BACKGROUND: The management of primary gastrointestinal stromal tumours (GISTs) 
has evolved with the introduction of adjuvant therapy. Recently reported results 
of the SSG XVIII/AIO trial by the Scandinavian Sarcoma Group (SSG) and the 
German Working Group on Medical Oncology (AIO) represent a significant change in 
the evidence for adjuvant therapy duration. The objectives of this European 
Expert Panel meeting were to describe the optimal management and best practice 
for the systemic adjuvant treatment of patients with primary GISTs.
MATERIALS AND METHODS: A panel of medical oncology experts from European sarcoma 
research groups were invited to a 1-day workshop. Several questions and 
discussion points were selected by the organising committee prior to the 
conference. The experts reviewed the current literature of all clinical trials 
available on adjuvant therapy for primary GISTs, considered the quality evidence 
and formulated recommendations for each discussion point.
RESULTS: Clinical issues were identified and provisional clinical opinions were 
formulated for adjuvant treatment patient selection, imatinib dose, duration and 
patient recall, mutational analysis and follow-up of primary GIST patients. 
Adjuvant imatinib 400 mg/day for 3 years duration is a standard treatment in all 
patients with significant risk of recurrence following resection of primary 
GISTs. Patient selection for adjuvant therapy should be based on any of the 
three commonly used patient risk stratification schemes. R1 surgery (versus R0) 
alone is not an indication for adjuvant imatinib in low-risk GIST. Recall and 
imatinib restart could be proposed in patients who discontinued 1-year adjuvant 
imatinib within the previous 3 months and may be considered on a case-by-case 
basis in patients who discontinued within the previous year. Mutational analysis 
is recommended in all cases of GISTs using centralised laboratories with good 
quality control. Treatment is not recommended in an imatinib-insensitive 
D842V-mutated GIST. During adjuvant treatment, patients are recommended to be 
clinically assessed at 1- to 3-month intervals. Upon discontinuation, computed 
tomography scan (CT) scans are recommended every 3 to 4 months for 2 years when 
the risk of relapse is highest, followed by every 6 months until year 5 and 
annually until year 10 after treatment discontinuation.
CONCLUSIONS: Key points in systemic adjuvant treatment and clinical management 
of primary GISTs as well as open questions were identified during this European 
Expert Panel meeting on GIST management.