Regional Treatment Options for Patients With Ocular Melanoma Metastatic to the Liver

From the Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Address correspondence and reprint requests to: H. Richard Alexander, Jr., MD, Surgical Metabolism Section, Surgery Branch, National Cancer Institute/NIH, Building 10, Room 2B07, Bethesda, MD 20892-1502; Fax: 301-402-1788.

	Abstract

Ocular melanoma is the most common primary ocular malignancy and has a significant predilection for metastasis to the liver. More than 40% of patients have hepatic metastases present at initial diagnosis, and the liver becomes involved in up to 95% of individuals who develop metastatic disease. The median survival of patients after diagnosis of liver metastasis ranges from 2 to 7 months. Metastatic disease localized to the liver has proven to be resistant to most available chemotherapy and immunotherapy regimens. Recognition of the grave prognosis associated with liver metastasis from ocular melanoma has led to the evaluation of new regional treatment modalities primarily designed to control tumor progression in the liver, including hepatic arterial chemotherapy, hepatic artery chemoembolization, regional immunotherapy, isolated hepatic perfusion, and percutaneous hepatic perfusion. This article reviews the efficacy, outcomes, and morbidities of the multiple locoregional therapies available today.

Key Words: Regional therapy, Liver metastases, Chemoembolization, Isolation perfusion, Intra-arterial chemotherapy, Immunotherapy

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