title: [Multidisciplinary Treatment for High-Risk GIST of the Stomach].
abstract: A 59-year-old man underwent total gastrectomy(with D2 dissection)and cholecystectomy for gastric cancer and a submucosal tumor of the stomach. The specimen was immunohistochemically positive for c-kit, the Ki-67 label index was 10%, and the mitotic count was 20/HPF. Finally, the patient was diagnosed with high-risk gastrointestinal stromal cancer with normal type gastric cancer. After discharge from hospital, we started administration of TS-1 as adjuvant therapy for the gastric cancer. As multiple recurrences of the GIST in the abdomen developed, the patient underwent 3 radical local resections. Mutational analysis revealed a PDGFRA mutation in exon 18, which causes resistance to both imatinib and sunitinib. As he was refractory to imatinib, the patient received regorafenib. After a while, it caused liver failure, which required 7 rounds of plasmapheresis. The patient died from multiple organ failure resulting from multiple recurrences 4 years after the first surgery.
authors.affiliation: Dept. of Surgery, Kansai Rosai Hospital.
authors.forename: Tomo
authors.initials: T
authors.lastname: Ishida
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Tamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takeno
authors.forename: Kohei
authors.initials: K
authors.lastname: Murakami
authors.forename: Yohei
authors.initials: Y
authors.lastname: Nose
authors.forename: Ryota
authors.initials: R
authors.lastname: Mori
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Oneda
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kuwahara
authors.forename: Takuya
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Naito
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Katsura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ohmura
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kagawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kato
mesh_terms: D003131:Combined Modality Therapy; D005091:Exons; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000235:genetics / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010951:Plasma Exchange; D020796:Receptor, Platelet-Derived Growth Factor alpha / Q000235:genetics; D013274:Stomach Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*
chemical_list: D020796:Receptor, Platelet-Derived Growth Factor alpha