title: Hepatic artery chemoembolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors.
abstract: BACKGROUND
  The efficacy of hepatic artery chemoembolization (HACE) was evaluated for gastrointestinal stromal tumors (GISTs) metastatic to the liver.
  
  
  METHODS
  Records for patients with metastatic GIST who underwent HACE between January 1993 and March 2005 were reviewed and cross-sectional images were used to determine objective tumor response. Progression-free survival in the liver (PFS-liver) and overall survival (OS) were calculated with the Kaplan-Meier method. Patient, tumor, and treatment variables were analyzed to identify factors influencing survival.
  
  
  RESULTS
  Of the 110 patients identified, the radiologic response to HACE could be evaluated in 85 patients, 12 of whom (14%) demonstrated partial responses, 63 of whom (74%) demonstrated stable disease, and 10 of whom (12%) demonstrated progressive disease. PFS-liver rates were 31.2%, 8.2%, and 5.4% at 1, 2, and 3 years, respectively; the median PFS time was 8.2 months. OS rates were 62% at 1 year, 32% at 2 years, and 20% at 3 years; the median OS time was 17.2 months. Patients who had >5 liver metastases and received only 1 HACE treatment were found to have a shorter PFS compared with patients with fewer metastases or those who received > or =2 HACE sessions. Extensive liver involvement, the presence of extrahepatic metastases, and progression of liver disease after HACE were associated with poor OS. Use of imatinib prolonged OS time.
  
  
  CONCLUSIONS
  HACE produced a durable tumor response or disease stabilization in the majority of patients with GISTs metastatic to liver. Extent of liver disease, presence of extrahepatic disease, number of embolization treatments, and use of imatinib were found to have prognostic influence on PFS, OS, or both.
authors.affiliation: Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Trent
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Savitri
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: Joe
authors.initials: J
authors.lastname: Ensor
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahrar
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: David C
authors.initials: DC
authors.lastname: Madoff
authors.forename: Ravi
authors.initials: R
authors.lastname: Murthy
authors.forename: Stephen E
authors.initials: SE
authors.lastname: McRae
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Hicks
mesh_terms: D000328:Adult; D000368:Aged; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome