Meta-Analysis of Isolated Hepatic Perfusion and Percutaneous Hepatic Perfusion as a Treatment for Uveal Melanoma Liver Metastases

Abstract

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.

Isolated Hepatic Perfusion With Melphalan for Patients With Isolated Uveal Melanoma Liver Metastases: A Multicenter, Randomized, Open-Label, Phase III Trial (the SCANDIUM Trial)

“…However, there were a higher complication rate (39.1% v 23.8%) and a higher 30-day mortality (5.5% v 1.8%) for IHP compared with PHP. 30 An interesting development is the combination of IHP or PHP with systemic immunotherapy. Data have shown a correlation between OS and a high infiltration of CD8 1 T cells in metastases and an activated immune cell profile in peripheral blood in patients treated with IHP, 31 and ongoing studies are currently investigating the combination of CTLA-4 and PD-1 inhibitors with either PHP (CHOPIN trial ClinicalTrials.gov identifier: NCT04283890) or IHP (SCANDIUM-II trial Clinical-Trials.gov identifier: NCT04463368).…”

Regional chemotherapy for uveal melanoma liver metastases

“…It is used mainly for patients with surgically unresectable liver tumors. Percutaneous Isolated Hepatic Perfusion (PHP) is a minimally invasive alternative to IHP and is repeatable [50] . IHP/ PHP is indicated for tumors totally or predominantly localized to the liver.…”

Anästhesiologisches und postinterventionelles Management bei perkutaner hepatischer Melphalanperfusion (Chemosaturation)

“…Die selektive perkutane hepatische Perfusion mit dem Chemotherapeutikum Melphalan (Chemosaturation) ist ein Ansatz zur Tumorlastreduktion bzw. Tumorkontrolle, der insbesondere beim hepatisch metastasierten Aderhautmelanom mit einer guten Ansprechrate einhergeht [ 3 , 7 , 9 , 14 – 16 , 22 , 23 , 32 , 35 , 37 , 39 , 49 ]. Auch bei anderen Tumorentitäten, z.…”

“…Aufgrund des Komplikationspotenzials dieses Verfahrens [ 17 ] folgten in den 1990er-Jahren erste Schritte zu einer minimal-invasiven perkutanen hepatischen Melphalanperfusion (PHMP) [ 5 ]. Im Vergleich zur IHP zeigte die PHMP deutlich geringere Komplikationsraten und eine geringere 30-Tage-Sterblichkeit [ 7 ].…”