Siegel R, Hauschild A, Kettelhack C, Kähler K C, Bembenek A, Schlag P M
Department of Surgery and Surgical Oncology, Charité-Universitätsmedizin Berlin, Campus Buch, Robert-Rössle-Tumour-Hospital at Helios Klinikum Berlin-Buch, D-13125 Berlin, Germany.
Eur J Surg Oncol. 2007 Jun;33(5):627-32. doi: 10.1016/j.ejso.2006.11.019. Epub 2006 Dec 28.
Hepatic metastases from melanoma are associated with poor prognosis. Systemic chemotherapy and biological treatments remain unsatisfactory. This study investigated the impact of hepatic arterial chemotherapy in patients with ocular and cutaneous melanoma.
In a retrospectively analysed observational study, 36 consecutive patients with hepatic metastases from ocular or cutaneous melanoma were assigned for surgical hepatic port-catheter implantation. Fotemustine was delivered weekly for a 4-week period, followed by a 5-week rest and a maintenance period every 3 weeks until progression. Overall survival, response and toxicity were analysed and compared.
After port-catheter implantation 30/36 patients were finally treated (18 with ocular and 12 with cutaneous melanoma). A median of 8 infusions per patient were delivered (range 3-24). 30% thrombocytopenia grade >or=3, 7% neutropenia grade >or=3 but no nausea or vomiting grade >or=3 were encountered. Nine out of 30 patients achieved partial remission, 10/30 stable disease; 11/30 patients were progressive. Median survival for all treated patients was 14 months. Partial remission and stable disease were associated with a survival advantage compared to progressive disease (19 vs. 5 months). No significant difference in survival was observed for ocular versus cutaneous melanoma. Serum LDH was a significant predictor of both response and survival.
Hepatic arterial Fotemustine chemotherapy was well tolerated. Meaningful response and survival rates were achieved in ocular as well as cutaneous melanoma. Careful patient selection in consideration of extra-hepatic involvement is crucial for the effectiveness of this treatment. Independent from the primary melanoma site, it is debatable if patients with highly elevated serum-LDH may benefit from this approach.
黑色素瘤肝转移预后较差。全身化疗和生物治疗效果仍不尽人意。本研究调查了肝动脉化疗对眼和皮肤黑色素瘤患者的影响。
在一项回顾性分析的观察性研究中，36例连续的眼或皮肤黑色素瘤肝转移患者被分配进行手术肝门静脉导管植入。福莫司汀每周给药一次，共4周，随后休息5周，每3周进行一个维持期，直至病情进展。分析并比较总生存期、反应和毒性。
门静脉导管植入后，30/36例患者最终接受治疗（18例眼黑色素瘤患者和12例皮肤黑色素瘤患者）。每位患者平均输注8次（范围3 - 24次）。出现30%的血小板减少≥3级，7%的中性粒细胞减少≥3级，但未出现≥3级的恶心或呕吐。30例患者中有9例达到部分缓解，10例病情稳定；11例患者病情进展。所有接受治疗患者的中位生存期为14个月。与病情进展相比，部分缓解和病情稳定患者具有生存优势（19个月对5个月）。眼黑色素瘤和皮肤黑色素瘤患者的生存期无显著差异。血清乳酸脱氢酶（LDH）是反应和生存的重要预测指标。
肝动脉福莫司汀化疗耐受性良好。眼和皮肤黑色素瘤均取得了有意义的反应率和生存率。考虑肝外受累情况仔细选择患者对该治疗的有效性至关重要。无论原发性黑色素瘤部位如何，血清LDH高度升高的患者是否能从这种方法中获益仍存在争议。
