title: [A Case of GIST of the Stomach with Long-Term Survival after Multidisciplinary Treatment, Including Four Surgical Resections of Liver Metastases].
abstract: The most frequent relapse site of gastrointestinal stromal tumors(GIST)is the liver. We encountered a patient with longterm survival treated with multidisciplinary treatment, including4 hepatectomies for liver metastases. The patient was a woman aged 69 years at the time of the first medical treatment. She underwent total gastrectomy and S6 segmental hepatec- tomy for a stomach GIST with a hepatic metastasis. The tumor diameter was 24 cm and the mitotic figure was 65/50 HPF. According to the guidelines, it was diagnosed as a high risk GIST based on strong positive immunostaining for CD34 and c-kit. The tumor had metastasized to the liver and greater omentum. She took imatinib in the year following surgery. Because the GIST had spread to the lung1 8 months after the operation, she took imatinib again. Two years after the operation the pulmonary metastasis showed a clinical complete response(cCR)and the CR lasted for 4 years. Six years after the surgery she had a hepatic recurrence in S5, and she underwent an S5/4 partial hepatic resection. Seven years after the first operation, a liver S7 metastasis developed and she underwent S7 partial hepatectomy. Ten years after the first surgery, the GIST relapsed in liver S6 with right adrenal gland permeation. She underwent partial S6/7 liver resection and a right adrenal gland resection. She resumed takingimatinib after this surgical resection. Now, 11 years after the first operation, she is alive with an S1 hepatic recurrence taking sunitinib. Therefore, multidisciplinary treatment with surgical resection prolongs the survival of patients with resectable liver metastases of GIST.
authors.affiliation: Dept. of Surgery, National Hospital Organization Osaka National Hospital.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kitakaze
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Hamakawa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Sakae
authors.initials: S
authors.lastname: Maeda
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Masakazu
authors.initials: M
authors.lastname: Miyake
authors.forename: Naoki
authors.initials: N
authors.lastname: Hama
authors.forename: Michihiko
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Masataka
authors.initials: M
authors.lastname: Ikeda
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakamori
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kiyokawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mano
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Sekimoto
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents