumors, there are many patients who are in need of more effective treatment than the currently recommended tyrosine kinase inhibitors (TKIs).
Data have indicated that newer radiotherapy technology may be useful in advanced or metastatic GIST cases. Due to there being only case reports and a few small clinical studies, Zhang and colleagues conducted a systematic review to provide evidence on the need to reassess the use of radiotherapy in the management of GISTs.
Searching PubMed, Web of Science, and Embase databases with no date limits, the researchers identified 41 articles (35 case reports and 6 case series) involving 112 patients. Most patients had advanced GISTs, and the most commonly treated areas were the bone and joints followed by the abdomen.
A subgroup analysis was conducted to determine the influence of TKIs on radiotherapy treatment. Although survival benefits were not reported, the researchers found that radiotherapy alone or combined with resistant TKIs was helpful in achieving an objective response in patients with advanced or metastatic GISTs.
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In patients with symptomatic GISTs, the pain was most often reported followed by neurologic dysfunction and bleeding. After excluding TKIs, the researchers found the symptom palliation rate to be 78.6% with radiotherapy. Overall, the researchers found radiotherapy to be well-tolerated, with most adverse reactions mild to moderate in severity.
A major limitation of this study is that because GISTs were previously considered insensitive to radiotherapy, any positive results are more likely to be published which could have influenced these findings. In addition, the included studies were all of low to moderate quality. Therefore, high-quality, randomized, controlled clinical studies are needed to confirm the efficacy and safety of radiotherapy in patients with GISTs.
”Overall, radiotherapy may relieve symptoms for some GIST patients with advanced or metastatic lesions and even help achieve objective response in selected patients without significantly reducing the quality of life,” the researchers concluded.
Zhang H, Jiang T, Mu M, et al. Radiotherapy in the management of gastrointestinal stromal tumors: a systematic review. Cancers. 2022;14:3169. Published online June 28, 2022. doi:10.3390/ cancers14133169