Management of liver metastases from gastrointestinal stromal tumors: where do we stand?

Machairas, Nikolaos; Prodromidou, Anastasia; Molmenti, Ernesto P.; Kostakis, Ioannis D.; Sotiropoulos, Georgios C.

doi:10.21037/jgo.2017.08.08

Cited by 21 publications

(25 citation statements)

References 29 publications

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“…For GIST, it has been reported that 15% of patients are primarily resistant to the drug[ 46 ], In general, 88% of patients suffer from recurrence about 2 years after imatinib treatment due to the secondary resistance mutations in additional KIT exons[ 47 , 48 ]. Given the poor results of palliative treatment including chemotherapy, ablation, and TACE in patients with tyrosine kinase inhibitor drug resistance, liver transplantation may be the only treatment that may improve prognosis and prolong the overall survival time[ 49 ]. In a case reported by Joyon et al[ 23 ], a patient received a first course of lipiodol chemoembolization, but a second intrahepatic lesion was discovered in the left lobe 3 mo later.…”

Section: Phgist Treatmentmentioning

confidence: 99%

Prevalence, diagnosis, and treatment of primary hepatic gastrointestinal stromal tumors

Qian¹,

Yan²,

Gao³

et al. 2020

WJG

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Gastrointestinal stromal tumors (GIST), which is the most common mesenchymal tumor of the digestive tract, account for 1%-3% of gastrointestinal tumors. Primary stromal tumors outside the gastrointestinal tract are collectively referred to as extra GISTs, and stromal tumors in different regions often have different prognoses. A primary hepatic GIST is a rare tumor with an unknown origin, which may be related to interstitial Cajal-like cells. Although primary hepatic GIST has certain characteristics on imaging, it lacks specific symptoms and signs; thus, the final diagnosis depends on pathological and genetic evidence. This review summarizes all cases of primary hepatic GIST described in the literature and comprehensively analyzes the detailed clinical data of all patients. In terms of treatment, local resection alone or with adjuvant therapy was the prioritized choice to obtain better disease-free survival and longer survival time. For advanced unresectable cases, imatinib mesylate was applied as the first-line chemotherapy agent. Moreover, transcatheter arterial chemoembolization, radiofrequency ablation, and microwave ablation were shown to improve overall survival for selected patients. Liver transplantation was a final treatment option after resistance to chemotherapy developed.

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Section: Phgist Treatmentmentioning

confidence: 99%

Prevalence, diagnosis, and treatment of primary hepatic gastrointestinal stromal tumors

Qian¹,

Yan²,

Gao³

et al. 2020

WJG

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“…[32][33][34]38 As stated, the optimal timing of metastasectomy remains controversial, but is recommended to take place within 3 to 6 months of TKI initiation to balance the time to optimal response with the chance of acquiring resistance. 7,34,39 Typically imatinib is stopped just a few days prior to resection and restarted as soon as the patient has recovered from surgery with adequate wound healing and normalizing liver function tests (ideally within 3-4 postoperative weeks). The use of adjuvant TKI therapy after resection of GIST LM is a matter of debate, but generally is considered standard practice, even after a curative-intent operation.…”

Section: Traditional Management Of Metastatic Gist To the Livermentioning

confidence: 99%

“…Reports of median survivals ranging from 33 to 60 months and 5-year OS rates as high as 91% have been achieved. 34,39,43 Importantly, postoperative morbidity and mortality remain low. 39 Complication rates in recent series range from 0 to 33%.…”

Section: Outcomes After Liver Resection For Gist Lmmentioning

confidence: 99%

“…34,39,43 Importantly, postoperative morbidity and mortality remain low. 39 Complication rates in recent series range from 0 to 33%. 3,[43][44][45][46] Perioperative complications after GIST LM resection are similar to other liver resection series, with major complications including bile leak, intra-abdominal fluid collection, postoperative bleeding, and hepatic insufficiency, and minor complications such as wound infection and intraoperative bleeding.…”

Section: Outcomes After Liver Resection For Gist Lmmentioning

confidence: 99%

“…A systematic review of many of these observational studies found that R0 resection and the use of combination TKI therapy and surgery were factors most predictive of survival. 39 Brudvik et al, in the largest report of GIST LM resections (n ¼ 49), found that patients treated with combination TKI therapy had a higher 5-year recurrencefree survival rate than those who underwent resection alone have been raised over reported higher frequencies of local tumor progression with the use of adjunctive local therapies compared with resection, there are several potential benefits suggesting that the use of these alternatives will continue to increase in popularity. First, many local therapies can be performed with minimally invasive techniques.…”

Section: Outcomes After Liver Resection For Gist Lmmentioning

confidence: 99%

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Treatment Options for Metastatic Gastrointestinal Stromal Tumors to the Liver: A Review

2019

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Up to half of patients with a gastrointestinal stromal tumor (GIST) will present with metastatic disease, most commonly involving the liver. Prior to the introduction of tyrosine kinase inhibitors, treatment options were limited for patients with metastatic GIST to the liver resulting in dismal survival rates. However, with the advent of effective systemic chemotherapy and continued advancements in both surgical and local adjunctive therapy options, significant improvements in survival have been achieved. In this review, the authors characterize the evolution of the treatment approach for metastatic GIST to the liver, including the roles of both surgical resection and adjunctive therapies in today's practice.

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Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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Background Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. Methods Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. Results The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. Conclusions These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher‐quality evidence.

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Management of liver metastases from gastrointestinal stromal tumors: where do we stand?

Cited by 21 publications

References 29 publications

Prevalence, diagnosis, and treatment of primary hepatic gastrointestinal stromal tumors

Prevalence, diagnosis, and treatment of primary hepatic gastrointestinal stromal tumors

Treatment Options for Metastatic Gastrointestinal Stromal Tumors to the Liver: A Review

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

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