title: High-dose immunoembolization: survival benefit in patients with hepatic metastases from uveal melanoma.
abstract: OBJECTIVE
  To retrospectively evaluate prognostic factors for survival in patients with uveal melanoma who received chemoembolization (CE) with 1,3-bis (2-chloroethyl)-1-nitrosourea or immunoembolization (IE) with granulocyte-macrophage colony-stimulating factor (GM-CSF) for hepatic metastases.
  
  
  METHODS
  Fifty-three consecutive patients with uveal melanoma were treated by using CE or IE in clinical trials approved by the Institutional Review Board. Prognostic factors associated with overall survival (OS) and progression-free survival (PFS) in the liver and extrahepatic (systemic) organs were retrospectively evaluated. Covariates of age, sex, preexisting extrahepatic metastases, liver enzyme levels, tumor volume, radiologic response in hepatic metastases, and treatment type were analyzed.
  
  
  RESULTS
  Compared with CE, high-dose (>or=1500 microg of GM-CSF) IE resulted in significantly better OS (20.4 vs 9.8 months, P = .005) and systemic PFS (12.4 vs 4.8 months, P = .001) at univariate analysis. Overall, women outlived men (14.4 vs 9.8 months, P = .01). Patients who achieved regression of hepatic metastases after embolization lived much longer than did those who did not achieve regression (27.2 vs 9.9 months, P < .001). At multivariate analysis, prolonged OS was confirmed for women, patients who underwent high-dose IE, younger patients (age < 60 years), and patients with regression of hepatic metastases. Independent predictors of longer systemic PFS included high-dose IE, younger age, and regression of hepatic metastases. No covariate predicted liver PFS except for hepatic response.
  
  
  CONCLUSIONS
  Treatment with high-dose IE prolonged survival of patients with uveal melanoma who received embolization of hepatic metastases and possibly delayed progression of extrahepatic metastases.
authors: Department of Medical Oncology, Jefferson Medical College, Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19107, USA.
authors: Akira
authors: A
authors: Yamamoto
authors: Inna
authors: I
authors: Chervoneva
authors: Kevin L
authors: KL
authors: Sullivan
authors: David J
authors: DJ
authors: Eschelman
authors: Carin F
authors: CF
authors: Gonsalves
authors: Michael J
authors: MJ
authors: Mastrangelo
authors: David
authors: D
authors: Berd
authors: Jerry A
authors: JA
authors: Shields
authors: Carol L
authors: CL
authors: Shields
authors: Mizue
authors: M
authors: Terai
authors: Takami
authors: T
authors: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014604:Uveal Neoplasms