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NCCN Guidelines for Patients

®

Soft Tissue Sarcoma, Version 1.2014

45

Chart 4.2.1

maps the treatment options for all

GISTs other than small stomach GISTs. Options are

listed by whether or not a tumor can first be treated

with surgery. Tumors that can first be treated with

surgery have not grown or spread far. Larger tumors,

cancer that has returned after surgery, and metastatic

disease are often first treated with imatinib.

Surgery first

Surgery can be your first treatment as long as it does

not leave you with long-term problems afterward.

You may receive more treatment after surgery. If all

the cancer appears to be removed, you could start

imatinib if there’s a high risk for the cancer returning.

Otherwise, read

Care after surgery

to learn what to do

next. If your surgeon was unable to remove all of the

cancer, you may start imatinib and consider a second

surgery.

Imatinib first

Imatinib may first be used for GISTs that can be

removed by surgery but the surgery would leave

you with long-term problems. In this case, imatinib is

given to shrink the tumor so that surgery won’t cause

long-term problems. It is very important that you don’t

stop taking imatinib once you’ve started.

After taking imatinib for a few weeks, a PET scan

can show if treatment is working. If the tumor is the

same size or smaller, keep taking the same dose of

imatinib. Once the tumor is small enough, you may

be able to have surgery. After surgery, start imatinib

again for adjuvant treatment. If the tumor grows while

taking imatinib, surgery may be done for some people.

Otherwise, read

Treatment after progression

on page

46 for the next steps of care.

Imatinib is also used for GISTs that can’t be removed

by surgery, returned after surgery, or have spread far.

It is very important that you don’t stop taking imatinib

once you’ve started. Within 3 months of starting

imatinib, your doctors will assess if it is working with a

CT scan.

If the tumor is the same size or smaller, keep taking

imatinib. The tumor may shrink enough for surgery.

Your surgeon and medical oncologist should assess

if surgery is possible. If you’re able to have surgery,

imatinib should be restarted afterwards unless your

doctor tells you not to. If you’re unable to have

surgery, stay on imatinib. Read

Treatment after

progression

if the tumor grows while on imatinib.

Chart 4.2.2

lists care for after surgery. You should

have follow-up tests. Tests recommendations are

based on surgery results. The surgery may have

removed all the cancer or some cancer may remain.

If all the cancer was removed,

testing can assess

if the cancer has returned. Getting follow-up tests

can help find cancer early. Cancer is more likely

to be cured if found early. To find cancer early, get

a medical history and physical exam every 3 to 6

months for 5 years. If results are normal for 5 years,

then these tests may be done every year. In addition,

get a CT of your abdomen and pelvis every 3 to 6

months for 3 to 5 years. If results are normal during

this time, CT is only recommended every year.

If not all the cancer was removed,

testing can assess

if the cancer is growing. Tests should include medical

history, physical exam, and CT of your abdomen and

pelvis every 3 to 6 months. If the cancer is growing,

read

Treatment after progression

on the next page.

4

Gastrointestinal stromal tumors Treatment for other GISTs