Hepatic arterial melphalan perfusion of liver predominant uveal melanoma metastasis

Abstract

Purpose : To evaluate the benefits and complications of patients undergoing isolated hepatic perfusion (IHP) for metastatic uveal melanoma (UM) at a single center

Methods : Retrospective chart review of patients known to the senior author with liver predominant UM metastasis that received open isolated hepatic arterial melphalan perfusion from 2011 to 2015.

Results : 6 patients were evaluated; all had primary ciliary body or choroidal melanoma (AJCC T1b-T4b). 4 were treated with enucleation and 2 with brachytherapy. The median time from diagnosis of uveal melanoma to liver metastases was 22.0 months (2.5-78.1). The median age at diagnosis with liver metastasis was 61 years (50-72). 5 of the 6 patients underwent IHP while 1 had an aborted procedure secondary to incompatible anatomy. Median duration of follow-up after IHP was 28.3 months (17.3-61.9). 2 of the 5 patients had complications including intraoperative splenic injury requiring splenectomy, post operative respiratory compromise, altered mental status, SIRS, acute renal insufficiency, and pancreatic fat necrosis. 3 of the 5 patients had complete response (CR), and 2 showed a partial or stable response. 1 of the 5 patients with CR had extrahepatic progression to bone after 23.9 months (and later to brain, orbit, and lungs after 26.4 months). The other 4 patients had hepatic progression (1 had hepatic and extrahepatic to lungs) after a median time of 20.0 months (13.6-57.3) from IHP. Median overall survival from time of diagnosis of liver metastases to present was 30.2 months (19.3-65.0).

Conclusions : This subset of patients treated with IHP had 30.2 month median survival. Median survival of patients with metastatic uveal melanoma noted in the literature is 2-12-months. The outcomes of the additional patients from the institution receiving IHP for metastatic UM (n=5) will be evaluated. A correlation of outcomes with the common somatic UM mutations will be performed.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.