Surgical Resection for Gastric GIST with Multiple Liver Metastases after Imatinib Therapy

Ryuichiro Sato, Masaya Oikawa, Yu Katayose, Toshiki Rikiyama, Kuniharu Yamamoto, Hiroki Hayashi, Iwao Sasaki* and Michiaki Unno

Division of Hepato-Biliary Pancreatic Surgery, Department of Surgery and General and Alimentary Tract Surgery and Department of Surgery*, Tohoku University Graduate School of Medical Science

Advanced gastrointestinal stromal tumor (GIST) with multiple liver metastases was successfully resected after pharmacological debulking with imatinib. A 47-year-old man with a huge gastric GIST with multiple liver metastases considered irresectable was administrated 400 mg/day of imatinib. The tumor responded dramatically but a resistant clone appeared 8 months later. A small mass was detected inside one of the liver lesions that had changed to a shrunken cystic mass. In subsequent surgery, we successfully treated all tumors with total gastrectomy, partial hepatic resection, and hepatic radiofrequency abrasion (RFA). The resected specimen showed viable cells of a new liver lesion. Genetic analysis of the tumor revealed 2 mutations in KIT gene and 1 mutation in platelet-derived growth factor receptor-α (PDGFRA) gene. Since only surgery can potentially cure the disease, advanced GIST patients on imatinib therapy should be closely monitored for resistant lesions and surgery should be considered repeatedly to improve outcome.

Key words
gastrointestinal stromal tumor, imatinib, neoadjuvant chemotherapy

Reprint requests
Ryuichiro Sato Division of Hepato-Biliary Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medical Science
1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JAPAN

Accepted
September 27, 2006

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