Introduction. Percutaneous hepatic perfusion with melphalan (PHP-M) for hepatic metastasis
of uveal melanoma (LMUM) achieves high local response rates, but the individual clinical
benefit is poorly defined. We aimed to determine cofactors of response and clinical
outcomes including the probability of long-term (5-years) overall survival (OS) in
PHP-M-treated patients with LMUM.Patients and Methods. We retrospectively reviewed
clinicopathological, radiological, and outcome data of 19 patients with unresectable
LMUM treated with 43 PHP-M (median 2 PHP-M) between 2014 and 2019. Tumor response
and adverse events were evaluated using RECIST 1.1 and the Clavien-Dindo classification.
Kaplan-Meier methods and Cox regression hazard proportional models were used.Results.
Of 19 patients, 10 (53%) achieved a partial response (PR) and 9 (47%) had stable disease
(SD). There was no progressive disease (PD) and no adverse events exceeding Clavien-Dindo
grade IV. Median OS was 16.7 months after the first PHP-M treatment and 26.4 months
after initial diagnosis. Low hepatic tumor volume (median of 10 mL vs. 150 mL) was
an independent predictor of favorable OS (hazard ratio (95% confidence interval):
0.190 (0.041, 0.893);p<0.05), and female patients were at a lower risk compared with
males (0.146 (0.017, 1.240)). Estimates of the overall survival were 0.213 (0.0449,
1) from first imaging (95% confidence interval) to 5 years and 0.793 (0.609, 1) and
0.604 (0.380, 0.960) for 1 and 2 years after chemosaturation, respectively.Discussion.
PHP-M for nonresectable LMUV provides a safe and locally efficient liver-directed
procedure that offers patients a chance for long-term OS, especially for patients
with a low hepatic tumor burden.
