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Hepatic Arterial Chemoembolization for Management of Metastatic Melanoma

¹ Mallinckrodt Institute of Radiology, Washington University School of Medicine.
² Siteman Comprehensive Cancer Center, Washington University School of Medicine, St. Louis, MO.
³ Department of Ophthalmology, Washington University School of Medicine, St. Louis, MO.
⁴ Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
⁵ Present address: Division of Cardiovascular and Interventional Radiology, Thomas Jefferson University Hospital, Suite 4200 Gibson Bldg., 111 S 11th St., Philadelphia, PA 19107.

OBJECTIVE. Hepatic arterial chemoembolization is an accepted therapy for stage 4 melanoma with liver-dominant metastasis. However, the reports of outcomes are limited. We present our outcomes with hepatic arterial chemoembolization for metastasis of stage 4 melanoma.

MATERIALS AND METHODS. Twenty patients with liver-dominant metastasis of ocular or cutaneous melanoma were treated with hepatic arterial chemoembolization. Overall survival and progression-free survival rates were calculated from the first treatment. Patients with intrahepatic tumor progression were treated with additional hepatic arterial chemoembolization. Both overall survival and progression-free survival were analyzed with the Kaplan-Meier method. Tumor pattern on angiography was characterized as either nodular or infiltrative on the basis of angiographic appearance.

RESULTS. The 20 patients underwent 46 hepatic arterial chemoembolization sessions (mean, 2.4 sessions; range, 1-5). The mean and median overall survival times were 334 ± 71 and 271 days, respectively. There were no deaths within 30 days of treatment. Thirteen of the 20 patients had progression of disease. The mean and median progression-free survival times for these patients were 231 ± 42 and 185 days, respectively. Patients with lesions that had a nodular angiographic appearance had longer progression-free survival than patients with lesions that had an infiltrative appearance (mean progression-free survival time, 249 vs 63 days). Patients with lesions that had a nodular angiographic appearance also survived significantly longer than those with lesions that had an infiltrative angiographic pattern (mean overall survival time, 621 vs 114 days; p = 0.0002).

CONCLUSION. Hepatic arterial chemoembolization for liver-dominant metastasis of stage 4 melanoma is a safe treatment that results in longer survival than has occurred among historical controls. Patients with lesions that have a nodular tumor appearance on angiography survive significantly longer than patients with lesions that have an infiltrative appearance on angiography.

Keywords: hepatic arterial chemoembolization • liver • metastatic disease • metastasis • ocular melanoma

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				P. N. Dayani, J. E. Gould, D. B. Brown, K. V. Sharma, G. P. Linette, and J. W. Harbour Hepatic Metastasis From Uveal Melanoma: Angiographic Pattern Predictive of Survival After Hepatic Arterial Chemoembolization Arch Ophthalmol, May 1, 2009; 127(5): 628 - 632. [Abstract] [Full Text] [PDF]