Pyrhönen S
Department of Oncology and Radiotherapy, Turku University Central Hospital, Finland.
Eur J Cancer. 1998 Jul;34 Suppl 3:S27-30. doi: 10.1016/s0959-8049(97)10161-7.
Malignant melanoma can occur in various ocular structures and accounts for 70% of all primary eye malignancies. At the time of initial diagnosis of uveal melanoma, most patients have no demonstrable evidence of metastatic disease. However, within 5 years, metastases appear in 19-35% of patients. The median relapse-free interval for these patients is 2-4 years. Unlike cutaneous melanoma, uveal melanoma most commonly metastasises to the liver. In fact, the liver is the sole site or the initial site of metastasis in more than 50% of patients. This paper reviews major studies that evaluated different treatment options for metastatic uveal melanoma, including surgery, systemic chemotherapy, intra-arterial chemotherapy, chemoembolisation and chemoimmunotherapy. Surgery and systemic chemotherapy offer minimal benefits for these patients. However, the use of intra-arterial fotemustine demonstrated a 40% response rate for patients with liver metastases of uveal melanoma. Additionally, chemoimmunotherapy with a four-drug chemotherapy regimen and interferon alfa has provided response rates of approximately 20% and may contribute to prolonged survival. Ongoing multicentre trials are expected to determine the feasibility of this regimen. The activity of immunotherapy, particularly interferon, encourages its use in combination with other active therapies, such as intra-arterial fotemustine.
恶性黑色素瘤可发生于各种眼部结构，占所有原发性眼部恶性肿瘤的70%。在葡萄膜黑色素瘤初诊时，大多数患者没有可证实的转移性疾病证据。然而，在5年内，19% - 35%的患者会出现转移。这些患者的无复发生存期中位数为2 - 4年。与皮肤黑色素瘤不同，葡萄膜黑色素瘤最常转移至肝脏。事实上，在超过50%的患者中，肝脏是唯一的转移部位或初始转移部位。本文回顾了评估转移性葡萄膜黑色素瘤不同治疗方案的主要研究，包括手术、全身化疗、动脉内化疗、化疗栓塞和化学免疫疗法。手术和全身化疗对这些患者的益处极小。然而，使用动脉内福莫司汀对葡萄膜黑色素瘤肝转移患者显示出40%的缓解率。此外，采用四联化疗方案和干扰素α的化学免疫疗法提供了约20%的缓解率，可能有助于延长生存期。正在进行的多中心试验有望确定该方案的可行性。免疫疗法，特别是干扰素的活性，促使其与其他有效疗法，如动脉内福莫司汀联合使用。
