Transarterial Hepatic Chemoperfusion of Uveal Melanoma Metastases: Survival and Response to Treatment

Zusammenfassung

Ziel: Evaluation der Überlebensdauer von Patienten mit hepatisch meastasierten Aderhautmelanomen unter sequentieller hepatischer Chemoperfusion. Material und Methoden: 61 Patienten (mittleres Alter: 60,3 ± 13,8 Jahre) wurden mit insgesamt 249 hepatischen Chemoperfusionen (Mittelwert: 4 Chemoperfusionen/Patient, Min.: 1 Chemoperfusion, Max.: 7 Chemoperfusionen, Standardabweichung: 2,3 Chemoperfusionen) behandelt. Bei allen Patienten wurde die Therapie mit Melphalan begonnen. Im Falle eines Progresses wurde Melphalan durch ein alternatives Chemoperfusionspräparat ersetzt. 38 Patienten wurden ausschließlich mit Melphalan behandelt, 23 Patienten wurden mit Melphalan, gefolgt von einer Chemoperfusion mit anderen Substanzen behandelt. Die mediane Überlebenszeit wurde für die gesamte Population und unterschiedliche Subgruppen errechnet. Es wurden statistisch signifikante Unterschiede bezüglich der Überlebensdauer zwischen den Subgruppen ermittelt. Die Komplikationsrate wurde ermittelt. Ergebnisse: Die mittlere Überlebensdauer der Gesamtpopulation betrug 10 Monate. Die Patienten der Subgruppe, die an maximal 9 hepatischen Metastasen litt, sowie die der Subgruppe, die keine extrahepatischen Metastasen zu Beginn der Therapie aufwies, überlebten statistisch signifikant länger als die Patienten mit mehr als 9 Metastasen/extrahepatischen Metastasen (p = 0,019, p = 0,008). Ein Patient (0,4 %) verstarb im Leberversagen nach initialer Chemoperfusion mit Melphalan. Schlussfolgerung: Sequenzielle intraarterielle hepatische Chemoperfusionen stellen eine minimalinvasive Behandlungsmöglichkeit mit guten Überlebensdauern und einer akzeptablen Major-Komplikationsrate bei Patienten mit hepatischen metastasierten Aderhautmelanomen dar.

Abstract

Purpose: To assess the survival of patients with hepatic uveal melanoma metastases undergoing sequential transarterial hepatic chemoperfusion. Materials and Methods: 61 patients (mean age, 60.3 ± 13.8y) underwent a total of 249 hepatic chemoperfusion procedures (mean: 4 chemoperfusion procedures; range, 1 – 7 chemoperfusion procedures; standard deviation, 2.3 chemoperfusion procedures). All patients started with melphalan. In the case of progressive disease, melphalan was replaced by a different chemoperfusion agent. 38 patients were treated with melphalan only, 23 patients were treated with a combination of melphalan and other drugs. The median overall survival time was calculated for the overall population and several sub-groups. Differences in the survival rate between the sub-groups were assessed for statistical significance. The complication rate was assessed. Results: The median overall survival of the entire population was 10 months. The patients in the subgroups with a maximum number of 9 hepatic metastases as well as the patients in the subgroup without extrahepatic metastases at the beginning of therapy survived significantly longer than patients with more than 9 metastases/extrahepatic metastases (p = 0.019, p = 0.008). One patient (0.4 %) died from liver failure after initial infusion of melphalan. Conclusion: Intraarterial sequential hepatic chemoperfusion offers a minimally invasive treatment in patients with hepatic uveal melanoma metastases with good survival times and an acceptable major complication rate.

Key words

angiography - interventional procedures - uveal melanoma - ocular melanoma - melphalan - chemoperfusion

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