Hepatectomy for a Hepatic Secondary Local Resistance in a Patient Treated by Imatinib Mesylate with Systemic Recurrence after Proximal Gastrectomy for Gastric Gastrointestinal Stromal Tumor

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  • 胃原発gastrointestinal stromal tumor術後のイマチニブ部分耐性肝転移に対して肝切除術を施行した1例

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Abstract

Imatinib is acceptable as a first-line therapy for unresectable and metastatic gastrointestinal stromal tumor (GIST). The significance of its surgical intervention remains unclear for focally imatinib-resistant GIST. We report a case of hepatectomy for liver metastasis from gastric GIST which was resistant to imatinib. An 82-year-old man underwent a proximal gastrectomy for GIST on June, 2008. Twelve months after the gastrectomy, abdominal CT showed multiple liver tumors. Multiple liver, bone and lymph node recurrences were revealed by PET. We initiated imatinib treatment (400 mg/day), and the patient maintained stable disease for 48 months. However, an abdominal CT scan revealed the regrowth of the tumor in S5 in the liver. PET showed focal progression of only the S5 lesion. Under a diagnosis of locally resistant GIST, we performed partial resection of the liver for localized progression of the PET positive S5 tumor on July, 2013. In this case, an exon 11 mutation of c-kit was initially noted. After the imatinib treatment, an additional point mutation arose in exon 13 that caused resistance to imatinib. He was discharged on postoperative day 23. The treatment with imatinib was restarted at 400 mg/day after hepatectomy, and the residual liver metastases are well controlled with imatinib at 18 months. This case suggests that a multidisciplinary treatment, including surgical resection may have some benefits for patients with secondary resistant GIST with focally progressive disease. Further studies are needed to confirm the efficacy and feasibility of surgical intervention for local resistant GIST.

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