Interventional Radiology
Treatment of Metastatic Uveal (Ocular) Melanoma
Jefferson is a nationwide referral center for patients with uveal melanoma, the most common malignant tumor originating in the eye. At the time of diagnosis, more than 95% of patients have tumors limited to the eye, but at least 30% of these patients will subsequently develop metastases to other parts of the body, most commonly the liver and often several years after the diagnosis of the primary tumor. The clinical course of patients with uveal melanoma is generally determined by progression of the disease in the liver. Historically, median survival of patients with metastatic uveal melanoma to the liver has been up to 5 months. There are currently no effective systemic chemotherapy regimens for treatment of liver metastases from this tumor.
In patients who are not candidates for surgical treatment of liver metastases due to either multiple tumors or additional tumors outside of the liver, we offer several treatment regimens, in close collaboration with Takami Sato, M.D., Ph.D., a medical oncologist specializing in the treatment of metastatic uveal melanoma.
IMMUNOEMBOLIZATION was developed at Jefferson as a novel therapy to improve survival in uveal melanoma patients with liver metastases. In this approach, cytokines (drugs which stimulate or modulate immune responses) are injected directly into the arteries supplying the liver in attempts to induce an inflammatory response in the tumor to eliminate tumor cells. The cytokine injection is combined with embolization of the hepatic artery. Embolization involves blocking off the blood supply to the tumors by injecting an oily liquid (Ethiodol) and a temporary dissolvable agent (Gelfoam) into the arteries supplying the liver which helps to kill the tumors. This also presents tumor antigens to the immune system. Local stimulation of the immune system may result in development of a systemic immune response against tumor cells which could suppress the growth of additional tumors outside of the liver.
CHEMOEMBOLIZATION is performed for patients with more extensive tumor involvement in the liver. BCNU (a chemotherapy drug) dissolved in an oily liquid (Ethiodol) is injected directly into the arteries supplying the liver, along with a temporary dissolvable agent (Gelfoam) to block off the blood supply to the tumors.
RADIOEMBOLIZATION (administration of Yttrium-90 radioactive microspheres) is also being investigated in the treatment of uveal melanoma metastases to the liver. Tiny beads with an embedded radioactive material are injected directly into the arteries supplying the liver to kill the tumors. We are initiating a clinical trial to further study the effectiveness of this procedure for these tumors.
Our division performs more than 300 liver embolization procedures/year for patients with metastatic uveal melanoma. We have treated a number of patients with this disease using radioactive microspheres.
Case Study
Arteriogram of a patient with Metastatic Uveal Melanoma prior to treatment with Immunoembolization.
Final arteriogram following treatment. The main hepatic arteries remain patent, allowing further therapy as needed.
This patient has tumors in both lobes of the liver.
Following Immunoembolization, the tumors are no longer radiographically apparent
This 50 year old female had been treated with immunoembolization and had partial response in all tumors except for one in the caudate lobe. This was then addressed with cryoablation. A needle is advanced from the left upper abdomen into the tumor.
A second needle is passed directly into the tumor from the right midabdomen
At the end of the ablation, an ice ball engulfs the tumor.
This 49-year old female had a solitary pulmonary nodule in addition to hepatic masses that were being treated with immunoembolization.This tumor was treated with radiofrequency ablation. This image demonstrates the mass in the left lower lobe.
After placing a radiofrequency electrode, the tumor was successfully treated