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Hepatic Arterial Chemoembolization for Management of Metastatic Melanoma

Karun V. Sharma1, Jennifer E. Gould1,2, J. William Harbour2,3, Gerald P. Linette2,4, Thomas K. Pilgram1, Pouya N. Dayani3 and Daniel B. Brown1,2,5

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.


Figure 1
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  		Fig. 1 —Graph shows results of Kaplan-Meier analysis of overall survival for entire group after hepatic arterial chemoembolization. Calculated mean and median survival times were 334 ± 71 and 272 days, respectively.

 

Figure 2
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  		Fig. 2 —Graph shows results of Kaplan-Meier analysis of time to progression for entire group after hepatic arterial chemoembolization. Calculated mean and median times to progression were 231 ± 42 and 185 days, respectively.

 

Figure 3
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  		Fig. 3A —51-year old woman with metastatic ocular melanoma. Angiogram shows nodular metastatic ocular melanoma before therapy.

 

Figure 4
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  		Fig. 3B —51-year old woman with metastatic ocular melanoma. Pretreatment PET/CT scan shows hypermetabolic focus in right lobe of liver.

 

Figure 5
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  		Fig. 3C —51-year old woman with metastatic ocular melanoma. PET/CT scan after hepatic arterial chemoembolization shows metabolic activity in dominant tumor has been eliminated and replaced with dense uptake of iodized oil. Patient survived 427 days from first embolization session.

 

Figure 6
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  		Fig. 4A —43-year-old man with metastatic ocular melanoma. Angiogram shows miliary pattern of contrast enhancement throughout liver without dominant nodules.

 

Figure 7
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  		Fig. 4B —43-year-old man with metastatic ocular melanoma. PET images 2 weeks before hepatic arterial chemoembolization suggest nodular appearance. This lack of correlation was common in patients with infiltrative angiographic appearance. Patient survived 45 days from first embolization session.

 

Figure 8
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  		Fig. 5 —Graph shows overall survival period after hepatic arterial chemoembolization is significantly longer in patients with nodular pattern (dashed line) compared with patients with infiltrative pattern (solid line) of disease. Mean and median survival periods for nodular group were 621 ± 87 and 750 days and for infiltrative group were 115 ± 22 and 109 days (p = 0.0002).

 

Figure 9
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  		Fig. 6 —Graph shows results of Kaplan-Meier analysis of time to disease progression. Mean time to progression was 250 days for patients with nodular angiographic pattern (dashed line) and 63 days for patients with infiltrative pattern (solid line) (p = 0.5).

 

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