Treatment for gastrointestinal stromal tumor with liver metastasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YI Xin ,  LUO Shiqiao

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

LUO Shiqiao, Email: shiqiaoluo@qq.com

Keywords：

gastrointestinal stromal tumor; liver metastasis; treatment; review

DOI：

10.7507/1007-9424.201910062

Video：

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Objective To summarize current treatment methods and research advances of liver metastasis in patients with gastrointestinal stromal tumor (GIST).Method The related literatures about treatment of liver metastasis in patients with GIST were collected and reviewed.Results GIST often occurred liver metastasis, which seriously affected the prognosis of patients. In the era of tyrosine kinase inhibitors (TKI) treatment, radical resection combined with TKI was the first choice. In addition, radiofrequency ablation and interventional therapy could be selected according to the patient’s condition.Conclusions Complete resection of tumor and TKI treatment can improve the prognosis and survival rate of GIST patients with liver metastasis. GIST patients with liver metastasis need multi-disciplinary and multi-mode combined treatment.

Citation： YI Xin, LUO Shiqiao. Treatment for gastrointestinal stromal tumor with liver metastasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 774-780. doi: 10.7507/1007-9424.201910062 Copy

1.	Ducimetière F, Lurkin A, Ranchère-Vince D, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PLoS One, 2011, 6(8): e20294.
2.	Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4^th) edition. Pathology, 2014, 46(2): 95-104.
3.	Wada R, Arai H, Kure S, et al. “Wild type” GIST: clinicopathological features and clinical practice. Pathol Int, 2016, 66(8): 431-437.
4.	DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastro-intestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg, 2000, 231(1): 51-58.
5.	Pawlik TM, Vauthey JN, Abdalla EK, et al. Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg, 2006, 141(6): 537-543.
6.	Nunobe S, Sano T, Shimada K, et al. Surgery including liver resection for metastatic gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Jpn J Clin Oncol, 2005, 35(6): 338-341.
7.	DeMatteo RP, Shah A, Fong Y, et al. Results of hepatic resection for sarcoma metastatic to liver. Ann Surg, 2001, 234(4): 540-548.
8.	Xia L, Zhang MM, Ji L, et al. Resection combined with imatinib therapy for liver metastases of gastrointestinal stromal tumors. Surg Today, 2010, 40(10): 936-942.
9.	Chen Q, Li C, Yang H, et al. Resection combined with TKI Therapy for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. J Gastrointest Surg, 2019, [Epub ahead of print].
10.	Brudvik KW, Patel SH, Roland CL, et al. Survival after resection of gastrointestinal stromal tumor and sarcoma liver metastases in 146 patients. J Gastrointest Surg, 2015, 19(8): 1476-1483.
11.	Turley RS, Peng PD, Reddy SK, et al. Hepatic resection for metastatic gastrointestinal stromal tumors in the tyrosine kinase inhibitor era. Cancer, 2012, 118(14): 3571-3578.
12.	Xiao B, Peng J, Tang J, et al. Liver surgery prolongs the survival of patients with gastrointestinal stromal tumor liver metastasis: a retrospective study from a single center. Cancer Manag Res, 2018, 10: 6121-6127.
13.	Kanda T, Masuzawa T, Hirai T, et al. Surgery and imatinib therapy for liver oligometastasis of GIST: a study of Japanese Study Group on GIST. Jpn J Clin Oncol, 2017, 47(4): 369-372.
14.	Ang C, Maki RG. Contemporary management of metastatic gastrointestinal stromal tumors: systemic and locoregional approaches. Oncol Ther, 2016, 4(1): 1-16.
15.	Shima Y, Horimi T, Ishikawa T, et al. Aggressive surgery for liver metastases from gastrointestinal stromal tumors. J Hepatobiliary Pancreat Surg, 2003, 10(1): 77-80.
16.	Gomez D, Al-Mukthar A, Menon KV, et al. Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experience. HPB (Oxford), 2007, 9(1): 64-70.
17.	de la Fuente SG, Deneve JL, Parsons CM, et al. A comparison between patients with gastrointestinal stromal tumours diagnosed with isolated liver metastases and liver metastases plus sarcomatosis. HPB (Oxford), 2013, 15(9): 655-660.
18.	Cheung TT, Chok KS, Chan AC, et al. Analysis of long-term survival after hepatectomy for isolated liver metastasis of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(11): 827-831.
19.	Cananzi FC, Belgaumkar AP, Lorenzi B, et al. Liver surgery in the multidisciplinary management of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(12): E1-E8.
20.	Vassos N, Agaimy A, Hohenberger W, et al. Management of liver metastases of gastrointestinal stromal tumors (GIST). Ann Hepatol, 2015, 14(4): 531-539.
21.	Seesing MF, Tielen R, van Hillegersberg R, et al. Resection of liver metastases in patients with gastrointestinal stromal tumors in the imatinib era: a nationwide retrospective study. Eur J Surg Oncol, 2016, 42(9): 1407-1413.
22.	Shi YN, Li Y, Wang LP, et al. Gastrointestinal stromal tumor (GIST) with liver metastases: an 18-year experience from the GIST cooperation group in North China. Medicine (Baltimore), 2017, 96(46): e8240.
23.	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.
24.	Inaba CS, Dosch A, Koh CY, et al. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc, 2019, 33(3): 923-932.
25.	Stanek M, Pisarska M, Rzepa A, et al. Laparoscopic treatment of large gastrointestinal stromal tumors (>5 cm). Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 170-175.
26.	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.
27.	Mussi C, Ronellenfitsch U, Jakob J, et al. Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients? Ann Oncol, 2010, 21(2): 403-408.
28.	Machairas N, Prodromidou A, Molmenti E, et al. Management of liver metastases from gastrointestinal stromal tumors: where do we stand? J Gastrointest Oncol, 2017, 8(6): 1100-1108.
29.	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.
30.	Keung EZ, Fairweather M, Raut CP. The role of surgery in metastatic gastrointestinal stromal tumors. Curr Treat Options Oncol, 2016, 17(2): 8.
31.	Antonescu CR, Besmer P, Guo T, et al. Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation. Clin Cancer Res, 2005, 11(11): 4182-4190.
32.	Zhu J, Yang Y, Zhou L, et al. A long-term follow-up of the imatinib mesylate treatment for the patients with recurrent gastrointestinal stromal tumor (GIST): the liver metastasis and the outcome. BMC Cancer, 2010, 10(1): 199.
33.	Lin JX, Chen QF, Zheng CH, et al. Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up. J Cancer Res Clin Oncol, 2017, 143(4): 727-734.
34.	Zhang X, Zhou Y, Wu X, et al. Cytoreductive surgery for metastatic gastrointestinal stromal tumors followed by sunitinib compared to followed by imatinib-a multi–center cohort study. Eur J Surg Oncol, 2019, 45(3): 318-323.
35.	Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol, 2012, 13(3): 265-274.
36.	Gaitanidis A, Alevizakos M, Tsaroucha A, et al. Incidence and predictors of synchronous liver metastases in patients with gastrointestinal stromal tumors (GISTs). Am J Surg, 2018, 216(3): 492-497.
37.	Cavnar MJ, Seier K, Curtin C, et al. Outcome of 1 000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre and post-imatinib eras. Ann Surg, 2019, [Epub ahead of print].
38.	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.
39.	Yoon IS, Shin JH, Han K, et al. Ultrasound-guided intraoperative radiofrequency ablation and surgical resection for liver metastasis from malignant gastrointestinal stromal tumors. Korean J Radiol, 2018, 19(1): 54-62.
40.	Chen Q, Li C, Yang H, et al. Radiofrequency ablation versus resection for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. Clin Res Hepatol Gastroenterol, 2019, 43(3): 317-323.
41.	Hakimé A, Le Cesne A, Deschamps F, et al. A role for adjuvant RFA in managing hepatic metastases from gastrointestinal stromal tumors (GIST) after treatment with targeted systemic therapy using kinase inhibitors. Cardiovasc Intervent Radiol, 2014, 37(1): 132-139.
42.	Jones RL, McCall J, Adam A, et al. Radiofrequency ablation is a feasible therapeutic option in the multi modality management of sarcoma. Eur J Surg Oncol, 2010, 36(5): 477-482.
43.	Jung JH, Won HJ, Shin YM, et al. Safety and efficacy of radio-frequency ablation for hepatic metastases from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2015, 26(12): 1797-1802.
44.	Maluccio MA, Covey AM, Schubert J, et al. Treatment of metastatic sarcoma to the liver with bland embolization. Cancer, 2006, 107(7): 1617-1623.
45.	Kobayashi K, Gupta S, Trent JC, et al. Hepatic artery chemo-embolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors. Cancer, 2006, 107(12): 2833-2841.
46.	Cao G, Li J, Shen L, et al. Transcatheter arterial chemoembolization for gastrointestinal stromal tumors with liver metastases. World J Gastroenterol, 2012, 18(42): 6134-6140.
47.	Cao G, Zhu X, Li J, et al. A comparative study between Embosphere(®) and conventional transcatheter arterial chemoembolization for treatment of unresectable liver metastasis from GIST. Chin J Cancer Res, 2014, 26(1): 124-131.
48.	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.
49.	Omari J, Drewes R, Matthias M, et al. Treatment of metastatic, imatinib refractory, gastrointestinal stroma tumor with image-guided high-dose-rate interstitial brachytherapy. Brachytherapy, 2019, 18(1): 63-70.
50.	Rathmann N, Diehl SJ, Dinter D, et al. Radioembolization in patients with progressive gastrointestinal stromal tumor liver metastases undergoing treatment with tyrosine kinase inhibitors. J Vasc Interv Radiol, 2015, 26(2): 231-238.
51.	Joensuu H, Eriksson M, Collan J, et al. Radiotherapy for GIST progressing during or after tyrosine kinase inhibitor therapy: a prospective study. Radiother Oncol, 2015, 116(2): 233-238.
52.	Radkani P, Ghersi MM, Paramo JC, et al. A multidisciplinary approach for the treatment of GIST liver metastasis. World J Surg Oncol, 2008, 6(1): 46.
53.	Iesari S, Mocchegiani F, Nicolini D, et al. Liver transplantation for metastatic wild-type gastrointestinal stromal tumor in the era of molecular targeted therapies: report of a first case. Am J Transplant, 2019, 19(10): 2939-2943.
54.	Serralta AS, Sanjuan FR, Moya AH, et al. Combined liver transplantation plus imatinib for unresectable metastases of gastrointestinal stromal tumours. Eur J Gastroenterol Hepatol, 2004, 16(11): 1237-1239.

1. Ducimetière F, Lurkin A, Ranchère-Vince D, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PLoS One, 2011, 6(8): e20294.
2. Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4^th) edition. Pathology, 2014, 46(2): 95-104.
3. Wada R, Arai H, Kure S, et al. “Wild type” GIST: clinicopathological features and clinical practice. Pathol Int, 2016, 66(8): 431-437.
4. DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastro-intestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg, 2000, 231(1): 51-58.
5. Pawlik TM, Vauthey JN, Abdalla EK, et al. Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg, 2006, 141(6): 537-543.
6. Nunobe S, Sano T, Shimada K, et al. Surgery including liver resection for metastatic gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Jpn J Clin Oncol, 2005, 35(6): 338-341.
7. DeMatteo RP, Shah A, Fong Y, et al. Results of hepatic resection for sarcoma metastatic to liver. Ann Surg, 2001, 234(4): 540-548.
8. Xia L, Zhang MM, Ji L, et al. Resection combined with imatinib therapy for liver metastases of gastrointestinal stromal tumors. Surg Today, 2010, 40(10): 936-942.
9. Chen Q, Li C, Yang H, et al. Resection combined with TKI Therapy for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. J Gastrointest Surg, 2019, [Epub ahead of print].
10. Brudvik KW, Patel SH, Roland CL, et al. Survival after resection of gastrointestinal stromal tumor and sarcoma liver metastases in 146 patients. J Gastrointest Surg, 2015, 19(8): 1476-1483.
11. Turley RS, Peng PD, Reddy SK, et al. Hepatic resection for metastatic gastrointestinal stromal tumors in the tyrosine kinase inhibitor era. Cancer, 2012, 118(14): 3571-3578.
12. Xiao B, Peng J, Tang J, et al. Liver surgery prolongs the survival of patients with gastrointestinal stromal tumor liver metastasis: a retrospective study from a single center. Cancer Manag Res, 2018, 10: 6121-6127.
13. Kanda T, Masuzawa T, Hirai T, et al. Surgery and imatinib therapy for liver oligometastasis of GIST: a study of Japanese Study Group on GIST. Jpn J Clin Oncol, 2017, 47(4): 369-372.
14. Ang C, Maki RG. Contemporary management of metastatic gastrointestinal stromal tumors: systemic and locoregional approaches. Oncol Ther, 2016, 4(1): 1-16.
15. Shima Y, Horimi T, Ishikawa T, et al. Aggressive surgery for liver metastases from gastrointestinal stromal tumors. J Hepatobiliary Pancreat Surg, 2003, 10(1): 77-80.
16. Gomez D, Al-Mukthar A, Menon KV, et al. Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experience. HPB (Oxford), 2007, 9(1): 64-70.
17. de la Fuente SG, Deneve JL, Parsons CM, et al. A comparison between patients with gastrointestinal stromal tumours diagnosed with isolated liver metastases and liver metastases plus sarcomatosis. HPB (Oxford), 2013, 15(9): 655-660.
18. Cheung TT, Chok KS, Chan AC, et al. Analysis of long-term survival after hepatectomy for isolated liver metastasis of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(11): 827-831.
19. Cananzi FC, Belgaumkar AP, Lorenzi B, et al. Liver surgery in the multidisciplinary management of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(12): E1-E8.
20. Vassos N, Agaimy A, Hohenberger W, et al. Management of liver metastases of gastrointestinal stromal tumors (GIST). Ann Hepatol, 2015, 14(4): 531-539.
21. Seesing MF, Tielen R, van Hillegersberg R, et al. Resection of liver metastases in patients with gastrointestinal stromal tumors in the imatinib era: a nationwide retrospective study. Eur J Surg Oncol, 2016, 42(9): 1407-1413.
22. Shi YN, Li Y, Wang LP, et al. Gastrointestinal stromal tumor (GIST) with liver metastases: an 18-year experience from the GIST cooperation group in North China. Medicine (Baltimore), 2017, 96(46): e8240.
23. 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.
24. Inaba CS, Dosch A, Koh CY, et al. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc, 2019, 33(3): 923-932.
25. Stanek M, Pisarska M, Rzepa A, et al. Laparoscopic treatment of large gastrointestinal stromal tumors (>5 cm). Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 170-175.
26. 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.
27. Mussi C, Ronellenfitsch U, Jakob J, et al. Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients? Ann Oncol, 2010, 21(2): 403-408.
28. Machairas N, Prodromidou A, Molmenti E, et al. Management of liver metastases from gastrointestinal stromal tumors: where do we stand? J Gastrointest Oncol, 2017, 8(6): 1100-1108.
29. 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.
30. Keung EZ, Fairweather M, Raut CP. The role of surgery in metastatic gastrointestinal stromal tumors. Curr Treat Options Oncol, 2016, 17(2): 8.
31. Antonescu CR, Besmer P, Guo T, et al. Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation. Clin Cancer Res, 2005, 11(11): 4182-4190.
32. Zhu J, Yang Y, Zhou L, et al. A long-term follow-up of the imatinib mesylate treatment for the patients with recurrent gastrointestinal stromal tumor (GIST): the liver metastasis and the outcome. BMC Cancer, 2010, 10(1): 199.
33. Lin JX, Chen QF, Zheng CH, et al. Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up. J Cancer Res Clin Oncol, 2017, 143(4): 727-734.
34. Zhang X, Zhou Y, Wu X, et al. Cytoreductive surgery for metastatic gastrointestinal stromal tumors followed by sunitinib compared to followed by imatinib-a multi–center cohort study. Eur J Surg Oncol, 2019, 45(3): 318-323.
35. Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol, 2012, 13(3): 265-274.
36. Gaitanidis A, Alevizakos M, Tsaroucha A, et al. Incidence and predictors of synchronous liver metastases in patients with gastrointestinal stromal tumors (GISTs). Am J Surg, 2018, 216(3): 492-497.
37. Cavnar MJ, Seier K, Curtin C, et al. Outcome of 1 000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre and post-imatinib eras. Ann Surg, 2019, [Epub ahead of print].
38. 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.
39. Yoon IS, Shin JH, Han K, et al. Ultrasound-guided intraoperative radiofrequency ablation and surgical resection for liver metastasis from malignant gastrointestinal stromal tumors. Korean J Radiol, 2018, 19(1): 54-62.
40. Chen Q, Li C, Yang H, et al. Radiofrequency ablation versus resection for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. Clin Res Hepatol Gastroenterol, 2019, 43(3): 317-323.
41. Hakimé A, Le Cesne A, Deschamps F, et al. A role for adjuvant RFA in managing hepatic metastases from gastrointestinal stromal tumors (GIST) after treatment with targeted systemic therapy using kinase inhibitors. Cardiovasc Intervent Radiol, 2014, 37(1): 132-139.
42. Jones RL, McCall J, Adam A, et al. Radiofrequency ablation is a feasible therapeutic option in the multi modality management of sarcoma. Eur J Surg Oncol, 2010, 36(5): 477-482.
43. Jung JH, Won HJ, Shin YM, et al. Safety and efficacy of radio-frequency ablation for hepatic metastases from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2015, 26(12): 1797-1802.
44. Maluccio MA, Covey AM, Schubert J, et al. Treatment of metastatic sarcoma to the liver with bland embolization. Cancer, 2006, 107(7): 1617-1623.
45. Kobayashi K, Gupta S, Trent JC, et al. Hepatic artery chemo-embolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors. Cancer, 2006, 107(12): 2833-2841.
46. Cao G, Li J, Shen L, et al. Transcatheter arterial chemoembolization for gastrointestinal stromal tumors with liver metastases. World J Gastroenterol, 2012, 18(42): 6134-6140.
47. Cao G, Zhu X, Li J, et al. A comparative study between Embosphere(®) and conventional transcatheter arterial chemoembolization for treatment of unresectable liver metastasis from GIST. Chin J Cancer Res, 2014, 26(1): 124-131.
48. 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.
49. Omari J, Drewes R, Matthias M, et al. Treatment of metastatic, imatinib refractory, gastrointestinal stroma tumor with image-guided high-dose-rate interstitial brachytherapy. Brachytherapy, 2019, 18(1): 63-70.
50. Rathmann N, Diehl SJ, Dinter D, et al. Radioembolization in patients with progressive gastrointestinal stromal tumor liver metastases undergoing treatment with tyrosine kinase inhibitors. J Vasc Interv Radiol, 2015, 26(2): 231-238.
51. Joensuu H, Eriksson M, Collan J, et al. Radiotherapy for GIST progressing during or after tyrosine kinase inhibitor therapy: a prospective study. Radiother Oncol, 2015, 116(2): 233-238.
52. Radkani P, Ghersi MM, Paramo JC, et al. A multidisciplinary approach for the treatment of GIST liver metastasis. World J Surg Oncol, 2008, 6(1): 46.
53. Iesari S, Mocchegiani F, Nicolini D, et al. Liver transplantation for metastatic wild-type gastrointestinal stromal tumor in the era of molecular targeted therapies: report of a first case. Am J Transplant, 2019, 19(10): 2939-2943.
54. Serralta AS, Sanjuan FR, Moya AH, et al. Combined liver transplantation plus imatinib for unresectable metastases of gastrointestinal stromal tumours. Eur J Gastroenterol Hepatol, 2004, 16(11): 1237-1239.

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Treatment for gastrointestinal stromal tumor with liver metastasis

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