Percutaneous Isolated Hepatic Perfusion as a Treatment for Isolated Hepatic Metastases of Uveal Melanoma: Patient Outcome and Safety in a Multi-centre Study

• Published in: Cardiovascular and interventional radiology 2017-06, Vol.40 (6), p.864-872
• Main Authors: Vogl, Thomas J., Koch, Silvia A., Lotz, Gösta, Gebauer, Bernhard, Willinek, Winfried, Engelke, Christoph, Brüning, Roland, Zeile, Martin, Wacker, Frank, Vogel, Arndt, Radeleff, Boris, Scholtz, Jan-Erik
• Format: Article
• Language: English
• Subjects: Adult; Aged; AUGER ELECTRON SPECTROSCOPY; Cardiology; Chemotherapy, Cancer, Regional Perfusion - methods; Clinical Investigation; Female; Follow-Up Studies; Humans; Imaging; LEUKOPENIA; LIVER; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Male; Medicine; Medicine & Public Health; Melanoma - drug therapy; Melanoma - mortality; MELANOMAS; Melphalan - therapeutic use; METASTASES; Middle Aged; Nuclear Medicine; PATIENTS; Quality of Life; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; SAFETY; Survival Rate; SURVIVAL TIME; Ultrasound; Uveal Neoplasms - drug therapy; Uveal Neoplasms - mortality
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-017-1588-2

Purpose Percutaneous isolated hepatic perfusion (PIHP) with Melphalan has been developed as a treatment for patients with isolated hepatic metastases of uveal melanoma. We discuss patient outcome and safety in a retrospective multi-centre study. Materials and Methods Between 2012 and 2016 18 patients with un-resectable isolated hepatic metastases of uveal melanoma received single or repeated PIHP with Melphalan ( n  = 35) at seven sites. Progression-free time, overall survival time (OS) and tumour response by means of RECIST 1.1 criteria were evaluated. Peri- and post-procedural adverse events (AE) were registered. Patients’ life quality was assessed using four-point scale questionnaires. Results Of 18 patients, initial PIHP treatment resulted in partial response (PR) in eight, stable disease (SD) in seven and progressive disease (PD) in three cases. Nine patients underwent second PIHP with PR in eight cases and PD in one case. Six patients were evaluated after third PIHP with PR in five patients and SD in one patient. Two patients received fourth PIHP with PD in both cases. Median OS was 9.6 months (range 1.6–41.0 months). Median progression-free survival time was 12.4 months (range 0.9–41.0 months) with 1-year survival of 44%. Most common post-procedural AE grade 3 and 4 were temporary leukopenia ( n  = 11) and thrombocytopenia ( n  = 8). Patients’ self-assessments showed good ratings for overall health and quality of life with only slight changes after PIHP, and a high degree of satisfaction with PIHP treatment. Conclusion PIHP with Melphalan proved to be a relatively safe, minimal-invasive and repeatable treatment for patients with non-resectable hepatic metastases of uveal melanoma.