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Lucy Xu, Arun D Singh; Liver Metastasis in Uveal Melanoma: Trends in Detection and Treatment. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3969.
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© ARVO (1962-2015); The Authors (2016-present)
The liver is the most common site of uveal melanoma metastasis. There is a lack of consensus on screening and treatment guidelines for liver metastasis. We report the trends in uveal melanoma liver metastasis detection, treatment and outcomes.
This was a retrospective observational study of patients with uveal melanoma metastatic to the liver from 2003-2016. Data collection included type of uveal melanoma, time to liver metastasis, detection method, treatment of liver metastasis, and time to death. Trends in detection and treatment of liver metastasis were divided between time periods 2003-2006, 2007-2010 and 2011-2016. Continuous variables were compared with Student's t-test.
73 patients were included in the study. Choroidal melanoma was the most common type of uveal melanoma (n=37, 50%). The average time from uveal melanoma diagnosis to liver metastasis was 32±39 (standard deviation) months. Most of the cases of metastatic disease were diagnosed with routine surveillance using liver ultrasound (n=49, 67%). Initial treatment was chemotherapy for 15 patients (21%) and 15 received radioembolization. 11 patients (15%) chose palliation, 11 received radiofrequency ablation, 5 received immunotherapy, 2 received liver resection, 7 had combination therapy and 7 patients did not follow up within our system. Routine surveillance with ultrasound was the most frequent mode of detection across the three time periods (2003-2006, 2007-2010 and 2011-2016). Systemic chemotherapy was the most common treatment for 2003-2010. Between 2011-2016, radioembolization (with and without immunotherapy) was the most common treatment. Most patients in the study had died (n=56, 77%) with the average time from liver metastasis diagnosis to death being 15±13 months. There was a statistical difference between the treated group (n=55) and palliative group (n=11) in the survival duration (17.6 months vs 4.6 months) following diagnosis of liver metastasis (p<0.01).
Routine imaging surveillance with ultrasound is the most common method of liver metastasis detection. Systemic chemotherapy was the most common form of treatment for liver metastasis but recently has been surpassed by radioembolization. Treatment of liver metastasis is associated with longer survival times. Future studies with larger patient populations are needed to elucidate detection and treatment guidelines for liver metastasis of uveal melanoma.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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