Treatment response after progression full read should be reassessed carefully by CT or PET scan. Conclusion The TSSG recommends that patients with GIST should be managed by an MDT with expertise in sarcoma, and the recommended treatment flow is shown in Figure 2. Importantly, mutation analysis should be considered in selected patients with primary disease to confirm the diagnosis of KIT-positive GISTs with atypical morphology or clinical features, or of KIT-negative GISTs, and to identify patients at higher risk of recurrence if considering postoperative imatinib therapy after resection of the primary tumor. For the treatment of GIST, surgery remains the mainstay therapy for resectable tumors. Imatinib treatment can substantially prolong survival of patients with unresectable or metastatic GIST, and is associated with mostly mild and manageable adverse effects.

Thus, imatinib should be considered as first-line treatment in metastatic GISTs. Adjuvant and neoadjuvant imatinib treatment may also be considered for patients with GIST. Figure 2 The treatment procedure for gastrointestinal stromal tumor (GIST) recommended by the Taiwan Surgical Society of Gastroenterology. Several clinical practice guidelines for GIST are now available, based on country-specific clinical practice, including those by the NCCN, ESMO, Korean GIST Study Group [58], and Japan Society of Clinical Oncology59. The guidelines presented here represent the updated recommendations of the TSSG for Taiwanese patients.

Prepared through a series of meetings involving multidisciplinary experts across Taiwan, the recommendations have taken into account recent evidence in the diagnosis and surgical and medical treatment for GIST, and are tailored to clinical practice in Taiwan. The guidelines are intended to provide guidance for physicians in decision-making and providing optimal care and treatment for patients with GIST patients in Taiwan. Abbreviations ACOSOG: American College of Surgeons Oncology Group; AFIP: Armed Forces Institute of Pathology; CT: Computed tomography; DFS: Disease-free survival; DOG-1: Discovered on GIST-1; EORTC: European Organisation for Research and Treatment of Cancer; ESMO: European Society of Medical Oncology; FDA: Food and Drugs Administration; FDG: Fluorodeoxyglucose; GIST: Gastrointestinal stromal tumors; MRI: Magnetic resonance imaging; NCCN: National Comprehensive Cancer Network; NED: no evidence of disease; NIH: National Institute of Health; OS: Overall survival; PDGFRA: Platelet-derived growth factor receptor-��; PET: Positron emission tomography; PFS: Progression-free survival; PS: Performance status; RECIST: Response Evaluation Criteria in Solid Tumors; RFS: Recurrence-free survival; RTOG: Radiation Therapy Oncology Group.

Competing interests The authors declare that they have no competing Batimastat interests.