Cancer Regional Therapy by Yuman Fong & T. Clark Gamblin & Ernest S. Han & Byrne Lee & Jonathan S. Zager

Author:Yuman Fong & T. Clark Gamblin & Ernest S. Han & Byrne Lee & Jonathan S. Zager
Language: eng
Format: epub
ISBN: 9783030288914
Publisher: Springer International Publishing

Current Clinical Indications

Ocular Melanoma

Ocular melanoma is the most common malignancy of the eye and accounts for 3–6% of all melanoma cases [19, 20]. These tumors typically arise within the pigmented uveal tract which includes the iris, the choroidal plexus, and the ciliary body. Ocular melanoma represents a distinct subset of melanoma with varying genomic drivers, clinical characteristics, patterns of metastasis, and response to therapy [19, 21–23]. Metastasis occurs in 30–60% of all cases with the most common site being the liver via hematogenous spread [19, 20, 24]. Prognosis in the setting of stage IV disease is poor with overall survival rates of approximately 2 months if left untreated [25]. Resection of isolated liver disease offers the best chance for prolonged survival, but liver metastases are often diffuse with bilobar distribution. Systemic options for these patients are limited as immunotherapy and BRAF targeted drugs that work well in cutaneous melanoma are usually ineffective [26, 27]. IHP has been shown to improve survival in metastatic ocular melanoma; the summary of evidence is outlined in Table 21.1. The SCANDIUM trial is the first randomized clinical trial to evaluate IHP in metastatic uveal melanoma and is ongoing [28].Table 21.1Contemporary studies of isolated hepatic perfusion in patients with metastatic ocular melanoma confined to the liver

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