Treatment of Ocular Melanoma Metastasic to the Liver

Ocular melanoma (OM), also known as uveal melanoma, is the most common cancer of the eye in adults, according to the National Cancer Institute (NCI). Left untreated, this cancer very likely will metastasize, or spread, to other parts of the body; even with treatment, metastasis is a very real possibility. The NCI reports that the liver is the most common target of metastasis for this type of malignancy. Options for the treatment of OM metastases of the liver are quite limited.

• Ocular melanoma is the most common cancer of the eye.

Ocular Melanoma

• This form of cancer may affect the iris, ciliary body and choroid, all three of which make up the uvea. However, MedlinePlus reports that the area most frequently affected by this malignancy is the choroid, a layer of blood vessels located between the retina and the sclera. The choroid provides a link between the ciliary body near the front of the eye and the optic nerve at its rear.

Significance

• If caught in its early stages, OM is unlikely to have spread to the liver or any other organ outside the eye. However, even with radiation treatment of the primary tumor, metastasis remains a possibility in the future, according to the EyeCancerNetwork website, which indicates that tumor size is generally the most accurate predictor of future metastasis. That is, the larger the tumor in the eye when first detected, the greater the chance it will spread beyond the eye.

Surgery and Chemotherapy

• Once OM has spread to the liver, it usually manifests as multiple tumors and is considered inoperable. If only a single tumor is present, surgical removal may be an option. EyeCancerNetwork reports in October 2009 that chemotherapy alone thus far has been unsuccessful in treating metastatic ocular melanoma but points out that new chemotherapy agents are always being introduced and tested, leaving open the possibility that an effective agent for this type of tumor may be found soon.

Chemo-Embolization

• Emphasizing that no cure has yet been found for OM that has spread to the liver, EyeCancerNetwork reports in October 2009 that some patients have been able to prolong their lives by undergoing chemo-embolization. This treatment involves the injection of chemo drugs and other particles into the blood vessels that supply the liver tumors. The EyeCancerNetwork website offers as an example a combination of cisplatin chemotherapy along with polyvinyl sponge particles. Such treatments have succeeded in temporarily shrinking liver tumors. However, they are not without side effects, which include fever, temporary intestinal paralysis (lasting a day or two), abdominal pain and elevated liver enzymes.

Y-90 Radioembolization

• A study published in the July 2009 issue of Cancer Investigation reported the injection of Yttrium-90 (Y-90) microspheres directly into the hepatic artery showed some promise in controlling OM metastases of the liver. This form of radioembolization---the injection of tiny radioactive substances into a blood vessel---previously had been used in treating primary liver cancer, as well as other types of cancer that had metastasized to the liver, but never reported previously for OM. The study indicated that the treatment showed positive responses in the 11 patients studied, none of whom experienced serious side effects.