Transcatheter arterial chemoembolization for gastrointestinal stromal tumors with liver metastases

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.