Selective internal radiation therapy for hepatic metastases of uveal melanoma: a systematic review

Objective: Uveal melanoma (UM) commonly metastasizes to the liver. Treatment usually consists of liver-directed therapies, such as selective internal radiation therapy (SIRT). This review aimed to assess the effectiveness and safety of SIRT for hepatic metastases from UM. Methods: The study protocol is available at OSF ( https://osf.io/vhyct/ ). EMBASE and MEDLINE were searched until July 2020, using terms related to SIRT and hepatic metastases from UM. Studies reporting outcomes of SIRT in patients with UM and at least one hepatic metastasis were included. Data on overall survival (OS), hepatic progression free survival (hPFS) or tumor response were collected. The Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. Results: 11 studies were included, reporting outcomes for 268 patients with hepatic metastases from UM. Most studies (n = 9, 81.8%) were retrospective. Disease control was achieved in 170 patients (67.5%) and the median OS from time of SIRT was 12.3 months. Median hPFS was 5.4 months. Low-grade side-effects were common but serious complications were infrequent. There were two treatment-related deaths. The median NOS score was 6 (moderate risk of bias). Conclusion: SIRT appears to be a safe and effective treatment for patients with unresectable hepatic metastases from UM. The certainty of our results is unclear due to predominantly retrospective data with moderate risk of bias. Further prospective studies are required to explore the role of SIRT in UM. Advances in knowledge: SIRT appears to be a safe treatment for patients with unresectable hepatic metastases from UM. Further prospective work is required.

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Selective internal radiation therapy (SIRT) as treatment for hepatic metastases of uveal melanoma: a Finnish nation-wide retrospective experience

Acta Oncologica ◽

10.1080/0284186x.2018.1465587 ◽

2018 ◽

Vol 57 (10) ◽

pp. 1373-1380 ◽

Cited By ~ 9

Author(s):

Sanni Tulokas ◽

Hanna Mäenpää ◽

Erno Peltola ◽

Tero Kivelä ◽

Pia Vihinen ◽

...

Keyword(s):

Radiation Therapy ◽

Uveal Melanoma ◽

Hepatic Metastases ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy

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Long-Term Maintained Response to Selective Internal Radiation Therapy in an Oligometastatic Uveal Melanoma Patient Treated with Concomitant Anti-PD-1 Therapy

Life ◽

10.3390/life11070692 ◽

2021 ◽

Vol 11 (7) ◽

pp. 692

Author(s):

Ilaria Proietti ◽

Nevena Skroza ◽

Luca Filippi ◽

Nicoletta Bernardini ◽

Alessandra Mambrin ◽

...

Keyword(s):

Radiation Therapy ◽

Uveal Melanoma ◽

Hepatic Metastases ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Durable Response ◽

Selective Internal Radiation ◽

Internal Radiation Therapy ◽

Primary Neoplasm

Uveal melanoma (UM) is a primary neoplasm of the eye arising from the melanocytes residing in the iris, ciliary body or choroid. It is the most frequent intraocular malignancy and often determines metastases at distant sites, with a peculiar tropism for the liver. Metastatic UM has a poor prognosis, as any treatment affects the natural course of this fatal disease. Herein, we report a case of a UM metastatic to the liver in a 54 year-old female patient, initially treated with nivolumab without success. The patient was then scheduled for selective internal radiation therapy (SIRT) while continuing immunotherapy. This combination led to a complete and durable response and the patient is currently free of disease, two years after the diagnosis of the hepatic metastases. The association between SIRT and immunotherapy (IT) has very promising perspectives for metastatic UM, especially considering the disappointing or contradictory results of classic chemotherapies, IT alone and targeted therapies. Furthermore, this combination has been shown to have a good security profile. However, further studies are needed to confirm the efficacy of associating SIRT and IT and to clarify some unsolved problems, such as the timing of administration of these two therapies.

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