The Long-term Efficacy of Imatinib With Hepatic Resection or Other Local Treatment for GIST Liver Metastases
Condition: GIST, Malignant; Liver Metastases
MeSH terms: Neoplasm Metastasis; Liver Neoplasms
Study type: Observational

Summary: 
      The goal of this observational study is to evaluate the overall survival benefits of local
      treatment combined with imatinib(IM) and IM alone in patients suffering from GIST liver
      metastases. The main question it aims to answer is:

      • Whether IM combined with hepatic resection (HR) or other local treatments such as
      radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) has better long-term
      survival benefits compared to IM monotherapy.

      Patients are divided into different treatment groups:

        -  IM group

        -  IM combined with HR group

        -  IM combined with RFA or TACE group

      Researchers will compare the IM + HR group and IM + RFA/TACE group with the IM group to see
      if it has a better Overall survival (OS).
    

Detailed description: 
      Gastrointestinal stromal tumors (GISTs) represent the most prevalent type of mesenchymal
      tumor within the gastrointestinal tract, and the liver is the most common site of metastasis
      from GIST. Imatinib (IM) has significantly enhanced clinical outcomes for patients with
      advanced disease. Since its approval in February 2002 for treating metastatic or unresectable
      GISTs, 38% of patients have shown a partial response, while 13.6% have experienced disease
      progression within 1 to 3 months of IM administration. Over half of the patients with
      metastases experienced disease progression within two years of IM treatment, attributed to
      secondary drug resistance. Few studies are comparing the survival benefits of different
      surgical modalities. The investigators aimed to evaluate IM combined with hepatic resection
      (HR) or other local treatments such as radiofrequency ablation (RFA) and transarterial
      chemoembolization (TACE), compared to IM monotherapy in long-term survival benefits in
      patients suffering from GIST liver metastases.
    

Intervention name(s): imatinib (IM); hepatic resection (HR); radiofrequency ablation (RFA); transarterial chemoembolization (TACE)
Intervention type(s): Drug; Procedure; Procedure; Procedure
Intervention description(s): Patients with GIST liver metastases were administered an initial IM dose of 400 mg daily, while those with KIT exon 9 mutations received 600-800 mg daily. All patients continued IM indefinitely unless progression or intolerable adverse reactions.; HR The determination of the surgical modality was established subsequent to comprehensive consultations tailored to each patient within the Department of Liver Surgery. The surgical strategy was established in consideration of factors such as the residual liver volume, tumour positioning, and the surgeon's personal preference. Employing an intraoperative ultrasonographic to enhance the precision of operative assessment.; RFA RFA was executed utilizing the commercially accessible Cool-tip™ RFA system or the RF 2000 system. The electrode was percutaneously inserted through a guide needle under real-time ultrasound guidance.The primary objective of the RFA procedures encompassed the complete elimination of the tumour entity, with a prescribed ablative margin of 0.5 cm meticulously factored in.; TACE Under a comprehensive assessment of the hepatic arterial blood supply, a selective catheter was introduced into the segmental or subsegmental arteries that supplied the tumour. The regimen of hepatic arterial infusion chemotherapy included infusion of carboplatin 300 mg, a mixture of 50 mg of epirubicin and 8 mg of mitomycin C, intimately blended with 5 mL of lipiodol. Embolization was finally performed with either absorbable gelatin sponge particles or polyvinyl alcohol particles .
Other intervention name(s): Gleevec
Intervention MeSH terms: Imatinib Mesylate
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        From January 2002 to April 2022, 330 consecutive patients were diagnosed with GIST liver
        metastases. Finally, a total of 238 patients were enrolled in our study. The patients were
        segregated into different treatment categories: IM therapy (n=126), IM combined with HR
        (n=81) and IM combined with RFA/TACE (n=31).