Yttrium-90 Microsphere Brachytherapy for Liver Metastases From Uveal Melanoma: Clinical Outcomes and the Predictive Value of Fluorodeoxyglucose Positron Emission Tomography.
OBJECTIVE
To report outcomes after yttrium-90 microsphere brachytherapy for unresectable liver metastases from uveal melanoma and to evaluate factors predictive for overall survival (OS) and hepatic progression-free survival (PFS).


METHODS
A total of 71 patients were consecutively treated with microsphere brachytherapy for unresectable liver metastases from uveal melanoma between 2007 and 2012. Clinical, radiographic, and positron emission tomography-derived, functional tumor parameters were evaluated by log-rank test in univariate analysis and backwards stepwise multivariate Cox proportional hazards regression. OS and hepatic PFS were estimated by Kaplan-Meier analysis.


RESULTS
A total of 134 procedures were performed in 71 patients with a median age of 63 years (range, 23 to 91 y). Fifty-eight patients (82%) received microsphere brachytherapy as a salvage therapy. Median hepatic PFS and OS after microsphere brachytherapy were 5.9 months (range, 1.3 to 19.1 mo) and 12.3 months (range, 1.9 to 49.3 mo), respectively. Median OS times after diagnosis of liver metastases was 23.9 months (range, 6.2 to 69.0 mo). In univariate analysis, female sex, pretreatment metabolic tumor volume, and total glycolic activity (TGA) were significantly correlated with hepatic PFS and OS. In multivariate analysis, female sex and TGA retained significance as independent predictors of hepatic PFS and OS. A low pretreatment TGA (<225 g) was associated with a significantly longer median OS than was a TGA≥225 g (17.2 vs. 9.7 mo, P=0.01).


CONCLUSIONS
Yttrium-90 microsphere brachytherapy provided favorable survival times in patients with unresectable liver metastases from uveal melanoma. Metabolic tumor volume and TGA are predictive functional tumor parameters, which may aid patient selection and risk stratification.
*Department of Radiation Oncology ‡Department of Radiology, Division of Interventional Radiology §Department of Radiology, Division of Nuclear Medicine ∥Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA †Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY.
Harriet
H
Eldredge-Hindy
Nitin
N
Ohri
Pramila R
PR
Anne
David
D
Eschelman
Carin
C
Gonsalves
Charles
C
Intenzo
Voichita
V
Bar-Ad
Adam
A
Dicker
Laura
L
Doyle
Jun
J
Li
Takami
T
Sato
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D008863:Microspheres; D008875:Middle Aged; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D055815:Young Adult; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*; D000098943:Uveal Melanoma
D015021:Yttrium Radioisotopes; D019788:Fluorodeoxyglucose F18