CardioVascular and Interventional Radiology

, Volume 38, Issue 6, pp 1532–1541 | Cite as

Transarterial Chemoembolization of Liver Metastases from Uveal Melanoma Using Irinotecan-Loaded Beads: Treatment Response and Complications

  • Ulrik CarlingEmail author
  • Eric J. Dorenberg
  • Sven-Petter Haugvik
  • Nils Andreas Eide
  • Dag Tallak Berntzen
  • Bjørn Edwin
  • Svein Dueland
  • Bård Røsok
Clinical Investigation



The purpose of this study was to evaluate treatment response and complications of transarterial chemoembolization using drug-eluting beads loaded with irinotecan (DEBIRI) in patients with liver metastases from uveal melanoma (UM).

Materials and Methods

Patients treated with DEBIRI (n = 14) were retrospectively analyzed regarding overall survival, compared to patients (n = 14) treated with intravenous dacarbazine (DTIC). Median overall survival was calculated from time of diagnosis of metastatic disease (OS1) and start of treatment (OS2). Radiological response for DEBIRI was assessed according to RECIST 1.1 on contrast-enhanced computed tomography (CT), obtained 1.5 months (range 1.2–3.7) post treatment. Major complications of DEBIRI were defined according to the Society of Interventional Radiology classification for complications by outcome.


In the DEBIRI group, OS1 was 14.8 months (range 3.9–47.5), and OS2 was 9.4 months (range 1.7–39). Further, 11/13 (84.6 %) of these patients had progressive disease on first follow-up CT and new lesions were seen in nine. There were 12 major complications in nine patients, possibly including one case of mortality due to disseminated intravascular coagulation (DIC).


For patients with liver metastases from UM, the effect on overall survival of DEBIRI alone is questionable. Compared to previous reports, the response rate of DEBIRI was poor, with new liver lesions observed in the majority of patients. Major complications possibly included one case of DIC.


Transarterial chemoembolization Uveal melanoma Liver metastases DEBIRI Irinotecan Drug-eluting beads 


Conflict of Interest

All authors declare that they have no conflicts of interest.

Statement of Informed Consent

Statement of informed consent does not apply to this article.

Statement of Human and Animal Rights

Statement of human and animal rights does not apply to this article.


  1. 1.
    Singh AD, Turell ME, Topham AK. Uveal melanoma: trends in incidence, treatment, and survival. Ophthalmology. 2011;118(9):1881–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Virgili G, Gatta G, Ciccolallo L, Capocaccia R, Biggeri A, Crocetti E, et al. Incidence of uveal melanoma in Europe. Ophthalmology. 2007;114(12):2309–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Cerbone L, Van Ginderdeuren R, Van den Oord J, Fieuws S, Spileers W, Van Eenoo L, et al. Clinical presentation, pathological features and natural course of metastatic uveal melanoma, an orphan and commonly fatal disease. Oncology. 2014;86(3):185–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Flaherty LE, Unger JM, Liu PY, Mertens WC, Sondak VK. Metastatic melanoma from intraocular primary tumors: the Southwest Oncology Group experience in phase II advanced melanoma clinical trials. Am J Clin Oncol. 1998;21(6):568–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Woodman SE. Metastatic uveal melanoma: biology and emerging treatments. Cancer J. 2012;18(2):148–52.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Bedikian AY, Legha SS, Mavligit G, Carrasco CH, Khorana S, Plager C, et al. Treatment of uveal melanoma metastatic to the liver: a review of the M. D. Anderson Cancer Center experience and prognostic factors. Cancer. 1995;76(9):1665–70.CrossRefPubMedGoogle Scholar
  7. 7.
    Patel K, Sullivan K, Berd D, Mastrangelo MJ, Shields CL, Shields JA, et al. Chemoembolization of the hepatic artery with BCNU for metastatic uveal melanoma: results of a phase II study. Melanoma Res. 2005;15(4):297–304.CrossRefPubMedGoogle Scholar
  8. 8.
    Huppert PE, Fierlbeck G, Pereira P, Schanz S, Duda SH, Wietholtz H, et al. Transarterial chemoembolization of liver metastases in patients with uveal melanoma. Eur J Radiol. 2010;74(3):e38–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Vogl T, Eichler K, Zangos S, Herzog C, Hammerstingl R, Balzer J, et al. Preliminary experience with transarterial chemoembolization (TACE) in liver metastases of uveal malignant melanoma: local tumor control and survival. J Cancer Res Clin Oncol. 2007;133(3):177–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Gupta S, Bedikian AY, Ahrar J, Ensor J, Ahrar K, Madoff DC, et al. Hepatic artery chemoembolization in patients with ocular melanoma metastatic to the liver: response, survival, and prognostic factors. Am J Clin Oncol. 2010;33(5):474–80.CrossRefPubMedGoogle Scholar
  11. 11.
    Edelhauser G, Schicher N, Berzaczy D, Beitzke D, Hoeller C, Lammer J, et al. Fotemustine chemoembolization of hepatic metastases from uveal melanoma: a retrospective single-center analysis. Am J Roentgenol (AJR). 2012;199(6):1387–92.CrossRefGoogle Scholar
  12. 12.
    Brown DB, Nikolic B, Covey AM, Nutting CW, Saad WE, Salem R, et al. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol (JVIR). 2012;23(3):287–94.CrossRefGoogle Scholar
  13. 13.
    Yamamoto A, Chervoneva I, Sullivan KL, Eschelman DJ, Gonsalves CF, Mastrangelo MJ, et al. High-dose immunoembolization: survival benefit in patients with hepatic metastases from uveal melanoma. Radiology. 2009;252(1):290–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Eldredge-Hindy H, Ohri N, Anne PR, Eschelman D, Gonsalves C, Intenzo C et al. Yttrium-90 microsphere brachytherapy for liver metastases from uveal melanoma: clinical outcomes and the predictive value of fluorodeoxyglucose positron emission tomography. Am J Clin Oncol. 2014 (Epub ahead of print).Google Scholar
  15. 15.
    Gonsalves CF, Eschelman DJ, Sullivan KL, Anne PR, Doyle L, Sato T. Radioembolization as salvage therapy for hepatic metastasis of uveal melanoma: a single-institution experience. Am J Roentgenol (AJR). 2011;196(2):468–73.CrossRefGoogle Scholar
  16. 16.
    Vogl TJ, Zangos S, Scholtz JE, Schmitt F, Paetzold S, Trojan J, et al. Chemosaturation with percutaneous hepatic perfusions of melphalan for hepatic metastases: experience from two European centers. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 2014;186(10):937–44.CrossRefPubMedGoogle Scholar
  17. 17.
    Forster MR, Rashid OM, Perez MC, Choi J, Chaudhry T, Zager JS. Chemosaturation with percutaneous hepatic perfusion for unresectable metastatic melanoma or sarcoma to the liver: a single institution experience. J Surg Oncol. 2014;109(5):434–9.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Yamamoto M, Zager JS. Isolated hepatic perfusion for metastatic melanoma. J Surg Oncol. 2014;109(4):383–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Olofsson R, Cahlin C, All-Ericsson C, Hashimi F, Mattsson J, Rizell M, et al. Isolated hepatic perfusion for ocular melanoma metastasis: registry data suggests a survival benefit. Ann Surg Oncol. 2014;21(2):466–72.CrossRefPubMedGoogle Scholar
  20. 20.
    Carter S, Martin RC II. Drug-eluting bead therapy in primary and metastatic disease of the liver. HPB (the official journal of the International Hepato Pancreato Biliary Association). 2009;11(7):541–50.CrossRefGoogle Scholar
  21. 21.
    Lewis AL, Dreher MR. Locoregional drug delivery using image-guided intra-arterial drug eluting bead therapy. J Control Release (official journal of the Controlled Release Society). 2012;161(2):338–50.CrossRefGoogle Scholar
  22. 22.
    Tang Y, Taylor RR, Gonzalez MV, Lewis AL, Stratford PW. Evaluation of irinotecan drug-eluting beads: a new drug-device combination product for the chemoembolization of hepatic metastases. J Control Release (official journal of the Controlled Release Society). 2006;116(2):e55–6.CrossRefGoogle Scholar
  23. 23.
    Fiorentini G, Aliberti C, Del Conte A, Tilli M, Rossi S, Ballardini P, et al. Intra-arterial hepatic chemoembolization (TACE) of liver metastases from ocular melanoma with slow-release irinotecan-eluting beads. Early results of a phase II clinical study. In Vivo. 2009;23(1):131–7.PubMedGoogle Scholar
  24. 24.
    Venturini M, Pilla L, Agostini G, Cappio S, Losio C, Orsi M, et al. Transarterial chemoembolization with drug-eluting beads preloaded with irinotecan as a first-line approach in uveal melanoma liver metastases: tumor response and predictive value of diffusion-weighted MR imaging in five patients. J Vasc Interv Radiol (JVIR). 2012;23(7):937–41.CrossRefGoogle Scholar
  25. 25.
    Valpione S, Aliberti C, Parrozzani R, Bazzi M, Pigozzo J, Midena E, et al. A retrospective analysis of 141 patients with liver metastases from uveal melanoma: a two-cohort study comparing transarterial chemoembolization with CPT-11 charged microbeads and historical treatments. Melanoma Research. 2014 (epub ahead of print).Google Scholar
  26. 26.
    Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol (JVIR). 2003;14(9 Pt 2):S199–202.CrossRefGoogle Scholar
  27. 27.
    Eschelman DJ, Gonsalves CF, Sato T. Transhepatic therapies for metastatic uveal melanoma. Semin Interv Radiol. 2013;30(1):39–48.CrossRefGoogle Scholar
  28. 28.
    Eskelin S, Pyrhonen S, Hahka-Kemppinen M, Tuomaala S, Kivela T. A prognostic model and staging for metastatic uveal melanoma. Cancer. 2003;97(2):465–75.CrossRefPubMedGoogle Scholar
  29. 29.
    Leyvraz S, Piperno-Neumann S, Suciu S, Baurain JF, Zdzienicki M, Testori A, et al. Hepatic intra-arterial versus intravenous fotemustine in patients with liver metastases from uveal melanoma (EORTC 18021): a multicentric randomized trial. Ann Oncol (official journal of the European Society for Medical Oncology/ESMO). 2014;25(3):742–6.CrossRefGoogle Scholar
  30. 30.
    Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol (official journal of the American Society of Clinical Oncology). 2007;25(13):1753–9.CrossRefGoogle Scholar
  31. 31.
    Hayano K, Fuentes-Orrego JM, Sahani DV. New approaches for precise response evaluation in hepatocellular carcinoma. World J Gastroenterol (WJG). 2014;20(12):3059–68.CrossRefGoogle Scholar
  32. 32.
    Martin RC, Howard J, Tomalty D, Robbins K, Padr R, Bosnjakovic PM, et al. Toxicity of irinotecan-eluting beads in the treatment of hepatic malignancies: results of a multi-institutional registry. Cardiovasc Interv Radiol. 2010;33(5):960–6.CrossRefGoogle Scholar
  33. 33.
    Narayanan G, Barbery K, Suthar R, Guerrero G, Arora G. Transarterial chemoembolization using DEBIRI for treatment of hepatic metastases from colorectal cancer. Anticancer Res. 2013;33(5):2077–83.PubMedGoogle Scholar
  34. 34.
    Richardson AJ, Laurence JM, Lam VW. Transarterial chemoembolization with irinotecan beads in the treatment of colorectal liver metastases: systematic review. J Vasc Interv Radiol (JVIR). 2013;24(8):1209–17.CrossRefGoogle Scholar
  35. 35.
    Fiorentini G, Aliberti C, Tilli M, Mulazzani L, Graziano F, Giordani P, et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res. 2012;32(4):1387–95.PubMedGoogle Scholar
  36. 36.
    Clark TW. Complications of hepatic chemoembolization. Semin Interv Radiol. 2006;23(2):119–25.CrossRefGoogle Scholar
  37. 37.
    Eichler K, Zangos S, Mack MG, Hammerstingl R, Gruber-Rouh T, Gallus C, et al. First human study in treatment of unresectable liver metastases from colorectal cancer with irinotecan-loaded beads (DEBIRI). Int J Oncol. 2012;41(4):1213–20.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Ulrik Carling
    • 1
    Email author
  • Eric J. Dorenberg
    • 1
  • Sven-Petter Haugvik
    • 2
  • Nils Andreas Eide
    • 3
  • Dag Tallak Berntzen
    • 1
  • Bjørn Edwin
    • 4
  • Svein Dueland
    • 5
  • Bård Røsok
    • 2
  1. 1.Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
  2. 2.Department of Hepato-Pancreato-Biliary SurgeryOslo University HospitalOsloNorway
  3. 3.Department of OphthalmologyOslo University HospitalOsloNorway
  4. 4.The Intervention CentreOslo University HospitalOsloNorway
  5. 5.Department of OncologyOslo University HospitalOsloNorway

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