CIO 2022-30 Yttrium-90 Radioembolization Treatment of Patients With Liver-Dominant Metastatic Melanoma

Purpose: Liver metastasis in melanoma patients portends a poor prognosis, with the overall survival (OS) across all treatment modalities being 5 to 7 months.  This study aims to evaluate the safety and efficacy of Yttrium-90 radioembolization of patients with liver-dominant metastatic melanoma.

Methods: This Institutional review board approved single center retrospective study included 19 patients (10 male, 9 female, average age 63.8, range: 36-81) who underwent radioembolization with Yttrium-90-labeled glass (15 patients) or resin (4 patients) microspheres between August 2010 and August 2021. Medical records and imaging data were reviewed to evaluate toxicities, tumor response, and overall survival.  12 patients received immunotherapy prior to radioembolization and 6 received immunotherapy after radioembolization, while 6 patients received systemic chemotherapy prior to treatment and 4 received systemic chemotherapy after treatment. 6 patients had extrahepatic disease at the time of treatment.  2 patients had prior liver directed treatments, while 9 had liver directed therapy after Yttrium-90 radioembolization.

Results: Median overall survival was 9.3 months (95% CI: 0-19.1) from Yttrium-90 radioembolization and 20.8 months (95% CI: 8.7-32.9) from liver metastases diagnosis. Median overall survival from original diagnosis was 82.3 months (95% CI: 21.9-142.8). 15 patients experienced mild (grade 1-2) clinical toxicities. (9 fatigue, 8 hepatic pain, 1 constipation, 1 nausea).  One patient experienced pneumonitis (grade 3), hypoxia (grade 3), and dyspnea (grade 3). 10 patients had low grade biochemical toxicities (grade 1-2) and 3 patients had high grade biochemical toxicities (grade 3 bilirubin, AST).

Conclusions: Radioembolization is safe and led to encouraging overall survival in melanoma patients with liver-dominant metastases.