The effectiveness of transarterial chemoembolization in metastatic uveal melanoma of the liver
Authors: V.Yu. Kosirev, D.V. Martynkov, E.R. Virshke, Yu.V. Buydenok, V.V. Nazarova
Aim: to study the effectiveness of the use of transarterial chemoembolization (TACE) in the treatment of patients with metastatic uveal melanoma.
Material and methods: in N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia in the period from 2000 to 2019 72 patients received treatment (TACE) for metastases of uveal melanoma in the liver. Of these: men – 22 (30,6%), women – 50 (69,4%). Average age 46,28±10,32 years, range 23–84 years. The time of detection of metastatic liver lesions after treatment of the primary tumor ranged from 2 to 252 months, the median was 24 months. The volume of liver damage was up to 25% in 19 patients, from 25% to 50% in 33 patients, from 50% to 75% in 20 patients. A total of 134 TACE interventions were performed. Depending on the volume of the lesion, the nature of the blood supply to the tumors and the response to treatment, patients underwent 1 to 5 sessions of TACE: in 27 patients one TACE, in 35 – two, in 5 – three, in 3 – four, and in 2 – five TACE. As an embolizing component, lipiodol 10 ml was used in 106 cases, microspheres in 16 cases (particle sizes varied from 100 to 500 μm), in 12 TACEs, combinations of the presented embolizing materials were used. Carboplatin, doxorubicin or gemcitabine were used as chemotherapy drugs.
Results: 58 patients (80,6%) had a moderate postembolization syndrome, expressed by pain, febrile temperature, nausea, and vomiting. A local response (including complete response, partial response, or stabilization by mRECIST criteria) was observed in 53/72 (73,6%) patients with metastases of uveal melanoma. The duration of observation of patients after TACE was from 2 to 60 months. The median follow-up was 12,5 months. The group that responded to treatment, including stabilization, achieved a 1-year Kaplan-Meier overall survival rate of 72% and a 2-year rate of 45,6%. In patients with continued growth of lesions, the 1-year overall survival rate according to the Kaplan-Meier method was 42,6%, and the 2-year survival rate was not achieved. 48 patients were alive at the time of the study, 24 died from disease progression.
Conclusions: the use of TACE in metastatic lesions of the liver by choroidal melanoma in combined treatment or in mono-regimen led to an objective response or stabilization of the process in 73,6% of patients. This method increases the overall survival of patients and is well tolerated.