Treatment of liver metastases from uveal melanoma by combined surgery-chemotherapy.
OBJECTIVE
To investigate sporadic results demonstrating prolonged survival after surgical resection and/or intraarterial chemotherapy (IACH) for liver metastases from uveal melanoma.


METHODS
From December 1992 to March 1997 every patient with liver metastases from uveal melanoma was enrolled in a prospective study including: (1) aggressive surgical approach removing as much liver disease as possible; (2) implantation of an intraaterial catheter; (3) intraarterial chemotherapy for 6 months. 75 patients were enrolled: 38 men, 37 women, mean age 51 years (range: 18-72), mean time from initial diagnosis of uveal melanoma to liver metastases 37 months (ranged: 1-168).


RESULTS
Disseminated disease in both lobes was present in all but one patient. Macroscopically curative surgery was possible in 27.5%. Significant tumour reduction was performed in 49.3% and a simple biopsy was possible in 23.2%. Eight patients did not receive chemotherapy and died soon after. IACH included Fotemustine and/or DTIC-Platinum for 4-9 cycles. Overall median survival was 9 months; very similar to non-operated historical controls. In the 61 patients receiving complete treatment surgery plus chemotherapy, median survival improved to 10 months. When curative resection was possible, survival increased to 22 months (P < 0.001).


CONCLUSIONS
Aggressive surgical resection, when possible, appears to be the best method of improving survival of liver metastases from uveal melanoma. New drug combinations are also required to improve survival.
Salmon
R J
RJ
Department of Surgery, Institut Curie, Paris, France.
Levy
C
C
Plancher
C
C
Dorval
T
T
Desjardins
L
L
Leyvraz
S
S
Pouillart
P
P
Schlienger
P
P
Servois
V
V
Asselain
B
B
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000008:administration & dosage; D009943:Organophosphorus Compounds / Q000008:administration & dosage; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000473:pathology*
D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; C054368:fotemustine; D002945:Cisplatin