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      Strategies for care of patients with gastrointestinal stromal tumor or soft tissue sarcoma during COVID‐19 pandemic: A guide for surgical oncologists

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          Abstract

          The coronavirus disease‐2019 (COVID‐19) pandemic is deeply impacting the accessibility of cancer patients to surgery. In resource‐limited conditions, the standard of care might not be deliverable, but evidence to support alternative management strategies often exists. By revisiting available treatment options, this review provides surgical oncologists with an evidence‐based framework for treating patients with gastrointestinal stromal tumor, extremity/truncal soft tissue sarcoma, and retroperitoneal sarcoma to rapidly adapt their decision‐making to the constant evolution of the COVID‐19 pandemic.

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          Most cited references76

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          Gastrointestinal stromal tumors: pathology and prognosis at different sites.

          Gastrointestinal (GI) stromal tumors (GISTs) are the most common mesenchymal tumors specific to the GI tract, generally defined as KIT (CD117)-positive tumors with a characteristic set of histologic features. These tumors, derived from Cajal cells or their precursors, most commonly occur at the age >50 years in the stomach (60%), jejunum and ileum (30%), duodenum (4-5%), rectum (4%), colon and appendix (1-2%), and esophagus ( 5 per 50 HPFs and >5 cm in diameter have a high risk for metastasis. In contrast, all intestinal GISTs >5 cm independent of mitotic rate have at least moderate risk for metastases, and all >5 mitoses per 50 HPFs have a high risk for metastases. Intestinal GISTs < or =5 cm with < or =5 mitoses per 50 HPFs have a low risk for metastases. Gastric GISTs can be divided into histologic subgroups including 4 spindle cell and 4 epithelioid variants. Intestinal GISTs are a histologically more homogeneous group and often contain distinctive extracellular collagen globules, skeinoid fibers. Immunohistochemical demonstration of KIT, CD34, or protein kinase theta positivity helps to properly identify these tumors.
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            Risk stratification of patients diagnosed with gastrointestinal stromal tumor.

            Accurate risk stratification of gastrointestinal stromal tumors (GISTs) has become increasingly important owing to emerging adjuvant systemic treatments. All GISTs have been considered to have some malignant potential, but this hypothesis is now seriously challenged by studies indicating that microscopic gastric GISTs that are common in the general population probably have little or no malignant potential. The National Institutes of Health (NIH) consensus classification system, based on tumor size and mitotic count, is commonly used to assess patient prognosis after surgical resection. Large retrospective cohort studies from several countries now uniformly indicate that the NIH classification carries substantial prognostic value. In particular, patients with high-risk GIST (approximately 44% of all) have substantially poorer outcome than those with intermediate-risk (24%) or low/very low-risk GIST (32%), whose survival is not markedly inferior to that of the general population in some studies. Gastric GISTs (approximately 58% of all GISTs) have a lower risk of recurrence than nongastric tumors of the same size and mitotic count, and tumor rupture confers clearly increased risk. These 2 important risk stratification factors are not considered in the NIH classification. Patients with certain nongastric tumors (2.1-5 cm and > 5 mitoses per 50 high-power fields or 5.1-10 cm and < or = 5 per 50 high-power fields) and those with tumor rupture are proposed to be included in the NIH high-risk category. High-risk patients defined by the proposed modified system have more than 15% to 20% risk of disease recurrence. The proposed system, if validated, may be useful in identifying which patients might potentially benefit from adjuvant therapy.
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              Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic

              During the COVID-19 global pandemic, the cancer community faces many difficult questions. We will first discuss safety considerations for patients with cancer requiring treatment in SARS-CoV-2 endemic areas. We will then discuss a general framework for prioritizing cancer care, emphasizing the precautionary principle in decision making.
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                Author and article information

                Contributors
                rebecca.gladdy@sinaihealth.ca
                Journal
                J Surg Oncol
                J Surg Oncol
                10.1002/(ISSN)1096-9098
                JSO
                Journal of Surgical Oncology
                John Wiley and Sons Inc. (Hoboken )
                0022-4790
                1096-9098
                06 October 2020
                : 10.1002/jso.26246
                Affiliations
                [ 1 ] Department of Surgery University of Toronto Toronto ON Canada
                [ 2 ] Department of Surgery Fondazione IRCCS Istituto Nazionale Tumori Milan Italy
                [ 3 ] Department of Surgery, Brigham and Women's Hospital, Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts USA
                [ 4 ] Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
                [ 5 ] Department of Surgery University of Washington Seattle Washington USA
                [ 6 ] Department of Radiation Oncology Gustave Roussy Villejuif France
                [ 7 ] Medical Oncology Department in University Hospital Virgen del Rocio and Institute of Biomedicine of Sevilla (IBIS) (HUVR, CSIC) University of Sevilla Sevilla Spain
                Author notes
                [*] [* ] Correspondence Rebecca Gladdy, Mt Sinai Hospital, 600 University Ave, #1225, Toronto, ON M5G 1X5, Canada.

                Email: rebecca.gladdy@ 123456sinaihealth.ca

                Author information
                http://orcid.org/0000-0002-3392-4002
                http://orcid.org/0000-0001-7297-3221
                http://orcid.org/0000-0002-8783-8484
                Article
                JSO26246
                10.1002/jso.26246
                7675701
                33022754
                098d6129-1eeb-402a-82e9-7ea8d45d70bf
                © 2020 Wiley Periodicals LLC

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 19 August 2020
                : 17 September 2020
                : 17 September 2020
                Page count
                Figures: 3, Tables: 2, Pages: 12, Words: 7205
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.4 mode:remove_FC converted:19.11.2020

                Oncology & Radiotherapy
                covid‐19,gastrointestinal stromal tumor,retroperitoneal sarcoma,sarcoma,soft tissue sarcoma

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