Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Department of Medical Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
J Nucl Med. 2020 Mar;61(3):350-356. doi: 10.2967/jnumed.119.230870. Epub 2019 Sep 3.
Survival of patients with uveal melanoma metastatic to the liver correlates strongly with disease control in the liver. Unfortunately, there are no standardized treatments for this chemoresistant disease. Selective internal radiation therapy (SIRT) has been tested as salvage therapy, but no data exist about its use as first-line therapy. The purpose of this study was to investigate the safety and efficacy of SIRT as first-line therapy in patients with uveal melanoma metastatic to the liver. This retrospective analysis of a prospectively collected cohort included 22 patients treated with first-line SIRT. Biochemical and clinical toxicities were recorded. Tumor response was determined according to the European Association for the Study of Liver Disease (EASL) criteria. Predictive factors of survival were analyzed by univariate and multivariate analysis. Overall survival was calculated using the Kaplan-Meier method with the log-rank test. Grade 3-4 biologic and clinical toxicities occurred in 24% of patients (for both). According to the EASL criteria, disease control at 6 mo after SIRT was achieved in 15 (52%) of the 29 SIRT patients and was predictive of survival. Median overall survival from the first SIRT was 18 mo (95% confidence interval [95%CI], 8-28 mo). At the time of the analysis, 5 patients (23%) were still alive. In multivariate analysis, largest lesion size (hazard ratio [HR], 1.22; 95%CI, 0.98-1.53], liver tumor volume (HR, 1.002; 95%CI, 1.0004-1.003), subsequent systemic therapy (HR, 0.04; 95%CI, 0.006-0.24), and liver-directed locoregional therapy (HR, 0.204; 95%CI, 0.04-0.94) were predictive of survival. First-line SIRT is safe and produced promising outcomes in patients with uveal melanoma metastatic to the liver. Subsequent systemic and liver-directed locoregional therapies ameliorated survival, highlighting the potential for improved outcomes with combination approaches. The results of this study suggest that prospective trials using first-line SIRT should be considered.
患者患有转移性眼黑色素瘤至肝脏，其生存与肝脏疾病控制密切相关。不幸的是，对于这种化疗耐药的疾病尚无标准化治疗方法。选择性内部放射治疗（SIRT）已被作为挽救疗法进行了测试，但尚无关于其作为一线治疗的用途的数据。本研究的目的是调查 SIRT 作为一线治疗转移性眼黑色素瘤患者的安全性和有效性。这项前瞻性队列研究的回顾性分析纳入了 22 例接受一线 SIRT 治疗的患者。记录了生化和临床毒性。根据欧洲肝病研究协会（EASL）标准确定肿瘤反应。通过单因素和多因素分析分析了生存的预测因素。使用 Kaplan-Meier 方法和对数秩检验计算总生存率。有 24%的患者发生 3-4 级生物和临床毒性（均如此）。根据 EASL 标准，29 例 SIRT 患者中有 15 例（52%）在 SIRT 后 6 个月时达到疾病控制，这与生存有关。从第一次 SIRT 开始的中位总生存期为 18 个月（95%置信区间[95%CI]，8-28 个月）。在分析时，5 例患者（23%）仍存活。在多因素分析中，最大病变大小（风险比[HR]，1.22；95%CI，0.98-1.53）、肝肿瘤体积（HR，1.002；95%CI，1.0004-1.003）、随后的全身治疗（HR，0.04；95%CI，0.006-0.24）和肝局部区域治疗（HR，0.204；95%CI，0.04-0.94）是生存的预测因素。一线 SIRT 治疗安全，并且对转移性眼黑色素瘤患者产生了有希望的结果。随后的全身和肝局部区域治疗改善了生存，突出了联合治疗方法改善结局的潜力。本研究结果表明，应考虑使用一线 SIRT 进行前瞻性试验。
