Adjuvant therapy for primary GIST has proven benefit in extending disease free survival. Defined risk factors for recurrent disease are based on GIST size, location, and mitotic rate and provide useful guidelines for selecting patients for adjuvant therapy considerations. Neoadjuvant therapy with tyrosine kinase inhibition has potential usefulness in primary GIST, although not yet as standard of care. Advantages can include tumor downsizing to provide opportunity for less morbid surgical resection as well as to decrease risk of intra-op tumor rupture. These theoretical considerations have not been evaluated in large clinical studies.