Preliminary experience with transarterial chemoembolization (TACE) in liver metastases of uveal malignant melanoma: local tumor control and survival

Abstract

Purpose: To evaluate results in the palliative treatment of patients with liver metastases of uveal malignant melanoma using transarterial chemoembolization (TACE).

Materials and methods: Superselective TACE was repeatedly performed in 12 patients with liver metastases of uveal malignant melanoma. Six patients presented with solitary liver metastases (6-12 cm in size) and six patients with oligonodular metastases (n < or = 6). The embolization suspension consisted of a maximum of 10 mg/m(2) Mitomycin C, 10 ml Lipiodol, and an injection of 200-450 mg resorbable microspheres for vascular occlusion. In the follow-up, magnetic resonance imaging was performed in 3-month intervals.

Results: The TACE procedure was well tolerated in all patients without any relevant side effects. Three patients responded to TACE with a size reduction of more than 50% (partial response), five patients with stable disease, and four patients with progressive disease with an increase in volume of more than 25%. Mean survival following primary tumor treatment was 32.9 months, and after first embolization 19.5 months. Lower survival rates were recorded for the progressive group (16.5 months).

Conclusion: Repeated TACE offers a palliative treatment option in patients with oligonodular liver metastases of uveal malignant melanoma.

Fig. 1

A 64-year-old woman with a solitary liver metastasis of a malignant melanoma in segment 7. a Transverse T1-weighted (TR116/TE 5) contrast-enhanced image shows a moderately hypervascular metastasis of 80 × 68 mm in size in the right liver lobe pre-TACE. b Angiogram obtained during the first course of TACE reveals the hypervascularity of the target metastasis (arrows). c Angiography of the right hepatic artery with devascularization. The embolization suspension consisted of 10 mg/m² of Mitomycin C and 15 ml of lipiodol, followed by an injection of 200–450 mg microspheres for vascular occlusion. Note the hyperdensity of the treated metastases due to intratumoral lipiodol uptake during embolization. d Unenhanced transverse CT scan—after the first course of TACE—shows the tumoral lesion with hyperattenuation caused by retention of iodized oil. e Transverse contrast-enhanced T1-weighted MR image demonstrates a 50% volume reduction of the tumor post three cycles TACE

Fig. 2

A 60-year-old man with a liver metastasis of malignant melanoma undergoing three cycles of TACE (pre- and post-procedure) (partial response group). a Transverse T1-weighted (TR/TE/FA = 198 ms/2 ms/70°) MR scan showing a lesion of 25 × 20 mm in size in the right liver lobe pre-TACE. Note the hyperintense rim in the posterior part of the tumor (arrows). b Transverse T2-weighted (TR/TE/FA = 1,000 ms, 84 ms, 150°) MR scan demonstrates the metastases with an intratumoral rim of high signal intensity centrally in the liver pre-TACE. c Unenhanced transverse CT shows lipiodol retention (arrows) in the down-sized tumor post-chemoembolization in the 6-month follow-up after TACE

Fig. 3

A 61-year-old man with oligonodular liver metastases in segments 5 and 2 and partial response after TACE. a Transverse T1-weighted (TR 118/TE5) unenhanced image demonstrates a hypointense liver metastasis of 30 × 28 mm in size in liver segment 5 (arrows). b Angiographic image in the final phase of the embolization reveals an intratumoral uptake of lipiodol (arrows) with a central low-density area (c). In this phase the lipiodol suspension is still visualized in the right hepatic artery. c Unenhanced CT post-TACE 1 day post-intervention demonstrates a high degree of lipiodol uptake in the peripheral parts of the lesion with a central necrosis. d Transverse T1-weighted (TR 118/TE 5) unenhanced image 1 month post third TACE with verification of the enormous size reduction of the treated metastasis (arrows). e Unenhanced CT post-TACE demonstrated a further reduction in size with homogeneous lipiodol deposits

Fig. 4

Survival after first TACE cycle in patients with oligonodular metastases of uveal malignant melanoma (Kaplan–Meier)

Fig. 5

Survival after ocular treatment of malignant melanoma (Kaplan–Meier)