title: Hepatic yttrium-90 radioembolization for metastatic melanoma: a single-center experience.
abstract: The aim of the study was to analyze the safety and efficacy of yttrium-90 ((90)Y) radioembolization in the treatment of unresectable hepatic melanoma metastases refractory to previous systemic/locoregional therapy. Between February 2004 and April 2010, 16 patients with hepatic melanoma metastases (ocular=7, skin=4, other sites=5) were treated with (90)Y radioembolization at a single center. Toxicity was assessed using the National Cancer Institute Common Terminology Criteria, version 3.0. Response to therapy was assessed by size and necrosis criteria. Progression-free survival (hepatic) and overall survival were calculated using the Kaplan-Meier method. The median dose to the treatment site was 108.57 Gy. Grade 1 and 2 clinical toxicities included fatigue (44%), nausea (19%), and vomiting (12%). Grade 3 absolute lymphocyte toxicity and aspartate aminotransferase toxicity were noted in 2 (12%) and 1 (7%) patients, respectively. Grade 4 bilirubin toxicity was observed in 1 (7%) patient. Overall, 13 (81%) patients showed disease control (response+stable disease) according to WHO, European Association for the Study of the Liver, and Response Evaluation Criteria for Solid Tumors. Progressive disease was observed in 3 (19%) patients according to WHO, European Association for the Study of the Liver, and Response Evaluation Criteria for Solid Tumors. The median overall and hepatic progression-free survival times were 7.63 and 4.23 months. Patients with disease control (responders+stable disease) survived longer than those with progressive disease (9.97 vs. 2.13 months, P<0.0001). Results from this small and single-center experience show that radioembolization is a safe therapy and its potential for being an efficacious therapy for hepatic melanoma metastases should be explored further. Radioembolization should be considered for liver-dominant disease refractory to other forms of systemic therapies.
authors.affiliation: aDepartment of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital bDepartment of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA.
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Kuzel
authors.forename: Michael
authors.initials: M
authors.lastname: Vouche
authors.forename: Rohi
authors.initials: R
authors.lastname: Atassi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002641:Chicago; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes