Korean J Radiol.  2018 Feb;19(1):54-62. 10.3348/kjr.2018.19.1.54.

Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors

• Yoon IS
• Shin JH
• Han K
• Kim PN
• Kim KH
• Kang YK
• Ko HK

• KMID: 2425109
• DOI: http://doi.org/10.3348/kjr.2018.19.1.54

Abstract

OBJECTIVE
To evaluate the effectiveness, safety, and feasibility of intraoperative radiofrequency ablation (IORFA) under ultrasound guidance for the treatment of liver metastases from gastrointestinal stromal tumors (GISTs).
MATERIALS AND METHODS
From August 2009 to February 2017, 24 patients with liver metastases of GISTs underwent IORFA, 14 underwent concurrent IORFA and primary GIST resection, and 10 underwent IORFA to treat hepatic recurrence after previous primary GIST resection. Seventy-six hepatic metastases were treated, of which 47 were surgically resected and 29 underwent IORFA. All included patients received imatinib therapy as standard treatment before and after IORFA or surgical resection. A retrospective medical record review was conducted, and follow-up data were collected. Technical success and effectiveness, overall and GIST-specific survival, and complications were assessed.
RESULTS
The mean follow-up duration was 50.7 ± 34.7 months. The technical success rate of IORFA was 100%. New metastases developed in three of the 24 patients (12.5%) following a complete response 16, 51, and 95 months after IORFA, respectively. The cumulative one-, three-, and five-year overall survival rates were 100, 94.4, and 87.7%, respectively. The one-, three-, and five-year GIST-related survival rates were 100, 94.4, and 94.4%, respectively. Two major complications (biliary stricture and hepatic abscess) were observed.
CONCLUSION
IORFA appears to be a feasible and safe treatment option for liver metastasis in patients with primary GISTs. In addition, IORFA and surgical resection may be complementary, helping to obtain complete response in cases of otherwise inoperable liver metastases secondary to GISTs.

Keyword

Intraoperative; Radiofrequency ablation; Hepatic metastasis; Gastrointestinal stromal tumor

MeSH Terms

Catheter Ablation*
Constriction, Pathologic
Follow-Up Studies
Gastrointestinal Stromal Tumors*
Humans
Imatinib Mesylate
Liver*
Medical Records
Neoplasm Metastasis*
Recurrence
Retrospective Studies
Survival Rate
Ultrasonography
Imatinib Mesylate

Figure

• 

  Fig. 1 71-year-old female patient (No. 13) presented with three liver metastases.A. Metastatic tumor in left lateral segment (arrow on axial CT) was surgically resected. B. Two tumors (arrows) in right lobe were ablated because of suspected hepatic failure after extensive hepatectomy. C. Radiofrequency electrode (arrows) was placed in hepatic tumor under intraoperative ultrasound guidance. D. Echogenic bubble was noted at tip of electrode (arrow) during ablation. E. Coronal CT image obtained seven days after IORFA shows two ablated zones (arrows) with complete coverage. F. Coronal CT image obtained 13 months after IORFA shows no evidence of local tumor progression. Ablation zones (arrows) indicate considerable decrease in size. CT = computed tomography, IORFA = intraoperative radiofrequency ablation

• 

  Fig. 2 38-year-old male (Patient 7) presented with five liver metastases.A. Metastatic tumors in segment 4 (arrows, axial CT) were surgically resected with sub-capsular metastatic tumors. B. Tumor (arrow) in right lobe could not be removed surgically because of risk of hepatic failure after extensive hepatectomy. C. Left lobectomy was performed to remove bulk of main metastases. D. IORFA (arrow) was performed for tumor located deep in right lobe. Partial hepatectomy (arrowhead) for sub-capsular tumor is visible. E. Axial CT image obtained five months after IORFA shows single recurrence (arrow) in right lobe. F. Axial CT image obtained 10 months after IORFA shows progression of multiple tumors and recurrence in remaining liver.

• 

  Fig. 3 Survival curves for overall and GIST-specific survival after IORFA.Five-year overall and GIST-specific survival rate was 87.7% and 94.4%, respectively. GIST = gastrointestinal stromal tumor

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