Metastatic melanoma to the liver: A contemporary and comprehensive review of surgical, systemic, and regional therapeutic options
Metastatic melanoma to the liver: A contemporary and comprehensive review of surgical, systemic, and regional therapeutic options
复制标题
肝脏转移性黑色素瘤：手术、全身和区域治疗方案的当代综合回顾
作者：
S. Agarwala;A. Eggermont;S. O'Day;J. Zager
眼部和皮肤黑色素瘤肝转移的有效治疗仍然是一个主要的治疗挑战。治疗方案包括肝切除术、肝动脉内化疗、化疗栓塞和肝灌注。评估这些干预措施的有效性受到大多数数据的回顾性性质的限制，尽管对照3期研究开始出现。肝切除术的研究强烈提示，在选定的患者手术后的生存获益。有效的全身药物转移性皮肤黑色素瘤是可用的，并支持随机对照3期试验。相比之下，转移性眼部黑色素瘤尚未发现积极的全身治疗方法。在一项随机3期试验中，对无法切除的黑色素瘤转移患者进行了HIA和静脉给药氟莫司汀的比较，但没有观察到两种方法之间的差异。根据非对照研究，肝动脉化疗栓塞似乎只有中等效果；针对肝脏受累较少的患者可能改善预后。最近的一项3期研究显示，与最佳替代治疗相比，经皮肝灌注治疗可显著改善转移性黑色素瘤患者的肝脏无进展生存期；然而，总生存分析因对照患者与积极治疗患者的交叉而混淆。总之，肝切除术为精心挑选的肝局限性黑色素瘤转移患者提供了长期生存的可能性。对于不可切除的皮肤黑色素瘤患者，有效的全身治疗是最好的治疗选择。对于无法切除的眼部黑色素瘤患者，在确定有效的全身治疗方法之前，局部治疗可能会发挥更大的作用。癌症2014;120:781 - 789。©2013美国癌症协会。
Effective management of hepatic metastases from ocular and cutaneous melanoma remains a major therapeutic challenge. Treatment options include hepatic resection, hepatic intra‐arterial (HIA) chemotherapy, chemoembolization, and hepatic perfusions. Evaluating the efficacy of these interventions is limited by the retrospective nature of most of the data, although controlled phase 3 studies are starting to emerge. Studies of hepatic resection are strongly suggestive of a survival benefit following surgery in selected patients. Effective systemic agents for metastatic cutaneous melanoma are available and supported by randomized controlled phase 3 trials. In contrast, no active systemic treatment has yet been identified for metastatic ocular melanoma. HIA and intravenous delivery of fotemustine have been compared in a randomized phase 3 trial in patients with unresectable metastases from melanoma, but no differences between the 2 approaches were observed. Hepatic arterial chemoembolization appears only to be moderately effective according to uncontrolled studies; targeting patients with less liver involvement may improve outcomes. A recent phase 3 study showed a significant improvement in hepatic progression‐free survival with percutaneous hepatic perfusion compared with best alternative care in patients with metastatic melanoma; however, the overall survival analysis was confounded by crossover of control patients to active treatment. In conclusion, hepatic resection offers the possibility of long‐term survival in carefully selected patients with liver‐limited metastases from melanoma. In patients with unresectable cutaneous melanoma, effective systemic therapy is the best treatment option. For patients with unresectable ocular melanoma, regional treatments are likely to assume a greater role until effective systemic treatments are identified. Cancer 2014;120:781–789. © 2013 American Cancer Society.
登录
查看更多内容
影响因子：
8.4
作者：
Kivelä, T;Suciu, S;Pyrhönen, S
通讯作者：
Pyrhönen, S
影响因子：
13.7
作者：
Onken MD;Worley LA;Char DH;Augsburger JJ;Correa ZM;Nudleman E;Aaberg TM Jr;Altaweel MM;Bardenstein DS;Finger PT;Gallie BL;Harocopos GJ;Hovland PG;McGowan HD;Milman T;Mruthyunjaya P;Simpson ER;Smith ME;Wilson DJ;Wirostko WJ;Harbour JW
通讯作者：
Harbour JW
影响因子：
45.3
作者：
Sato, Takami;Eschelman, David J.;Sullivan, Kevin L.
通讯作者：
Sullivan, Kevin L.
影响因子：
--
作者：
M. Diener-West;S. Reynolds;Donna J Agugliaro;R. Caldwell;K. Cumming;J. Earle;B. Hawkins;J. Hayman;I. Jaiyesimi;L. Jampol;J. Kirkwood;W. Koh;D. Robertson;J. Shaw;B. Straatsma;J. Thoma
通讯作者：
M. Diener-West;S. Reynolds;Donna J Agugliaro;R. Caldwell;K. Cumming;J. Earle;B. Hawkins;J. Hayman;I. Jaiyesimi;L. Jampol;J. Kirkwood;W. Koh;D. Robertson;J. Shaw;B. Straatsma;J. Thoma
套件作为转移性黑色素瘤的治疗靶标。
影响因子：
120.7
作者：
Carvajal, Richard D.;Antonescu, Cristina R.;Wolchok, Jedd D.;Chapman, Paul B.;Roman, Ruth-Ann;Teitcher, Jerrold;Panageas, Katherine S.;Busam, Klaus J.;Chmielowski, Bartosz;Lutzky, Jose;Pavlick, Anna C.;Fusco, Anne;Cane, Lauren;Takebe, Naoko;Vemula, Swapna;Bouvier, Nancy;Bastian, Boris C.;Schwartz, Gary K.
通讯作者：
Schwartz, Gary K.