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
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.