Hepatic artery chemoembolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors.
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.
Kobayashi
Katsuhiro
K
Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Gupta
Sanjay
S
Trent
Jonathan C
JC
Vauthey
Jean-Nicolas
JN
Krishnamurthy
Savitri
S
Ensor
Joe
J
Ahrar
Kamran
K
Wallace
Michael J
MJ
Madoff
David C
DC
Murthy
Ravi
R
McRae
Stephen E
SE
Hicks
Marshall E
ME
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