Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2012; 18(42): 6134-6140
Published online Nov 14, 2012. doi: 10.3748/wjg.v18.i42.6134
Transcatheter arterial chemoembolization for gastrointestinal stromal tumors with liver metastases
Guang Cao, Jian Li, Lin Shen, Xu Zhu
Guang Cao, Xu Zhu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education of China), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Beijing 100142, China
Jian Li, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education of China), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
Author contributions: Cao G and Li J contributed equally to this work, both authors collected and analyzed the data of the patients, and prepared the manuscript; Shen L and Zhu X supervised the project and revised the manuscript.
Correspondence to: Xu Zhu, Master of Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education of China), Department of Interventional Therapy, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing 100142, China. drzhuxu@163.com
Telephone: +86-10-88121122 Fax: +86-10-88196561
Received: July 18, 2012
Revised: August 28, 2012
Accepted: October 19, 2012
Published online: November 14, 2012
Abstract

AIM: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) for gastrointestinal stromal tumor (GIST) with liver metastases after the failure of tyrosine kinase inhibitors (TKIs).

METHODS: Patients with histologically confirmed CD117-positive GIST with liver metastases who were resistant and/or intolerant to prior imatinib and/or sunitinib and who received TACE for at least one treatment cycle or only best supportive care and TKI reintroduction were eligible for the study. The patients were divided into two groups: those in TACE group received TACE treatment containing 5-20 mL iodized oil and 40-80 mg doxorubicin hydrochloride and TKI reintroduction or best supportive care, those in control group only received TKI reintroduction or best supportive care. The primary end-point was overall survival and the secondary end-points were, progression-free survival (PFS), response rates, and safety.

RESULTS: Sixty patients admitted between June 2008 and October 2011 were eligible for this study, including 22 in TACE group and 38 in control group. In the TACE group, 12 (54.5%) achieved liver partial response, 5 (22.7%) had stable disease, and 5 (22.7%) had liver progressive disease. Disease control rate of liver metastases was 77.3% in the TACE group and 39.5% in the control group. The median liver PFS in TACE group was 47.1 wk (95% CI: 23.9-70.3). The median PFS in TACE group was longer than in control group (30.0 wk, 95% CI: 20.1-39.9 vs 12.9 wk, 95% CI: 11.9-13.9) (P = 0.0001). The median overall survival in TACE group was also longer than in control group (68.5 wk, 95% CI: 57.4-79.6 vs 25.7 wk, 95% CI: 23.2-28.2) (P = 0.0001). TACE treatment significantly reduced the risk of death (hazard ratio: 0.109). Patients without extrahepatic metastases treated with TACE had significantly better prognosis. Most of the adverse events were of grade 1 or 2 and tolerable.

CONCLUSION: TACE is effective and well tolerated in GIST patients with liver metastases after TKI failure, and it may be an optional treatment for this disease.

Keywords: Gastrointestinal stromal tumor, Liver metastases, Transcatheter arterial chemoembolization, Tyrosine kinase inhibitor failure, Overall survival