Treatment of liver metastases from uveal melanoma.
BACKGROUND
Uveal melanoma patients with liver metastases have a poor prognosis. The effect of screening and multimodality treatment (including surgery) should be evaluated.


METHODS
A total of 602 patients treated for uveal melanoma during a 14-year period had abdominal ultrasonography screening every 6 months. Sixty-three developed liver metastases as the first extraocular metastatic site. When possible, liver surgery and intra-arterial catheter implantation were performed. The influence on survival of demographics, uveal tumor characteristics, liver metastasis presentation, and treatment was studied.


RESULTS
The median time to liver metastasis was 29 months. Twenty-eight patients (44%) were operated on: 14 (22%) had R0 liver surgery, and 14 with diffuse liver involvement had R2 liver surgery (there were no significant surgical complications). Thirty-five patients with diffuse liver involvement received systemic chemotherapy or best supportive care only. The median overall survival was 15 months (range, 3-110 months): 25 months for the 14 patients with R0 surgery, 16 months for the 14 with R2 surgery, and 11 months for the 35 with chemotherapy or supportive care. By univariate analysis, age (< or =70 years), number of metastases (< or =10), and quality of operation (R0) were predictive of a better prognosis.


CONCLUSIONS
In the case of liver metastases from uveal melanoma, aggressive treatment permitting tumor eradication seems to offer a chance of long-term survival to selected patients. Nevertheless, neither ultrasound screening nor quality of operation had an effect on the outcome of most patients (78%). Better screening tests and more effective multimodality treatments are required to improve survival in uveal melanoma patients with hepatic metastases.
Rivoire
Michel
M
Department of Surgery, Centre Léon Bérard, 28 Rue Laennec, 69373 Lyon Cedex 08, France. rivoire@lyon.fnclcc.fr
Kodjikian
Laurent
L
Baldo
Stefano
S
Kaemmerlen
Pierre
P
Négrier
Sylvie
S
Grange
Jean-Dominique
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D014463:Ultrasonography; D014604:Uveal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery