TREATMENT OF UVEAL MELANOMA METASTATIC TO THE LIVER - A REVIEW OF THEM-D-ANDERSON-CANCER-CENTER EXPERIENCE AND PROGNOSTIC FACTORS

Citation
Ay. Bedikian et al., TREATMENT OF UVEAL MELANOMA METASTATIC TO THE LIVER - A REVIEW OF THEM-D-ANDERSON-CANCER-CENTER EXPERIENCE AND PROGNOSTIC FACTORS, Cancer, 76(9), 1995, pp. 1665-1670
Citations number
19
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Oncology
Journal title
CancerACNP
ISSN journal
0008-543X
Volume
76
Issue
9
Year of publication
1995
Pages
1665 - 1670
Database
ISI
SICI code
0008-543X(1995)76:9<1665:TOUMMT>2.0.ZU;2-K
Abstract
Background. Liver metastasis develops in approximately two-thirds of p atients with recurrent uveal melanoma. Despite therapy, the median sur vival of those with. liver metastasis is 5 to 7 months. The recognitio n of a grave prognosis associated with liver metastasis has led to eva luation of new modalities of therapy, including the use of regional th erapies such as intrahepatic arterial chemotherapy and either emboliza tion or chemoembolization of hepatic metastases. In this study, the re sults of an institutional experience over the past 2 decades are revie wed and prognostic factors that affect survival from the time the live r metastasis is diagnosed are assessed. Methods. In this study of 201 patients with uveal melanoma involving the liver who were treated at M . D. Anderson Cancer Center between 1968 and 1991, the authors retrosp ectively reviewed the cases and compared the results of systemic thera pies, hepatic intra-arterial chemotherapies, and chemoembolization of liver metastases. Cox's multivariate analysis and stepwise logistic re gression were then computed to determine significant prognostic variab les. Results. The systemic therapies produced a response rate of less than 1%. Chemoembolization was the most effective treatment, inducing responses in 36% of patients. Survival curves were calculated using th e life-table method of Kaplan and Meier. Patient- and tumor-related ch aracteristics were examined and their relation to on survival from the time of diagnosis of liver metastasis was determined. Levels of serum alkaline phosphatase, treatment showed a strong relation to survival. In contrast, univariate analysis showed that patient age and gender, metastasis free interval, presence of extrahepatic metastasis, and typ e of therapy for liver metastasis did not influence survival. Multivar iate stepwise regression analysis identified serum alkaline phosphatas e and metastasis free interval as the main independent prognostic fact ors for survival after liver metastasis diagnosis. Conclusions. Of the three modalities of therapy used for choroidal melanoma metastatic to the liver, only chemoembolization using cisplatin-based regimens prod uced a meaningful response rate. Information from this analysis can be used to predict the outcome of patients with uveal melanoma metastati c to the liver. Patients with metastatic ocular melanoma confined to t he liver should be treated with chemoembolization and should not be in cluded in chemotherapy trials designed for cutaneous melanoma.