title: Uveal Melanoma Metastatic to the Liver: Chemoembolization With 1,3-Bis-(2-Chloroethyl)-1-Nitrosourea.
abstract: OBJECTIVE
  The purpose of this study is to evaluate whether chemoembolization with 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) is a safe and effective treatment for bulky uveal melanoma liver metastasis.
  
  
  METHODS
  Over a 7-year period, 63 treatment-naïve patients presented with uveal melanoma metastasis replacing 50% or more of the normal liver parenchyma. Patients with Eastern Cooperative Oncology Group 0-2 performance status, no extensive extrahepatic metastases, and adequate liver and renal function were treated with BCNU (200 mg) chemoembolization. Pretreatment tumor burdens were classified by MRI as 50-75% and more than 75%. Lactate dehydrogenase (LDH) levels were divided into less than or equal to 500 and more than 500 IU/L (i.e., more than twice the normal level). Treatment toxicity was assessed using Common Terminology Criteria for Adverse Events (version 4.0). CT and MRI were used to determine best radiologic response (Response Evaluation Criteria in Solid Tumors). Overall survival (OS) and progression-free survival (PFS) were compared with tumor burden and LDH levels.
  
  
  RESULTS
  Fifty patients (31 men; mean age, 59.1 years; range, 30-88 years) met the inclusion criteria. A total of 271 chemoembolization procedures were performed. Grade 3 thrombocytopenia occurred in two patients, grade 3 hyperbilirubinemia (n = 2) was attributed to disease progression, and asymptomatic grade 4 transaminitis occurred after 16 treatments. Best radiologic response was as follows: partial response, n = 3; stable disease, n = 33; and disease progression, n = 12 (no follow-up imaging, n = 2). The median OS was 7.1 months (range, 1.2-32.3 months), and the median PFS was 5.0 months (range, 1.1-32.3 months). Eleven patients (22%) survived longer than 12 months (range, 12.2-32.3) with one patient alive at follow-up. Tumor burden and LDH levels showed no statistically significant effect on OS (p = 0.20 and p = 0.14, respectively) or PFS (p = 0.10 and p = 0.34, respectively).
  
  
  CONCLUSIONS
  BCNU chemoembolization should be considered as a treatment option for patients with bulky uveal melanoma hepatic metastases.
authors.affiliation: 1 Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Ste 766, Philadelphia, PA 19107.
authors.forename: Carin F
authors.initials: CF
authors.lastname: Gonsalves
authors.affiliation: 1 Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Ste 766, Philadelphia, PA 19107.
authors.forename: David J
authors.initials: DJ
authors.lastname: Eschelman
authors.affiliation: 2 Department of Radiology, Northwestern University, Evanston, IL.
authors.forename: Bartley
authors.initials: B
authors.lastname: Thornburg
authors.affiliation: 1 Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Ste 766, Philadelphia, PA 19107.
authors.forename: Andrea
authors.initials: A
authors.lastname: Frangos
authors.affiliation: 3 Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: Takami
authors.initials: T
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D002330:Carmustine / Q000008:administration & dosage*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary*; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000473:pathology*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine
keywords: BCNU; chemoembolization; transarterial liver-directed therapy; uveal melanoma