Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, 132 S 10th St., Main Bldg., Ste. 766, Philadelphia, PA 19107, USA.
AJR Am J Roentgenol. 2011 Feb;196(2):468-73. doi: 10.2214/AJR.10.4881.
The purpose of this study was to assess the safety and efficacy of radioembolization in the management of hepatic metastasis of uveal melanoma after failure of immunoembolization or chemoembolization.
From January 2007 through April 2009, 32 patients underwent radioembolization therapy for hepatic metastasis of uveal melanoma. Pretreatment tumor burdens were divided into three categories: less than 25% (n = 25), 25-50% (n = 5), and greater than 50% (n = 2). Toxicity, extrahepatic disease, and hepatic tumor response were assessed 1 month and then every 3 months after treatment. Best radiographic response of hepatic metastasis was determined with the Response Evaluation Criteria in Solid Tumors criteria. Overall survival and progression-free survival of hepatic metastasis were estimated by Kaplan-Meier analysis. Differences in survival between subgroups were evaluated by log-rank test in univariate analysis.
The clinical follow-up period ranged from 1.0 to 29.0 months (median, 10.0 months). The median overall survival was 10.0 months, and the progression-free survival of hepatic metastasis, 4.7 months. Twenty-two patients died 1.0-29.0 months (median, 5.8 months) after treatment owing to progression of liver disease (n = 13), extrahepatic disease (n = 4), or both (n = 5). Patients who had a pretreatment tumor burden less than 25% had longer median overall survival (10.5 vs 3.9 months, p = 0.0003) and progression-free survival (6.4 vs 3.0 months, p = 0.03) than patients who had a pretreatment tumor burden of 25% or greater. Patients who had a complete response (n = 1), partial response (n = 1), or stable disease (n = 18) had longer median overall survival (14.7 vs 4.9 months, p = 0.0006) and progression-free survival of hepatic metastasis (7.9 vs 3.1 months, p < 0.0001) than patients with tumor progression (n = 12). Self-limiting grade 1-2 systemic toxicity included tiredness (n = 9), indigestion (n = 2), and abdominal discomfort (n = 5). Grade 3-4 hepatic toxicity was attributed to tumor progression.
Radioembolization is safe and effective salvage therapy for limited metastasis of uveal melanoma.
本研究旨在评估在免疫栓塞或化疗栓塞失败后，放射性栓塞治疗葡萄膜黑色素瘤肝转移的安全性和有效性。
2007 年 1 月至 2009 年 4 月，32 例患者因葡萄膜黑色素瘤肝转移而行放射性栓塞治疗。治疗前肿瘤负荷分为三组：小于 25%（n=25）、25-50%（n=5）和大于 50%（n=2）。治疗后 1 个月和之后每 3 个月评估毒性、肝外疾病和肝肿瘤反应。采用实体瘤反应评估标准确定肝转移的最佳影像学反应。通过 Kaplan-Meier 分析估计肝转移的总生存率和无进展生存率。采用单因素分析中的对数秩检验评估亚组间生存差异。
临床随访时间为 1.0-29.0 个月（中位数 10.0 个月）。中位总生存期为 10.0 个月，肝转移无进展生存期为 4.7 个月。22 例患者分别在治疗后 1.0-29.0 个月（中位数 5.8 个月）因肝病进展（n=13）、肝外疾病（n=4）或两者（n=5）死亡。治疗前肿瘤负荷小于 25%的患者中位总生存期（10.5 个月 vs. 3.9 个月，p=0.0003）和肝转移无进展生存期（6.4 个月 vs. 3.0 个月，p=0.03）均长于肿瘤负荷为 25%或更高的患者。完全缓解（n=1）、部分缓解（n=1）或稳定疾病（n=18）的患者中位总生存期（14.7 个月 vs. 4.9 个月，p=0.0006）和肝转移无进展生存期（7.9 个月 vs. 3.1 个月，p<0.0001）均长于肿瘤进展患者（n=12）。自限性 1-2 级全身毒性包括疲劳（n=9）、消化不良（n=2）和腹部不适（n=5）。3-4 级肝毒性归因于肿瘤进展。
放射性栓塞治疗是葡萄膜黑色素瘤局限性转移的安全有效的挽救性治疗方法。
