Percutaneous Locoregional Therapies for the Treatment of Liver Metastases from Uveal Melanoma: A Systematic Review

Abstract

IntroductionThe prognosis of patients with uveal melanoma is related to several factors, including local or extraocular extension of the disease. Up to 50% of the patients with initial diagnosis of uveal melanoma develop metastases within few years and the liver represents the main site of metastatic spread. Patients with metastatic disease have a generally poor prognosis and few treatment options are available. In the last decades, the role of interventional radiology has expanded the range of treatment options and different minimally invasive liver-directed therapies were developed for liver metastases from uveal melanoma. The purpose of our systematic review was to analyze and review techniques, outcomes and safety of targeted-liver minimally invasive therapies in patients with metastatic uveal melanoma.MethodsAccording to PRISMA criteria, an extensive literature research (including more than 1600 articles) was finalized to collect the main articles on minimally invasive therapies. Based on the inclusion and exclusion criteria, 26 studies were selected for inclusion in the present systematic review (20/26 articles were retrospective studies, 6/26 articles were prospective studies). We collected data on 955 patients underwent the following procedures: radioembolization, transcatheter arterial chemoembolization, transarterial immunoembolization, percutaneous hepatic perfusion and thermal therapies.ResultsAmong procedures analyzed, the median overall survival was 16 months, the median progression-free survival was 8.2 months, while the median overall response rate was 39%. Post-procedure haematologic and gastrointestinal adverse events were predominant after percutaneous hepatic procedures.ConclusionTo date, different minimally invasive therapies are available for the treatment of metastatic uveal melanoma. Studies on percutaneous liver-directed therapies have demonstrated improvement in outcomes, prolonging overall survival and progression-free survival, and with an acceptable safety profile.

Keywords: chemoembolizationtherapeutic (E02.520.360.150, E02.926.500.150); eye (A01.456.505.420); eye neoplasms (C04.588.364); melanoma (C04.557.465.625.650.510); radiologyinterventional (H02.403.740.675); uvea (A09.371.894); uveal neoplasms (C04.588.364.978).

Figure 1.

Flow-Chart Illustrating Selection Process Of The Articles Included In The Systematic Review.