Ini' Corrado, Foti Pietro Valerio, Farina Renato, Tiralongo Francesco, Castiglione Davide Giuseppe, Cannarozzo Marta, Spatola Corrado, David Emanuele, Palmucci Stefano, Russo Andrea, Broggi Giuseppe, Avitabile Teresio, Basile Antonio
Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy.
NANOMED-Research Centre for Nanomedicine and Pharmaceutical Nanotechnology, University of Catania, Catania, Italy.
Technol Cancer Res Treat. 2025 Jan-Dec;24:15330338251343144. doi: 10.1177/15330338251343144. Epub 2025 May 25.
IntroductionThe prognosis of patients with uveal melanoma is related to several factors, including local or extraocular extension of the disease. Up to 50% of the patients with initial diagnosis of uveal melanoma develop metastases within few years and the liver represents the main site of metastatic spread. Patients with metastatic disease have a generally poor prognosis and few treatment options are available. In the last decades, the role of interventional radiology has expanded the range of treatment options and different minimally invasive liver-directed therapies were developed for liver metastases from uveal melanoma. The purpose of our systematic review was to analyze and review techniques, outcomes and safety of targeted-liver minimally invasive therapies in patients with metastatic uveal melanoma.MethodsAccording to PRISMA criteria, an extensive literature research (including more than 1600 articles) was finalized to collect the main articles on minimally invasive therapies. Based on the inclusion and exclusion criteria, 26 studies were selected for inclusion in the present systematic review (20/26 articles were retrospective studies, 6/26 articles were prospective studies). We collected data on 955 patients underwent the following procedures: radioembolization, transcatheter arterial chemoembolization, transarterial immunoembolization, percutaneous hepatic perfusion and thermal therapies.ResultsAmong procedures analyzed, the median overall survival was 16 months, the median progression-free survival was 8.2 months, while the median overall response rate was 39%. Post-procedure haematologic and gastrointestinal adverse events were predominant after percutaneous hepatic procedures.ConclusionTo date, different minimally invasive therapies are available for the treatment of metastatic uveal melanoma. Studies on percutaneous liver-directed therapies have demonstrated improvement in outcomes, prolonging overall survival and progression-free survival, and with an acceptable safety profile.
引言
葡萄膜黑色素瘤患者的预后与多种因素相关，包括疾病的局部或眼外扩展。初诊为葡萄膜黑色素瘤的患者中，高达50%会在数年内发生转移，肝脏是转移扩散的主要部位。转移性疾病患者的预后通常较差，且可用的治疗选择有限。在过去几十年中，介入放射学的作用扩大了治疗选择范围，针对葡萄膜黑色素瘤肝转移开发了不同的微创肝脏定向治疗方法。我们系统评价的目的是分析和回顾转移性葡萄膜黑色素瘤患者靶向肝脏微创治疗的技术、疗效和安全性。
方法
根据PRISMA标准，完成了一项广泛的文献研究（包括1600多篇文章），以收集有关微创治疗的主要文章。根据纳入和排除标准，选择了26项研究纳入本系统评价（26篇文章中有20篇为回顾性研究，6篇为前瞻性研究）。我们收集了955例接受以下治疗的患者的数据：放射性栓塞、经动脉化疗栓塞、经动脉免疫栓塞、经皮肝灌注和热疗。
结果
在所分析的治疗中，中位总生存期为16个月，中位无进展生存期为8.2个月，而中位总缓解率为39%。经皮肝脏治疗后，血液学和胃肠道不良事件最为常见。
结论
迄今为止，有多种不同的微创治疗方法可用于治疗转移性葡萄膜黑色素瘤。针对经皮肝脏定向治疗的研究表明，其疗效有所改善，延长了总生存期和无进展生存期，且安全性可接受。
