1 Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Ste 766, Philadelphia, PA 19107.
2 Department of Radiology, Northwestern University, Evanston, IL.
AJR Am J Roentgenol. 2015 Aug;205(2):429-33. doi: 10.2214/AJR.14.14001. Epub 2015 Apr 23.
The purpose of this study is to evaluate whether chemoembolization with 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) is a safe and effective treatment for bulky uveal melanoma liver metastasis.
Over a 7-year period, 63 treatment-naïve patients presented with uveal melanoma metastasis replacing 50% or more of the normal liver parenchyma. Patients with Eastern Cooperative Oncology Group 0-2 performance status, no extensive extrahepatic metastases, and adequate liver and renal function were treated with BCNU (200 mg) chemoembolization. Pretreatment tumor burdens were classified by MRI as 50-75% and more than 75%. Lactate dehydrogenase (LDH) levels were divided into less than or equal to 500 and more than 500 IU/L (i.e., more than twice the normal level). Treatment toxicity was assessed using Common Terminology Criteria for Adverse Events (version 4.0). CT and MRI were used to determine best radiologic response (Response Evaluation Criteria in Solid Tumors). Overall survival (OS) and progression-free survival (PFS) were compared with tumor burden and LDH levels.
Fifty patients (31 men; mean age, 59.1 years; range, 30-88 years) met the inclusion criteria. A total of 271 chemoembolization procedures were performed. Grade 3 thrombocytopenia occurred in two patients, grade 3 hyperbilirubinemia (n = 2) was attributed to disease progression, and asymptomatic grade 4 transaminitis occurred after 16 treatments. Best radiologic response was as follows: partial response, n = 3; stable disease, n = 33; and disease progression, n = 12 (no follow-up imaging, n = 2). The median OS was 7.1 months (range, 1.2-32.3 months), and the median PFS was 5.0 months (range, 1.1-32.3 months). Eleven patients (22%) survived longer than 12 months (range, 12.2-32.3) with one patient alive at follow-up. Tumor burden and LDH levels showed no statistically significant effect on OS (p = 0.20 and p = 0.14, respectively) or PFS (p = 0.10 and p = 0.34, respectively).
BCNU chemoembolization should be considered as a treatment option for patients with bulky uveal melanoma hepatic metastases.
本研究旨在评估 1,3-双（2-氯乙基）-1-亚硝基脲（BCNU）化疗栓塞治疗大体积葡萄膜黑色素瘤肝转移是否安全有效。
在 7 年期间，63 例初治患者出现葡萄膜黑色素瘤转移，占正常肝实质的 50%或以上。Eastern Cooperative Oncology Group 0-2 表现状态、无广泛肝外转移、肝肾功能良好的患者采用 BCNU（200mg）化疗栓塞治疗。采用 MRI 将预处理肿瘤负荷分为 50-75%和大于 75%。乳酸脱氢酶（LDH）水平分为小于或等于 500IU/L 和大于 500IU/L（即高于正常水平的两倍）。采用不良事件常用术语标准（第 4.0 版）评估治疗毒性。采用 CT 和 MRI 确定最佳影像学反应（实体瘤反应评价标准）。比较肿瘤负荷和 LDH 水平与总生存（OS）和无进展生存（PFS）。
50 例患者（31 例男性；平均年龄 59.1 岁；范围 30-88 岁）符合纳入标准。共进行了 271 次化疗栓塞术。2 例患者出现 3 级血小板减少症，2 例 3 级高胆红素血症（归因于疾病进展），16 次治疗后出现无症状 4 级转氨酶升高。最佳影像学反应如下：部分缓解，n=3；稳定疾病，n=33；疾病进展，n=12（无随访影像学，n=2）。中位 OS 为 7.1 个月（范围 1.2-32.3 个月），中位 PFS 为 5.0 个月（范围 1.1-32.3 个月）。11 例（22%）患者存活时间超过 12 个月（范围 12.2-32.3），其中 1 例患者仍存活。肿瘤负荷和 LDH 水平对 OS（p=0.20 和 p=0.14）或 PFS（p=0.10 和 p=0.34）均无统计学显著影响。
BCNU 化疗栓塞治疗应被视为大体积葡萄膜黑色素瘤肝转移患者的治疗选择。
