title: Long-term survival of a case with multiple liver metastases from duodenal gastrointestinal stromal tumor drastically reduced by the treatment with imatinib and hepatectomy.
abstract: Constitutive activation of KIT receptor tyrosine kinase is a critical factor in the pathogenesis of gastrointestinal stromal tumors (GISTs). But there is little information on whether combination of imatinib mesylate (IM) and surgical treatment can prolong survival in the cases with unresectable multiple liver metastases. We report a case of postoperative recurrence of GIST treated by the tyrosine kinase inhibitor IM and surgical treatment. The initial complete response (CR) to treatment continued for 18 mo, but single liver metastasis showed regrowth in the left hepatic lobe during IM treatment. After partial resection of the recurrent tumor, postoperative course was uneventful and the patient has survived without recurrence for 24 mo. Currently, imatinib is the first-line therapy for non-resectable GISTs, but a single agent therapy often leads to tumor resistance. Even if tolerance to imatinib occurs, a combination of imatinib and surgical treatment can prolong survival in some cases as reported here. However, further studies on a large number of cases of recurrent GIST are necessary to evaluate the effectiveness of IM treatment combined with surgery.
authors.affiliation: Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-dori, Kyoto 602, Japan. sakakura@koto.kpu-m.ac.jp
authors.forename: Chouhei
authors.initials: C
authors.lastname: Sakakura
authors.forename: Akeo
authors.initials: A
authors.lastname: Hagiwara
authors.forename: Koji
authors.initials: K
authors.lastname: Soga
authors.forename: Koji
authors.initials: K
authors.lastname: Miyagawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Nakashima
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kin
authors.forename: Yuenn
authors.initials: Y
authors.lastname: Nakase
authors.forename: Nobuki
authors.initials: N
authors.lastname: Yamaoka
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Sagara
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Yamagishi
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D004379:Duodenal Neoplasms / Q000473:pathology*; D046152:Gastrointestinal Stromal Tumors / Q000737:chemistry / Q000556:secondary* / Q000628:therapy*; D006498:Hepatectomy; D006801:Humans; D000068877:Imatinib Mesylate; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000628:therapy*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery; D010879:Piperazines / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011743:Pyrimidines / Q000627:therapeutic use*; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases