A Role for Adjuvant RFA in Managing Hepatic Metastases from Gastrointestinal Stromal Tumors (GIST) After Treatment with Targeted Systemic Therapy Using Kinase Inhibitors

Hakimé, Antoine; Cesne, Axel Le; Deschamps, Frédèric; Farouil, Geoffroy; Boudabous, Sana; Aupérin, Anne; Dômont, Julien; Debaere, Thierry

doi:10.1007/s00270-013-0615-1

Cited by 33 publications

(11 citation statements)

References 28 publications

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“…Radiofrequency ablation (RFA) has recently been evaluated as an alternative form of treatment in several cases of unresectable GIST with liver metastasis ( 3 10 11 12 13 ). RFA may be a useful therapeutic option for patients with metastatic GIST and should be performed at the time of best clinical response, followed by post-procedural imatinib maintenance therapy ( 14 ). Among RFA techniques, intraoperative RFA (IORFA), with or without surgical resection, has been reported to yield several advantages when compared with percutaneous RFA, including a broader indication for surgical resection as a treatment for various hepatic metastases ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors

et al. 2018

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ObjectiveTo evaluate the effectiveness, safety, and feasibility of intraoperative radiofrequency ablation (IORFA) under ultrasound guidance for the treatment of liver metastases from gastrointestinal stromal tumors (GISTs).Materials and MethodsFrom August 2009 to February 2017, 24 patients with liver metastases of GISTs underwent IORFA, 14 underwent concurrent IORFA and primary GIST resection, and 10 underwent IORFA to treat hepatic recurrence after previous primary GIST resection. Seventy-six hepatic metastases were treated, of which 47 were surgically resected and 29 underwent IORFA. All included patients received imatinib therapy as standard treatment before and after IORFA or surgical resection. A retrospective medical record review was conducted, and follow-up data were collected. Technical success and effectiveness, overall and GIST-specific survival, and complications were assessed.ResultsThe mean follow-up duration was 50.7 ± 34.7 months. The technical success rate of IORFA was 100%. New metastases developed in three of the 24 patients (12.5%) following a complete response 16, 51, and 95 months after IORFA, respectively. The cumulative one-, three-, and five-year overall survival rates were 100, 94.4, and 87.7%, respectively. The one-, three-, and five-year GIST-related survival rates were 100, 94.4, and 94.4%, respectively. Two major complications (biliary stricture and hepatic abscess) were observed.ConclusionIORFA appears to be a feasible and safe treatment option for liver metastasis in patients with primary GISTs. In addition, IORFA and surgical resection may be complementary, helping to obtain complete response in cases of otherwise inoperable liver metastases secondary to GISTs.

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Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors

et al. 2018

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“…Locally ablative or locoregional therapies are in use in a variety of tumors, including primary and secondary liver neoplasms, and may constitute a less invasive modality for tumor debulking in this disease. Radiofrequency ablation [94,95], transarterial chemoembolization [96,97] and transarterial yttrium-90 radioembolization [98,99] have all been used in patients with metastatic GISTs. As with surgery, data regarding local interventional treatments are retrospective and based on limited patient numbers.…”

Section: Management Of Advanced/metastatic Gistsmentioning

confidence: 99%

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Garlipp

Bruns

2014

Gastrointest Tumors

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Background: Gastrointestinal stromal tumors (GISTs) are the most frequently diagnosed mesenchymal neoplasms of the gastrointestinal tract. Despite their biological and clinical heterogeneity, the majority of these tumors are positive for the receptor tyrosine kinase KIT and are driven by KIT- or platelet-derived growth factor receptor alpha (PDGFRA)-activating mutations. There are still uncertainties regarding their clinical and molecular characterization and the optimal treatment regimens, making it difficult to establish a universal treatment algorithm for these tumors. Summary: From a clinical perspective, the main difference between GISTs and other gastrointestinal neoplasms is that the benign or malignant behavior of GISTs cannot be predicted from histopathology, but instead relies on empirically established scoring systems. Clinical data suggest that malignant potential may be an inherent quality of some GISTs rather than a feature acquired by the tumor during disease progression. Thus, some patients may require prolonged anti-tumor treatment even after complete surgical removal of the tumor. Key Message: Although GISTs are the most frequently occurring mesenchymal neoplasms in the gastrointestinal tract, no universal treatment algorithms exist. This paper reviews the current evidence that guides the management of GISTs. Practical Implications: The management of localized GISTs involves the use of surgical resection, with the inclusion of preoperative tyrosine kinase inhibitor treatment for locally advanced, primarily unresectable tumors and for resectable cases requiring extensive surgery. Imatinib is also indicated as adjuvant therapy after complete surgical removal of GISTs with a high estimated risk of recurrence unless specific mutations conferring imatinib resistance are present. The optimal duration of adjuvant treatment is still controversial. For patients with metastatic imatinib-sensitive GISTs, imatinib constitutes the first-line standard treatment. Molecular characterization of the tumor (with respect to the PDGFRA and KIT genes) is mandatory prior to imatinib therapy. Sunitinib and regorafenib are established as alternative treatments for patients demonstrating generalized disease progression on imatinib. New tyrosine kinase inhibitors such as ponatinib and crenolanib as well as drugs targeting alternative pathways are currently under investigation. Surgery and locally ablative treatments may be indicated in some metastatic patients.

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“…The authors believe that their treatment modality is effective and safe in patients with GIST liver metastases who undergo imatinib treatment, and that the treatment should be applied at the appropriate time for the best clinical response. 16 …”

Section: Discussionmentioning

confidence: 99%

Management of gastrointestinal stromal tumors: A 10-year experience of a single surgical department

Janczak

Rać²,

Pawłowski

et al. 2018

Adv Clin Exp Med

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A Role for Adjuvant RFA in Managing Hepatic Metastases from Gastrointestinal Stromal Tumors (GIST) After Treatment with Targeted Systemic Therapy Using Kinase Inhibitors

Abstract: RFA in patients, previously treated with TKI, is feasible and safe. Our data suggest that RFA is a useful therapeutic option in patients with metastatic GIST and should be performed at the time of best clinical response with patient maintained under TKI after the procedure.

Cited by 33 publications

References 28 publications

Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors

Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Management of gastrointestinal stromal tumors: A 10-year experience of a single surgical department

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