veal melanoma (UM) is the most common primary malignant intraocular tumor in adults with an incidence of 5.1 cases per million in the United States (1-3). Up to 50% of patients with UM develop metastatic disease (3). The liver is the primary site of metastasis in greater than 90% of patients, and less than 10% of patients are candidates for surgical resection due to multiplicity of tumors at the time of diagnosis (3). Currently, there are no effective systemic therapies for patients with metastatic UM. In general, without treatment, median overall survival (OS) following detection of hepatic metastases is reportedly less than 6 months, with a 1-year survival of 10%-15% (3). Most commonly, patient death is due to growth of hepatic metastases ultimately leading to hepatic failure. Therefore, stabilization of liver metastases is essential to prolonging OS for patients with metastatic UM. Transarterial catheter-directed therapies used to control the growth of UM hepatic metastases include immunoembolization, chemoembolization, and percutaneous hepatic perfusion (4-15). A few retrospective studies have also reported encouraging results following radioembolization (RE) of UM hepatic metastases (4-7). In 2009, a small multicenter trial reported a 1-year survival of 80% for patients with UM treated with RE (4). In 2011, a median OS of 10.0 months was reported for patients treated with RE following failure of both immunoembolization and chemoembolization (5). In addition, a larger retrospective trial reported a median OS of 12.3 months following RE of 71 patients with UM hepatic metastases (6). The purpose of our study was

There is no FDA-approved treatment for metastatic uveal melanoma (UM) and overall outcomes are generally poor for those who develop liver metastasis. We performed a retrospective single-institution chart review on consecutive series of UM patients with liver metastasis who were treated at Thomas Jefferson University Hospital between 1971–1993 (Cohort 1, n = 80), 1998–2007 (Cohort 2, n = 198), and 2008–2017 (Cohort 3, n = 452). In total, 70% of patients in Cohort 1 received only systemic therapies as their treatment modality for liver metastasis, while 98% of patients in Cohort 2 and Cohort 3 received liver-directed treatment either alone or with systemic therapy. Median Mets-to-Death OS was shortest in Cohort 1 (5.3 months, 95% CI: 4.2–7.0), longer in Cohort 2 (13.6 months, 95% CI: 12.2–16.6) and longest in Cohort 3 (17.8 months, 95% CI: 16.6–19.4). Median Eye Tx-to-Death OS was shortest in Cohort 1 (40.8 months, 95% CI: 37.1–56.9), and similar in Cohort 2 (62.6 months, 95% CI: 54.6–71.5) and Cohort 3 (59.4 months, 95% CI: 56.2–64.7). It is speculated that this could be due to the shift of treatment modalities from DTIC-based chemotherapy to liver-directed therapies. Combination of liver-directed and newly developed systemic treatments may further improve the survival of these patients.

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Uveal melanoma is the most common primary intraocular malignant tumor in adults. Approximately 50% of patients develop metastatic disease of which greater than 90% of patients develop hepatic metastases. Following the development of liver tumors, overall survival is dismal with hepatic failure being the cause of death in nearly all cases. To prolong survival for patients with metastatic uveal melanoma, controlling the growth of hepatic tumors is essential. This article will discuss imaging surveillance following the diagnosis of primary uveal melanoma; locoregional therapies used to control the growth of hepatic metastases including chemoembolization, immunoembolization, radioembolization, percutaneous hepatic perfusion, and thermal ablation; as well as currently available systemic treatment options for metastatic uveal melanoma.

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