title: Radioembolization in patients with progressive gastrointestinal stromal tumor liver metastases undergoing treatment with tyrosine kinase inhibitors.
abstract: OBJECTIVE
  Gastrointestinal stromal tumors (GISTs) spread frequently to the peritoneum and the liver. If metastasectomy or tyrosine kinase inhibitors (TKIs) fail, interventional ablation techniques are considered. The purpose of this study is to assess the progression-free interval (PFI) of GIST liver metastases after radioembolization (RE).
  
  
  METHODS
  Eleven patients with progressive GIST liver metastases undergoing TKI therapy were referred for RE; one was excluded because of a large hepatopulmonary shunt, and one was lost to follow-up. Depending on intrahepatic tumor distribution, one or both liver lobes were treated with RE. Contrast-enhanced magnetic resonance imaging, contrast-enhanced computed tomography (CT), and [(18)F]fluorodeoxyglucose positron-emission tomography/CT were used for follow-up.
  
  
  RESULTS
  In all, 16 liver lobes were treated with a mean activity of 1.06 GBq ± 0.37 (range, 0.55-1.88) per lobe. Three patients showed complete response, five showed partial response, and one showed stable disease. No patient showed progressive disease after RE. Median PFI was 15.9 months (range, 4-29 mo). Median survival was 29.8 months (range, 10-72 mo). No radiation-induced liver disease developed; however, one patient required surgery for persistent stomach ulcer.
  
  
  CONCLUSIONS
  RE offers a safe and effective treatment for patients with GIST liver metastases who do not show a response to TKIs. RE could be an option for earlier phases of therapy in patients with mutational status. The results might also challenge the notion that GISTs are resistant to radiation therapy.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim. Electronic address: nils.rathmann@umm.de.
authors.forename: Nils
authors.initials: N
authors.lastname: Rathmann
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim.
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Diehl
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Dinter
authors.affiliation: Department of Oncology/Hematology, Marien-Hospital Düsseldorf, Düsseldorf.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schütte
authors.affiliation: Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pink
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim.
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.affiliation: Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim.
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D059248:Chemoradiotherapy / Q000379:methods*; D005770:Gastrointestinal Neoplasms / Q000628:therapy; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D011505:Protein-Tyrosine Kinases