Hyperthermic isolated hepatic perfusion using melphalan for patients with ocular melanoma metastatic to liver

Median survival after diagnosis of liver metastasis from ocular melanoma is short and no satisfactory treatment options exist. This clinical trial evaluated isolated hepatic perfusion (IHP) for patients with this condition. Twenty-nine patients with unresectable liver metastases from ocular melanoma were treated with a 60-min hyperthermic IHP using 1.5 mg/kg of melphalan (mean total dose 105 mg). By means of laparotomy, perfusion inflow was established with a cannula positioned in an isolated segment of the retrohepatic inferior vena cava. Portal and infra-renal inferior vena cava blood flow was shunted externally to the axillary vein using a veno-veno bypass circuit. Patients were assessed for toxicity, radiographic response, and survival. There was no treatment related mortality and transient grade three-fourths hepatic toxicity was observed in 19 patients (65%). Mean length of operation and hospital stay was 8.3 hours and 10 days, respectively. There were 3 complete responses (10%) (duration: 12, 14+, 15 months) and 15 partial responses (52%) (mean duration: 10 months). The initial site of disease progression included liver in 17 (68%) of 25 patients who recurred. At median follow-up of 30.7 months, the median actuarial progression-free and overall survivals were 8 and 12.1 months, respectively. IHP with melphalan alone results in significant regression of established liver metastases for patients with ocular melanoma. However, after IHP, disease progression is most commonly observed in the liver, and survival after disease progression is short. On the basis of a pattern of tumor progression predominantly to the liver, continued clinical evaluation of hepatic directed therapy in the patient population is justified.—Hans E. Grossniklaus