Transarterial chemoembolization of liver metastases in patients with uveal melanoma

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Summary

Metastases from uveal melanoma are often confined to the liver. Palliative hepatic chemoembolization has been considered to be a reasonable treatment approach.

We enrolled 14 patients with hepatic metastases from uveal melanoma into a pilot trial of transarterial chemoembolization (TACE). All patients received additional systemic immuno-chemotherapy or best supportive care. In 31 procedures 100 mg/m2 of cisplatine was continuously infused by means of a power injector preceding embolization by manual injection of polyvinyl alcohol particles. In three procedures cisplatine was replaced by 200 mg/m2 carboplatine because of increased serum creatinine levels. Tumor response was evaluated using RECIST criteria.

Fourteen patients received 34 TACE's (mean: 2.4 treatments). Eight patients (57%) achieved partial response (PR), four patients (29%) had stable disease and two patients (14%) tumor progression. Median time to progression was 8.5 months (5–35 months). Median survival after first TACE was 14.5 months in responders compared to 10 months in non-responders (p = 0.18, not significant) and 11.5 months (3–69 months) in all patients. In seven patients with metastases occupying less than 25% of liver volume median survival was 17 months compared to 11 months in seven patients with tumor involvement of more than 25% (p = 0.02) with partial response rate of 86% and 29%, respectively.

TACE of liver metastases from uveal melanoma is well tolerated and may prolong survival in patients with limited tumor extension.

Section snippets

Introduction and purpose

Uveal melanomas represent about 5% of all melanomas [1]. Its dissemination is characterized by a strong tendency of hepatic involvement. Up to 50% of all patients develop metastases, about 87% to the liver, 46% to the lung and 29% to the bones; up to 60% of patients with tumor dissemination suffer from isolated liver involvement [1], [2], [3], [4]. The time interval between primary diagnosis and liver metastases ranges from 5 to 240 months, with a median of 36 months [1], [5].

Spontaneous

Patients

Between july 2001 and december 2006 we treated 14 patients with hepatic metastases secondary to uveal melanoma by hepatic transarterial chemoembolization (TACE). All procedures were in accordance with the ethical standards of the World Medical Association. Gender, age and liver tumor involvement are summarized in Table 1. Interval between the detection of the primary tumor and liver metastases ranged from 1 month to 20 years (mean 48 months). Two to four weeks prior to TACE systemic

Methods

Thirty-four TACE‘s were performed in 14 patients (range: 1–5 treatments per patient, mean: 2.4 treatments). The procedure was repeated with a mean interval of 8 weeks (range: 4–24 weeks). In patients with multiple metastases involving both liver lobes our strategy was to start with the segments containing the largest tumor nodules. To limit side effects, we did not treat more than 3 segments during one session. The intention was to treat all liver segments involved by tumor at least one time

Results

Treatment of all liver segments by at least one TACE was completed in 11 patients. In one patient the segments 4–8 showed metastases during CT and angiography but segment 2 and 3 did not; treatment was performed only in segment 4–8. In two patients metastases in the right liver lobe were treated, however small metastases (<8 mm) of segment 2 and 3 were not treated, because patients did not attend further treatments for individual reasons.

In all patients metastases showed moderate

Discussion

For patients with isolated liver metastases from uveal melanoma hepatic arterial infusion (HAI) and TACE are reasonable palliative treatment options. Cisplatine, carboplatine, fotemustine, melphalan and BCNU have been selected in previous studies for cytostatic drug infusion whereas iodized oil, polyvenylalcohol particles and gelfoam cubes where applied for embolization (Table 3). Cisplatine-based protocols for TACE showed in three of four series response rates varying from 25% to 50% [15], [16]

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