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Diagnosis and multi-disciplinary management of hepatic metastases from gastrointestinal stromal tumour
European Journal of Surgical Oncology, 06/26/09

Ye YJ et al. - In a study to explore the present application of diagnosis and management of hepatic metastases from gastrointestinal stromal tumour (GIST), it was found that the liver is a common metastatic site for GIST. Appropriate initial evaluation remains paramount for selecting the correct management strategy. Multi-disciplinary management of this disease is important for both curative and palliative treatment in these pts. Combining repeated surgery with tyrosine kinase inhibitor (TKI) treatment may be the most effective management for GIST pts with liver metastases.

Methods

A review of the literature was done for studies concerning hepatic metastases from GIST.
A literature search was performed using the Medline/PubMed databases to identify publications relevant to the review published from January 1998 to December 2008.
113 relevant articles were retrieved.
Abstracts from recent ASCO symposia were hand searched for relevant articles.
After the primary filtration, articles on review and with repetitive content were excluded.
Articles on clinical research, which were issued in authorized journals, were selected.
69 articles were included for review.

Results

Rate of liver metastases was reported as 15.9% in primary GISTs.
Recurrence rate following surgical resection for hepatic metastases from GIST had been reported as 70–77%.
For metastatic GIST pts with TKI treatment, it demonstrated rates of CR, PR, and SD respectively of 5.84%, 50.7%, and 32.4%.
Combining repeated surgery with TKI treatment, R0/R1 resection rates range in various series between 48 and 82%.
For those pts with unresectable disease confined to the liver or unable to tolerate liver resection due to co-morbidity or advanced age, RFA, HACE, TKI therapy, or even liver transplantation, can also improve survival.

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