Chemoreduction of Orbital Recurrence of Uveal Melanoma by Intra-Arterial Melphalan

Abstract

Background/Aims: The treatment of orbital melanoma poses a management challenge. This case explores the delivery of high-dose melphalan to an orbital recurrence of uveal melanoma via intra-arterial delivery of melphalan to the orbit. A 62-year-old man developed recurrent orbital disease 7 months after enucleation for a large uveal melanoma. He received 6 monthly intra-arterial infusions of melphalan to the orbit, ranging in dose from 20 to 30 mg per infusion. Following the last infusion, mild temporary erythema was noted on the forehead along the distribution of the supratrochlear artery. The orbital recurrence was reduced in size by 66% in the longest dimension as measured by magnetic resonance imaging (MRI). However, 9 months following intra-arterial melphalan, tumor regrowth was detected on MRI, and additional treatment options were pursued. Conclusion: This case demonstrates that intra-arterial melphalan can result in nonsustained tumor regression of recurrent orbital uveal melanoma. It suggests that local delivery of high-dose melphalan may be helpful as a neoadjuvant treatment for uveal melanoma, and future studies will be useful to confirm the value of this approach in additional cases of recurrent and possibly in primary uveal melanoma.

Adjuvant External Beam Radiotherapy Following Enucleation of Eyes With Extraocular Extension From Uveal Melanoma

“…20 Recently, neoadjuvant intraarterial melphalan has been used in an effort to cytoreduce orbital recurrence of UM prior to surgery. 25 Neoadjuvant and Adjuvant Radiotherapy. In 1990s, the Collaborative Ocular Melanoma Study (COMS) group investigated preenucleation radiotherapy for large choroidal melanomas.…”

“…20 Recently, neoadjuvant intra-arterial melphalan has been used in an effort to cytoreduce orbital recurrence of uveal melanoma prior to surgery. 25…”

Melanoma maligna orbita: sebuah laporan kasus

“…Terdapat kasus melanoma uvea rekuren yang dilakukan terapi dengan melphalan intraarterial dosis 30 mg setiap 6 bulan sekali setelah dilakukan enukleasi, dapat menurunkan ukuran tumor hingga 66% dengan tujuan terapi sitoreduksi. 22,23 Melphalan juga dapat diadministrasikan melalui Percutaneous Hepatic Perfusion (PHP) menuju hepar langsung. Terdapat juga pengunaan Tebentafusp (IMCgp100) ,suatu antibodi spesifik yang mengarahkan sel CD3 ke sel melanoma yang mengekspresikan gp 100 dan menginduksi sitolisis 24 dan laser diode intraokular atau brakiterapi plak episkleral.…”