Treatment of 1 patient with small intestine stromal tumor with liver metastasis by MDT model_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DU Yong ¹ , LIU Lianghua ² , YE Pengcheng ¹ , ZHANG Ke ³ ,  WEI Shoujiang ¹

1. Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
3. Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

WEI Shoujiang, Email: nsmcwsj@163.com

Keywords：

gastrointestinal stromal tumor; liver metastasis; imatinib; multi-disciplinary team

DOI：

10.7507/1007-9424.201909114

Video：

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Objective To investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastrointestinal stromal tumor (GIST) with liver metastasis.Method The experiences of MDT model in treating huge (>10 cm) GIST with liver metastasis in the Affiliated Hospital of North Sichuan Medical College on August 2018 were summarized.Results The 46 years old female patient diagnosed with intestinal stromal tumor with liver metastasis at the initial visit. There was no chance of surgery. After the neoadjuvant therapy, the tumor was shrunk. After 2 MDT discussions, the R0 resection of the primary tumor or metastases was successfully performed. And then the patient continued to receive the oral imatinib 600 mg/d. The current overall survival was 31 months till now. No recurrence of the tumor was observed and the follow-up was still continued.Conclusions Tyrosine kinase inhibitors combined metastasectomy may be the most appropriate treatment for patient diagnosed with GIST with liver metastasis, which can improve the survival. In clinical work, MDT model could be used reasonably and carried out during the whole treatment process to provide the best treatment option for patient with GIST with liver metastasis.

Citation： DU Yong, LIU Lianghua, YE Pengcheng, ZHANG Ke, WEI Shoujiang. Treatment of 1 patient with small intestine stromal tumor with liver metastasis by MDT model. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(3): 337-344. doi: 10.7507/1007-9424.201909114 Copy

1.	Corless CL, Barnett CM, Heinrich MC. Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer, 2011, 11(12): 865-878.
2.	Bayraktar UD, Bayraktar S, Rocha-Lima CM. Molecular basis and management of gastrointestinal stromal tumors. World J Gastroenterol, 2010, 16(22): 2726-2734.
3.	Dematteo RP, Gold JS, Saran L, et al. Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer, 2008, 112(3): 608-615.
4.	中国研究型医院学会消化道肿瘤专业委员会, 中国医师协会外科医师分会多学科综合治疗专业委员会. 胃肠间质瘤多学科综合治疗协作组诊疗模式专家共识. 中国实用外科杂志, 2017, 37(1): 39-41.
5.	Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population-based study in western Sweden. Cancer, 2005, 103(4): 821-829.
6.	Corless CL, Heinrich MC. Molecular pathobiology of gastrointestinal stromal sarcomas. Annu Rev Pathol, 2008, 3: 557-586.
7.	Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw, 2010, 8 Suppl 2: S1-S41.
8.	Huss S, Pasternack H, Ihle MA, et al. Clinicopathological and molecular features of a large cohort of gastrointestinal stromal tumors (GISTs) and review of the literature: BRAF mutations in KIT/PDGFRA wild-type GISTs are rare events. Hum Pathol, 2017, 62: 206-214.
9.	Joyon N, Dumortier J, Aline-Fardin A, et al. Gastrointestinal stromal tumors (GIST) presenting in the liver: Diagnostic, prognostic and therapeutic issues. Clin Res Hepatol Gastroenterol, 2018, 42(2): e23-e28.
10.	Sciot R, Debiec-Rychter M, Daugaard S, et al. Distribution and prognostic value of histopathologic data and immuno histochemical markers in gastrointestinal stromal tumours (GISTs): An analysis of the EORTC phase Ⅲ trial of treatment of metastatic GISTs with imatinib mesylate. Eur J Cancer, 2008, 44(13): 1855-1860.
11.	Cai Z, Yin Y, Shen C, et al. Role of surgical resection for patients with recurrent or metastatic gastrointestinal stromal tumors: A systematic review and meta-analysis. Int J Surg, 2018, 56: 108-114.
12.	Zaydfudim V, Okuno SH, Que FG, et al. Role of operative therapy in treatment of metastatic gastrointestinal stromal tumors. J Surg Res, 2012, 177(2): 248-254.
13.	Bauer S, Rutkowski P, Hohenberger P, et al. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib—analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol, 2014, 40(4): 412-419.
14.	Sato S, Tsujinaka T, Masuzawa T, et al. Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry. Surg Today, 2017, 47(1): 58-64.
15.	Van Glabbeke M, Verweij J, Casali PG, et al. Initial and late resistance to imatinib in advanced gastrointestinal stromal tumors are predicted by different prognostic factors: a European Organisation for Research and Treatment of Cancer-Italian Sarcoma Group-Australasian Gastrointestinal Trials Group study. J Clin Oncol, 2005, 23(24): 5795-5804.
16.	Reichardt P, Kang YK, Rutkowski P, et al. Clinical outcomes of patients with advanced gastrointestinal stromal tumors: safety and efficacy in a worldwide treatment-use trial of sunitinib. Cancer, 2015, 121(9): 1405-1413.
17.	Demetri GD, Reichardt P, Kang YK, et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet, 2013, 381(9863): 295-302.
18.	von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563.
19.	Debiec-Rychter M, Sciot R, Le Cesne A, et al. KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours. Eur J Cancer, 2006, 42(8): 1093-1103.
20.	Patrikidou A, Chabaud S, Ray-Coquard I, et al. Influence of imatinib interruption and rechallenge on the residual disease in patients with advanced GIST: results of the BFR14 prospective French Sarcoma Group randomised, phase III trial. Ann Oncol, 2013, 24(4): 1087-1093.
21.	高晓东, 沈坤堂. 靶向治疗时代手术在胃肠间质瘤肝转移治疗中的地位. 中国普外基础与临床杂志, 2017, 24(2): 151-153.
22.	Verweij J, Casali PG, Zalcberg J, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet, 2004, 364(9440): 1127-1134.
23.	Heinrich MC, Corless CL, Blanke CD, et al. Molecular correlates of imatinib resistance in gastrointestinal stromal tumors. J Clin Oncol, 2006, 24(29): 4764-4774.
24.	Komatsu Y, Ohki E, Ueno N, et al. Safety, efficacy and prognostic analyses of sunitinib in the post-marketing surveillance study of Japanese patients with gastrointestinal stromal tumor. Jpn J Clin Oncol, 2015, 45(11): 1016-1022.
25.	von Mehren M, Joensuu H. Gastrointestinal stromal tumors. J Clin Oncol, 2018, 36(2): 136-143.
26.	Zheng S, Huang KE, Pan YL, et al. KIT and BRAF heterogeneous mutations in gastrointestinal stromal tumors after secondary imatinib resistance. Gastric Cancer, 2015, 18(4): 796-802.
27.	Miranda C, Nucifora M, Molinari F, et al. KRAS and BRAF mutations predict primary resistance to imatinib in gastrointestinal stromal tumors. Clin Cancer Res, 2012, 18(6): 1769-1776.
28.	Takaki H, Litchman T, Covey A, et al. Hepatic artery embolization for liver metastasis of gastrointestinal stromal tumor following imatinib and sunitinib therapy. J Gastrointest Cancer, 2014, 45(4): 494-499.
29.	Yamanaka T, Takaki H, Nakatsuka A, et al. Radiofrequency ablation for liver metastasis from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2013, 24(3): 341-346.
30.	Husted TL, Neff G, Thomas MJ, et al. Liver transplantation for primary or metastatic sarcoma to the liver. Am J Transplant, 2006, 6(2): 392-397.
31.	曹晖, 高志冬, 何裕隆, 等. 胃肠间质瘤规范化外科治疗中国专家共识(2018 版). 中国实用外科杂志, 2018, 38(9): 965-973.

1. Corless CL, Barnett CM, Heinrich MC. Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer, 2011, 11(12): 865-878.
2. Bayraktar UD, Bayraktar S, Rocha-Lima CM. Molecular basis and management of gastrointestinal stromal tumors. World J Gastroenterol, 2010, 16(22): 2726-2734.
3. Dematteo RP, Gold JS, Saran L, et al. Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer, 2008, 112(3): 608-615.
4. 中国研究型医院学会消化道肿瘤专业委员会, 中国医师协会外科医师分会多学科综合治疗专业委员会. 胃肠间质瘤多学科综合治疗协作组诊疗模式专家共识. 中国实用外科杂志, 2017, 37(1): 39-41.
5. Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population-based study in western Sweden. Cancer, 2005, 103(4): 821-829.
6. Corless CL, Heinrich MC. Molecular pathobiology of gastrointestinal stromal sarcomas. Annu Rev Pathol, 2008, 3: 557-586.
7. Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw, 2010, 8 Suppl 2: S1-S41.
8. Huss S, Pasternack H, Ihle MA, et al. Clinicopathological and molecular features of a large cohort of gastrointestinal stromal tumors (GISTs) and review of the literature: BRAF mutations in KIT/PDGFRA wild-type GISTs are rare events. Hum Pathol, 2017, 62: 206-214.
9. Joyon N, Dumortier J, Aline-Fardin A, et al. Gastrointestinal stromal tumors (GIST) presenting in the liver: Diagnostic, prognostic and therapeutic issues. Clin Res Hepatol Gastroenterol, 2018, 42(2): e23-e28.
10. Sciot R, Debiec-Rychter M, Daugaard S, et al. Distribution and prognostic value of histopathologic data and immuno histochemical markers in gastrointestinal stromal tumours (GISTs): An analysis of the EORTC phase Ⅲ trial of treatment of metastatic GISTs with imatinib mesylate. Eur J Cancer, 2008, 44(13): 1855-1860.
11. Cai Z, Yin Y, Shen C, et al. Role of surgical resection for patients with recurrent or metastatic gastrointestinal stromal tumors: A systematic review and meta-analysis. Int J Surg, 2018, 56: 108-114.
12. Zaydfudim V, Okuno SH, Que FG, et al. Role of operative therapy in treatment of metastatic gastrointestinal stromal tumors. J Surg Res, 2012, 177(2): 248-254.
13. Bauer S, Rutkowski P, Hohenberger P, et al. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib—analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol, 2014, 40(4): 412-419.
14. Sato S, Tsujinaka T, Masuzawa T, et al. Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry. Surg Today, 2017, 47(1): 58-64.
15. Van Glabbeke M, Verweij J, Casali PG, et al. Initial and late resistance to imatinib in advanced gastrointestinal stromal tumors are predicted by different prognostic factors: a European Organisation for Research and Treatment of Cancer-Italian Sarcoma Group-Australasian Gastrointestinal Trials Group study. J Clin Oncol, 2005, 23(24): 5795-5804.
16. Reichardt P, Kang YK, Rutkowski P, et al. Clinical outcomes of patients with advanced gastrointestinal stromal tumors: safety and efficacy in a worldwide treatment-use trial of sunitinib. Cancer, 2015, 121(9): 1405-1413.
17. Demetri GD, Reichardt P, Kang YK, et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet, 2013, 381(9863): 295-302.
18. von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563.
19. Debiec-Rychter M, Sciot R, Le Cesne A, et al. KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours. Eur J Cancer, 2006, 42(8): 1093-1103.
20. Patrikidou A, Chabaud S, Ray-Coquard I, et al. Influence of imatinib interruption and rechallenge on the residual disease in patients with advanced GIST: results of the BFR14 prospective French Sarcoma Group randomised, phase III trial. Ann Oncol, 2013, 24(4): 1087-1093.
21. 高晓东, 沈坤堂. 靶向治疗时代手术在胃肠间质瘤肝转移治疗中的地位. 中国普外基础与临床杂志, 2017, 24(2): 151-153.
22. Verweij J, Casali PG, Zalcberg J, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet, 2004, 364(9440): 1127-1134.
23. Heinrich MC, Corless CL, Blanke CD, et al. Molecular correlates of imatinib resistance in gastrointestinal stromal tumors. J Clin Oncol, 2006, 24(29): 4764-4774.
24. Komatsu Y, Ohki E, Ueno N, et al. Safety, efficacy and prognostic analyses of sunitinib in the post-marketing surveillance study of Japanese patients with gastrointestinal stromal tumor. Jpn J Clin Oncol, 2015, 45(11): 1016-1022.
25. von Mehren M, Joensuu H. Gastrointestinal stromal tumors. J Clin Oncol, 2018, 36(2): 136-143.
26. Zheng S, Huang KE, Pan YL, et al. KIT and BRAF heterogeneous mutations in gastrointestinal stromal tumors after secondary imatinib resistance. Gastric Cancer, 2015, 18(4): 796-802.
27. Miranda C, Nucifora M, Molinari F, et al. KRAS and BRAF mutations predict primary resistance to imatinib in gastrointestinal stromal tumors. Clin Cancer Res, 2012, 18(6): 1769-1776.
28. Takaki H, Litchman T, Covey A, et al. Hepatic artery embolization for liver metastasis of gastrointestinal stromal tumor following imatinib and sunitinib therapy. J Gastrointest Cancer, 2014, 45(4): 494-499.
29. Yamanaka T, Takaki H, Nakatsuka A, et al. Radiofrequency ablation for liver metastasis from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2013, 24(3): 341-346.
30. Husted TL, Neff G, Thomas MJ, et al. Liver transplantation for primary or metastatic sarcoma to the liver. Am J Transplant, 2006, 6(2): 392-397.
31. 曹晖, 高志冬, 何裕隆, 等. 胃肠间质瘤规范化外科治疗中国专家共识(2018 版). 中国实用外科杂志, 2018, 38(9): 965-973.

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Treatment of 1 patient with small intestine stromal tumor with liver metastasis by MDT model

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