PT  - JOURNAL ARTICLE
AU  - Ponti, Alexandre
AU  - Denys, Alban
AU  - Digklia, Antonia
AU  - Schaefer, Niklaus
AU  - Hocquelet, Arnaud
AU  - Knebel, Jean-François
AU  - Michielin, Olivier
AU  - Dromain, Clarisse
AU  - Duran, Rafael
TI  - First-Line Selective Internal Radiation Therapy in Patient with Uveal Melanoma Liver Metastases
AID  - 10.2967/jnumed.119.230870
DP  - 2019 Aug 01
TA  - Journal of Nuclear Medicine
PG  - jnumed.119.230870
4099  - http://jnm.snmjournals.org/content/early/2019/08/29/jnumed.119.230870.short
4100  - http://jnm.snmjournals.org/content/early/2019/08/29/jnumed.119.230870.full
AB  - Survival of patients with uveal melanoma liver metastases is strongly correlated with disease control in the liver. Unfortunately, there are no standardized treatments for this chemo-resistant disease. Selective Internal Radiation Therapy (SIRT) has been tested as salvage therapy but no data exist about its use as first-line therapy. The purpose of this study was to investigate the safety and efficacy of SIRT used as first-line therapy in patients with uveal melanoma metastatic to the liver. Methods: This retrospective analysis of a prospectively collected cohort included 22 patients treated with first-line SIRT. Biochemical and clinical toxicities were recorded. Tumor response included European Association for the Study of Liver Disease (EASL) criteria. Predictive factors of survival were analyzed by uni-/multivariate analysis. Overall survival was calculated using the Kaplan-Meier method with the log-rank test. Results: Grade 3-4 biological and clinical toxicities occurred in 24% of patients (for both). According to EASL, disease control at 6 months after SIRT was achieved in 15 (52%) of the 29 SIRT and was predictive of survival. Median overall survival from the first SIRT was 18 months [95% confidence interval (95%CI), 8-28]. At the time of the analysis, 5 patients (23%) were still alive. In multivariate analysis, largest lesion size [1.22 hazard ratio (HR); 95%CI, 0.98-1.53], liver tumor volume [1.002 HR; 95%CI, 1.0004-1.003], subsequent systemic [0.04 HR; 95%CI, 0.006-0.24] and liver-directed locoregional therapies [0.204 HR; 95%CI, 0.04-0.94] were predictive of survival. Conclusion: First-line SIRT is safe and demonstrated promising outcomes in patients with uveal melanoma liver metastases. Subsequent systemic and liver-directed locoregional therapies ameliorated survival, highlighting the potential for improved outcomes with combinatorial approaches. The results of this study suggest that prospective trials using first-line SIRT should be considered.