Objectives: To investigate survival, efficacy, and safety of selective internal yttrium-90 radioembolization therapy (90Y-SIRT) in patients with unresectable metastatic melanoma (MM) to liver refractory to systemic therapy.
Methods: An IRB-approved retrospective review of 58 patients diagnosed with unresectable MM to the liver, refractory to systemic therapy, between February 2003 and March 2012 was conducted. Of these, 28 received resin-based 90Y-SIRT (group A), and 30 patients received best supportive care (group B). Survival was calculated using the Kaplan-Meier method and Cox proportional hazard models.
Results: Groups A and B were similar for the Child-Pugh class, ECOG scores, age, sex, and race. Median overall survival (OS) from diagnosis of primary melanoma in groups A and B were 119.9 and 26.1 months, respectively (P<0.001). Median OS from hepatic metastasis in groups A and B were 19.9 and 4.8 months, respectively (P<0.0001). In group A, median OS from hepatic metastasis in the Child-Pugh A, B, and C patients was 37.7, 4.2, and 3.6 months, respectively (P<0.001). In group B, median OS from hepatic metastasis in the Child-Pugh A, B, and C patients was 7.8, 4.2, and 1.9 months, respectively (P=0.04). Within group A, median OS from first 90Y-SIRT was 10.1 months; median OS of the Child-Pugh A, B, and C patients from first 90Y-SIRT was 10.3, 1.2, and 0.9 months, respectively (P=0.04). Median OS from first 90Y-SIRT was significantly greater in the absence of diffuse (>10) liver metastases (15.1 vs. 4.7 mo, P=0.02), and in the absence of extrahepatic metastases (21.3 vs. 8.6 mo, P<0.001). Common clinical toxicities following 90Y-SIRT included abdominal pain (17.9%), fatigue (14.3%), and self-limiting grade III bilirubin toxicity (10.7%).
Conclusion: For patients with unresectable MM to the liver refractory to systemic therapy, resin-based 90Y was associated with longer survival from liver metastases than best supportive care. Child-Pugh A patients with <10 metastatic lesions and absence of extrahepatic metastases demonstrated greatest survival following 90Y-SIRT.
*Division of Interventional Radiology, Department of Radiology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
†Interventional Radiology and Image-guided Medicine, Department of Radiology and Imaging Sciences
Departments of ‡Hematology and Medical Oncology
§Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
The authors declare no conflicts of interest.
Reprints: Hyun S. Kim, MD, FSIR, Vice Chair, Image Guided Therapy and Interventional Oncology Research; Director, Interventional Oncology Translational Laboratory; Chief, Interventional Radiology, Cancer Therapeutics Program of University of Pittsburgh Cancer Institute, UPMC Cancer Center; Department of Radiology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Presbyterian South Tower, Suite 3950, 200 Lothrop Street, Pittsburgh, PA 15213-3553. E-mail: firstname.lastname@example.org.