Department of Hematology and Oncology, Campus Benjamin Franklin, Hindenburgdamm, Berlin, Germany.
Melanoma Res. 2010 Jun;20(3):191-6. doi: 10.1097/CMR.0b013e328334c36e.
The liver is the predominant site of metastases in the majority of patients with uveal melanoma, suggesting the evaluation of regional treatment approaches. Here we report our experience with transarterial chemoembolization (TACE) in uveal melanoma patients with pretreated liver metastases. Twenty-five patients were treated with fotemustine-based or cisplatin-based TACE after treatment failure of systemic therapy between 2003 and 2008 at our institution. Grade III toxicity consisted of gastric ulcer (n=1), fever (n=3), splenic infarction (n=1), and thrombocytopenia (n=1). No grade IV toxicity or catheter-associated complications were observed. Fourteen of 25 patients (56%) had stable disease for at least 2 months and four had partial remission. The median progression-free survival (PFS) was 3 months (95% confidence interval: 2-4 months) and the median overall survival (OS) was 6 months (95% confidence interval: 5-7 months), with 15% of patients alive at 1 year. Both PFS and OS were significantly longer, when pretreatment lactate dehydrogenase was below the two-fold upper limit of normal (n=11): PFS 5 versus 2 months (P<0.001) and OS 11 versus 5 months (P=0.012). All patients with lactate dehydrogenase less than 2xupper limit of normal had a clinically detectable benefit. TACE is well tolerated and effective in pretreated patients with liver metastases from uveal melanoma. TACE should further be evaluated as first-line therapy in prospective randomized clinical trials.
肝脏是大多数葡萄膜黑色素瘤患者转移的主要部位，这表明需要评估区域性治疗方法。在此，我们报告了我们在有预处理肝转移的葡萄膜黑色素瘤患者中使用经动脉化疗栓塞（TACE）的经验。2003 年至 2008 年期间，我们机构对 25 例在全身性治疗失败后接受基于福莫司汀或顺铂的 TACE 治疗的患者进行了研究。3 级毒性包括胃溃疡（n=1）、发热（n=3）、脾梗死（n=1）和血小板减少症（n=1）。未观察到 4 级毒性或与导管相关的并发症。25 例患者中有 14 例（56%）至少有 2 个月的稳定疾病，4 例有部分缓解。无进展生存期（PFS）的中位数为 3 个月（95%置信区间：2-4 个月），总生存期（OS）的中位数为 6 个月（95%置信区间：5-7 个月），1 年后有 15%的患者存活。当预处理乳酸脱氢酶低于两倍正常上限（n=11）时，PFS 和 OS 均显著延长：PFS 分别为 5 个月和 2 个月（P<0.001），OS 分别为 11 个月和 5 个月（P=0.012）。所有乳酸脱氢酶低于 2xupper 限的患者均有临床获益。TACE 在预处理过的肝转移葡萄膜黑色素瘤患者中耐受性良好且有效。TACE 应进一步在前瞻性随机临床试验中作为一线治疗进行评估。
