Predictive Parameters in Patients Undergoing Percutaneous Hepatic Perfusion with Melphalan for Unresectable Liver Metastases from Uveal Melanoma: A Retrospective Pooled Analysis

CardioVascular and Interventional Radiology, vol. 45, pp. 1304–1313

Abstract

PURPOSE: The aim of this study was to identify positive predictors for survival in uveal melanoma (UM) patients treated with percutaneous hepatic perfusion with melphalan (M-PHP), by retrospectively pooling data from three centers. MATERIALS AND METHODS: Retrospective analysis including patients ([Formula: see text] 18 years) treated with M-PHP between February 2014 and December 2019 for unresectable liver-dominant or liver-only metastases from UM. Predictors for OS were assessed using uni- and multivariate analyses. Other study outcome measures were response rate, progression-free survival (PFS), liver progression-free survival (LPFS), overall survival (OS) and complications according to CTCAEv5.0. RESULTS: In total, 101 patients (47.5% males; median age 59.0 years) completed a minimum of one M-PHP. At a median follow-up time of 15.0 months, complete response (CR), partial response (PR), stable disease (SD) and progressive disease were seen in five (5.0%), 55 (54.5%), 30 (29.7%) and 11 (10.9%) patients, respectively, leading to a 89.1% disease control rate. Median PFS, LPFS and OS were 9.0, 11.0 and 20.0 months, respectively. Survival analyses stratified for radiological response demonstrated significant improved survival in patients with CR or PR and SD category. Treatment of the primary tumor with radiotherapy, ≥ 2 M-PHP and lactate dehydrogenase (LDH) < 248 U/L were correlated with improved OS. Thirty-day mortality was 1.1% (n = 2). Most common complication was hematological toxicity (self-limiting in most cases). CONCLUSION: M-PHP is safe and effective in patients with UM liver metastases. Achieving CR, PR or SD is associated with improved survival. Primary tumor treatment with radiotherapy, normal baseline LDH and > 1 M-PHP cycles are associated with improved OS.

Authors 14

1. Thaïs M. L. Tong Aachen Department of Medical Oncology Department of Radiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

   Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

2. Mariam Samim

   University Medical Center Utrecht

   Affiliation as printed

   Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands

3. Ellen Kapiteijn Aachen Department of Medical Oncology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

4. T. Susanna Meijer Aachen Department of Radiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

5. Frank M. Speetjens Aachen Department of Medical Oncology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

6. Roland Brüning

   Asklepios Klinik Barmbek

   Affiliation as printed

   Department of Radiology and Neuroradiology, Asklepios Klinik Barmbek, Hamburg, Germany

7. T. H. Schroeder

   Asklepios Klinik Barmbek

   Affiliation as printed

   Department of Radiology and Neuroradiology, Asklepios Klinik Barmbek, Hamburg, Germany

8. S. El-Sanosy

   Asklepios Klinik Barmbek

   Affiliation as printed

   Department of Radiology and Neuroradiology, Asklepios Klinik Barmbek, Hamburg, Germany

9. H. Maschke

   Asklepios Klinik Barmbek

   Affiliation as printed

   Department of Radiology and Neuroradiology, Asklepios Klinik Barmbek, Hamburg, Germany

10. Frank K. Wacker

    Medizinische Hochschule Hannover

    Affiliation as printed

    Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany

11. Arndt Vogel

    Medizinische Hochschule Hannover

    Affiliation as printed

    Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

12. Cornelia L. A. Dewald

    Medizinische Hochschule Hannover

    Affiliation as printed

    Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany

13. Jelle J. Goeman Aachen Department of Biomedical Data Sciences

    Leiden University Medical Center

    Affiliation as printed

    Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

14. Mark Christiaan Burgmans corresponding Aachen Department of Radiology

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. m.c.burgmans@lumc.nl

    Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands