Radioembolization as salvage therapy for hepatic metastasis of uveal melanoma: a single-institution experience.
OBJECTIVE
The purpose of this study was to assess the safety and efficacy of radioembolization in the management of hepatic metastasis of uveal melanoma after failure of immunoembolization or chemoembolization.


METHODS
From January 2007 through April 2009, 32 patients underwent radioembolization therapy for hepatic metastasis of uveal melanoma. Pretreatment tumor burdens were divided into three categories: less than 25% (n = 25), 25-50% (n = 5), and greater than 50% (n = 2). Toxicity, extrahepatic disease, and hepatic tumor response were assessed 1 month and then every 3 months after treatment. Best radiographic response of hepatic metastasis was determined with the Response Evaluation Criteria in Solid Tumors criteria. Overall survival and progression-free survival of hepatic metastasis were estimated by Kaplan-Meier analysis. Differences in survival between subgroups were evaluated by log-rank test in univariate analysis.


RESULTS
The clinical follow-up period ranged from 1.0 to 29.0 months (median, 10.0 months). The median overall survival was 10.0 months, and the progression-free survival of hepatic metastasis, 4.7 months. Twenty-two patients died 1.0-29.0 months (median, 5.8 months) after treatment owing to progression of liver disease (n = 13), extrahepatic disease (n = 4), or both (n = 5). Patients who had a pretreatment tumor burden less than 25% had longer median overall survival (10.5 vs 3.9 months, p = 0.0003) and progression-free survival (6.4 vs 3.0 months, p = 0.03) than patients who had a pretreatment tumor burden of 25% or greater. Patients who had a complete response (n = 1), partial response (n = 1), or stable disease (n = 18) had longer median overall survival (14.7 vs 4.9 months, p = 0.0006) and progression-free survival of hepatic metastasis (7.9 vs 3.1 months, p < 0.0001) than patients with tumor progression (n = 12). Self-limiting grade 1-2 systemic toxicity included tiredness (n = 9), indigestion (n = 2), and abdominal discomfort (n = 5). Grade 3-4 hepatic toxicity was attributed to tumor progression.


CONCLUSIONS
Radioembolization is safe and effective salvage therapy for limited metastasis of uveal melanoma.
Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, 132 S 10th St., Main Bldg., Ste. 766, Philadelphia, PA 19107, USA. carin.gonsalves@jefferson.edu
Carin F
CF
Gonsalves
David J
DJ
Eschelman
Kevin L
KL
Sullivan
P Rani
PR
Anne
Laura
L
Doyle
Takami
T
Sato
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D000078702:Radiofrequency Therapy; D016879:Salvage Therapy; D015996:Survival Rate; D047368:Tumor Burden; D014604:Uveal Neoplasms / Q000401:mortality; D000098943:Uveal Melanoma