Abstract
Purpose: :
There is currently no effective treatment for metastatic uveal melanoma (UM); median survival upon diagnosis of metastasis is less than one year. We studied patients diagnosed with metastatic UM who have survived >24 months since detection of metastasis to identify characteristics that may predispose to long-term survival.
Methods: :
Patients at Ohio State University who were diagnosed with metastatic UM and survived >24 months after metastatic spread were drawn from our database of records of UM patients (enrolled 2006 -Present) with an IRB approved protocol.
Results: :
Of the 367 UM patients in the database, 13 developed metastatic disease. The 4 patients with metastatic UM and >24 months survival were studied. The primary tumors were treated by the same physician and adjuvant therapy for all patients was managed primarily by the same oncologist. The average age at initial diagnosis was 47 years (range 28-71 years). The average length of time to metastatic spread was 9.5 years (range 3-22 years). Survival after discovery of metastasis averaged 50 months (range 26-84 months). Location of the primary tumor was the choroid (3/4) and ciliary body (1/4). Average tumor height was 2.6 mm (range 1.46-4 mm) and greatest basal diameter was 12.25 mm (range 10.5-14 mm). High risk characteristics included extrascleral extension (1/4) and optic disc extension (1/4). Tumor cell type was mixed (2/4) and spindle (2/4). Initial treatment of the primary tumor included transpupillary thermal therapy (2/4) and enucleation (2/4). The eyes not undergoing enucleation both eventually had secondary treatment with Iodine-125 brachytherapy. All metastasis first presented to the liver (4/4) and most commonly involved a single lesion (3/4). All patients were screened with hepatic ultrasound every 6-12 months. Treatment of metastasis included liver resection (4/4), isolated hepatic perfusion with alkylating agents (3/4), systemic alkylating agent therapy (3/4), systemic interleukin-2 administration (1/4), tyrosine kinase receptor inhibitor (2/4), and paclitaxel administration (2/4).
Conclusions: :
Median survival for patients with metastasis from uveal melanoma is short. However, in some patients, long-term survival is possible. Long-term surviving patients had a relatively long disease-free interval before metastasis presentation, small-medium initial tumor burden, regular screening with hepatic ultrasound and aggressive treatment including hepatic resection.
Keywords: melanoma • choroid • ciliary body