A Thirteen and a Half Year Survival Case of Small Intestine Gastrointestinal Stromal Tumor with Multiple Liver Metastases Treated with Combined Therapies Including Radiofrequency Ablation

Abstract

A 45-year-old man presented to our hospital complaining of pain in the left lower abdominal quadrant and fever. Laboratory findings and abdominal ultrasound conducted by a local doctor suggested penetration of sigmoid colon cancer and multiple liver metastases. A contrast abdominal CT, a colonoscopic examination and a small bowel series in our hospital made the diagnosis of small intestine tumor with multiple liver metastases. We conducted partial resection of the small intestine. The pathological diagnosis was small intestine gastrointestinal stromal tumor (GIST). We started imatinib mesylate treatment. A CT scan one month after the start of chemotherapy showed that the multiple liver metastases increased in size. We thus added radiofrequency ablation (RFA) to the imatinib mesylate treatment. RFA was used three times for 14 lesions. For two years and six months after the initial RFA, multiple liver metastases kept the reduced states and there were no new recurrences. We performed hepatectomy for liver metastases two, five, seven, and ten years after the primary surgery. After that, there were lung metastases, adrenal metastasis, anterior mediastinal recurrence, retroperitoneal recurrence, pancreatic metastasis and posterior mediastinal recurrence, for which we performed surgical resections. He is free of tumor recurrence and has been on the imatinib treatment, as of 13 years and six months after the primary surgery. Combined therapies including RFA may be an effective treatment for simultaneous unresectable multiple liver metastases of small intestine GIST.