Abstract
Simple SummaryIsolated hepatic perfusion is one of the available treatment options for patients with liver metastases from uveal melanoma. This is an open surgical procedure where the liver is isolated from the circulation and perfused with a chemotherapeutic agent. A modern development is the minimally invasive percutaneous hepatic perfusion, where the liver is endovascularly isolated and then perfused with a chemotherapeutic agent through a catheter in the arterial system. Within this systematic review and meta-analysis, we aim to compare these modalities in terms of overall survival, progression-free survival, complications and response.Background: Uveal melanoma is the most commonly occurring primary intraocular malignancy in adults, and patients have a high risk of developing metastatic disease, mostly in the liver. Isolated hepatic perfusion (IHP) with melphalan is a liver-directed therapy for patients with liver metastases. Percutaneous hepatic perfusion (PHP), a minimally invasive technique, is available as well. PHP benefits from the fact that the procedure can be repeated and therefore possibly offers better survival. We conducted a systematic review and meta-analysis comparing both techniques. Methods: A systematic literature search was performed using the electronic databases of Scopus, MEDLINE, Web of Science, PubMed and Cochrane CENTRAL. A total of nine articles reporting on eight studies were included in the analysis. Individual survival data were extracted from each study. Results: The median overall survival (OS) was 17.1 months for IHP and 17.3 months for PHP. The median progression-free survival (PFS) was 7.2 months for IHP and 9.6 months for PHP. The median hepatic progression-free survival was 10 months for IHP and 9.5 months for PHP. The complication rate and 30-day mortality rate were 39.1% and 5.5% for IHP and 23.8% and 1.8% for PHP. Conclusion: There was no difference in OS or PFS between IHP and PHP for patients with uveal melanoma liver metastases, but patients have significantly less of a risk for complications and mortality following PHP.
Highlights
In 80–85% of the patients with uveal melanoma, the tumor arises from melanocytes in the choroid region, while the remaining tumors arise from the iris and ciliary body [1,6,7]
The calculated overall survival (OS) data show that there is no difference between Isolated hepatic perfusion (IHP) and Percutaneous hepatic perfusion (PHP) for patients with liver metastases from uveal melanoma in the long term, but that patients have a significantly lower risk of complications and mortality following PHP
Of all patients included in the IHP studies, the majority did not receive any prior treatment for their liver metastases
Summary
Uveal melanoma is the most commonly occurring primary intraocular malignancy in adults [1]. It is very different from cutaneous melanoma, considering clinical behavior, response to treatment and known mutations [2,3]. The liver is the most common site for metastases, and it is involved in up to 90% of cases for patients with metastatic disease. Uveal melanoma is the most commonly occurring primary intraocular malignancy in adults, and patients have a high risk of developing metastatic disease, mostly in the liver. Isolated hepatic perfusion (IHP) with melphalan is a liver-directed therapy for patients with liver metastases. Percutaneous hepatic perfusion (PHP), a minimally invasive technique, is available as well. We conducted a systematic review and meta-analysis comparing both techniques
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