CIO 2022-23 Radioembolization as a Locoregional Treatment of Hepatic Metastasis of Melanoma

Purpose: To evaluate the effectiveness, safety, and predictors of outcome of patients treated with yttrium-90 (90Y) radioembolization for hepatic involvement of metastatic melanoma.

Materials and Methods: The original articles evaluating treatment outcomes of patients with 90Y for hepatic metastasis of melanoma were searched in PubMed on May 31, 2022, using the following search criteria: (“Yttrium Radioisotopes”[MeSH Terms] OR “Y90”[Text Word] OR “yttrium*”[Text Word]) AND (“Brachytherapy”[MeSH Terms] OR “radioembo*”[Text Word] OR “selective internal radiation therapy”[Text Word]) AND “Melanoma”[MeSH Terms]. Twenty-two articles were found. The number of articles after reviewing the titles was 13. The number of articles after reviewing the abstracts and excluding three studies with only one case was 9.

Results: Four prospective and five retrospective studies met the search criteria. Patients (n = 156) with hepatic involvement in metastatic melanoma who received 90Y radioembolization treatment had mean age of 58.5 years with nearly 47% male. The majority of the patients had uveal melanoma as their primary cancer (n = 129) followed by cutaneous melanoma (n = 22); the remainder primary sites compromised a very small fraction (n = 5). Extrahepatic metastasis was noted at the time of therapy in 46 patients. The mean dose applied was 1.76 GBq in eight studies. Grade 1 to 2 toxicity was fairly common with two grade 3, two grade 4, two grade 5, and one grade 6 toxicities. Complete remission was seen in only 1 patient, and 40 of the 144 patients had progressive disease on follow-up despite treatment. The overall median survival period ranged from 7.6 to 35.5 months.

Conclusions: The prognosis of patients with metastatic melanoma remains dismal despite addition of locoregional therapy with 90Y radioembolization to systemic or other liver-directed therapies.