aDepartment of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital bDepartment of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA.
Melanoma Res. 2014 Jun;24(3):244-51. doi: 10.1097/CMR.0000000000000051.
The aim of the study was to analyze the safety and efficacy of yttrium-90 ((90)Y) radioembolization in the treatment of unresectable hepatic melanoma metastases refractory to previous systemic/locoregional therapy. Between February 2004 and April 2010, 16 patients with hepatic melanoma metastases (ocular=7, skin=4, other sites=5) were treated with (90)Y radioembolization at a single center. Toxicity was assessed using the National Cancer Institute Common Terminology Criteria, version 3.0. Response to therapy was assessed by size and necrosis criteria. Progression-free survival (hepatic) and overall survival were calculated using the Kaplan-Meier method. The median dose to the treatment site was 108.57 Gy. Grade 1 and 2 clinical toxicities included fatigue (44%), nausea (19%), and vomiting (12%). Grade 3 absolute lymphocyte toxicity and aspartate aminotransferase toxicity were noted in 2 (12%) and 1 (7%) patients, respectively. Grade 4 bilirubin toxicity was observed in 1 (7%) patient. Overall, 13 (81%) patients showed disease control (response+stable disease) according to WHO, European Association for the Study of the Liver, and Response Evaluation Criteria for Solid Tumors. Progressive disease was observed in 3 (19%) patients according to WHO, European Association for the Study of the Liver, and Response Evaluation Criteria for Solid Tumors. The median overall and hepatic progression-free survival times were 7.63 and 4.23 months. Patients with disease control (responders+stable disease) survived longer than those with progressive disease (9.97 vs. 2.13 months, P<0.0001). Results from this small and single-center experience show that radioembolization is a safe therapy and its potential for being an efficacious therapy for hepatic melanoma metastases should be explored further. Radioembolization should be considered for liver-dominant disease refractory to other forms of systemic therapies.
本研究旨在分析钇-90((90)Y)放射性栓塞治疗既往全身/局部治疗失败的不可切除肝黑素瘤转移的安全性和疗效。2004 年 2 月至 2010 年 4 月，在一家中心对 16 例肝黑素瘤转移患者（眼 7 例、皮肤 4 例、其他部位 5 例）进行了(90)Y 放射性栓塞治疗。使用国家癌症研究所通用术语标准，第 3.0 版评估毒性。通过大小和坏死标准评估治疗反应。使用 Kaplan-Meier 方法计算无进展生存（肝）和总生存。治疗部位的中位剂量为 108.57 Gy。1 级和 2 级临床毒性包括疲劳（44%）、恶心（19%）和呕吐（12%）。2 例（12%）和 1 例（7%）患者分别出现 3 级绝对淋巴细胞毒性和天冬氨酸氨基转移酶毒性。1 例（7%）患者出现 4 级胆红素毒性。根据世界卫生组织、欧洲肝脏研究协会和实体瘤反应评价标准，13 例（81%）患者的疾病控制（反应+稳定疾病）。根据世界卫生组织、欧洲肝脏研究协会和实体瘤反应评价标准，3 例（19%）患者出现进行性疾病。疾病控制（反应者+稳定疾病）患者的总生存和肝无进展生存时间中位数分别为 7.63 和 4.23 个月。与进展性疾病患者相比，疾病控制患者（反应者+稳定疾病）的生存期更长（9.97 个月 vs. 2.13 个月，P<0.0001）。这项来自小型单中心的经验结果表明，放射性栓塞是一种安全的治疗方法，其对肝黑素瘤转移的潜在疗效应进一步探索。对于其他全身治疗失败的肝优势型疾病，应考虑放射性栓塞治疗。
