Survival of patients with uveal melanoma metastatic to the liver correlates strongly with disease control in the liver. Unfortunately, there are no standardized treatments for this chemoresistant disease. Selective internal radiation therapy (SIRT) has been tested as salvage therapy, but no data exist about its use as first-line therapy. The purpose of this study was to investigate the safety and efficacy of SIRT as first-line therapy in patients with uveal melanoma metastatic to the liver. Methods: This retrospective analysis of a prospectively collected cohort included 22 patients treated with first-line SIRT. Biochemical and clinical toxicities were recorded. Tumor response was determined according to the European Association for the Study of Liver Disease (EASL) criteria. Predictive factors of survival were analyzed by univariate and multivariate analysis. Overall survival was calculated using the Kaplan–Meier method with the log-rank test. Results: Grade 3–4 biologic and clinical toxicities occurred in 24% of patients (for both). According to the EASL criteria, disease control at 6 mo after SIRT was achieved in 15 (52%) of the 29 SIRT patients and was predictive of survival. Median overall survival from the first SIRT was 18 mo (95% confidence interval [95%CI], 8–28 mo). At the time of the analysis, 5 patients (23%) were still alive. In multivariate analysis, largest lesion size (hazard ratio [HR], 1.22; 95%CI, 0.98–1.53], liver tumor volume (HR, 1.002; 95%CI, 1.0004–1.003), subsequent systemic therapy (HR, 0.04; 95%CI, 0.006–0.24), and liver-directed locoregional therapy (HR, 0.204; 95%CI, 0.04–0.94) were predictive of survival. Conclusion: First-line SIRT is safe and produced promising outcomes in patients with uveal melanoma metastatic to the liver. Subsequent systemic and liver-directed locoregional therapies ameliorated survival, highlighting the potential for improved outcomes with combination approaches. The results of this study suggest that prospective trials using first-line SIRT should be considered.

葡萄膜黑色素瘤转移至肝脏的患者的生存与肝脏疾病的控制密切相关。不幸的是，没有针对这种化学抗性疾病的标准化治疗。选择性内部放射疗法（SIRT）已作为挽救疗法进行了测试，但尚无有关其用作一线疗法的数据。这项研究的目的是调查SIRT作为葡萄膜黑色素瘤转移至肝脏的患者的一线治疗的安全性和有效性。方法：这项前瞻性收集队列的回顾性分析包括22例接受一线SIRT治疗的患者。记录生化和临床毒性。根据欧洲肝病研究协会（EASL）标准确定肿瘤反应。生存的预测因素通过单因素和多因素分析进行​​了分析。使用Kaplan-Meier方法和对数秩检验计算总生存期。结果：24％的患者发生了3–4级的生物学和临床毒性（均为两者）。根据EASL标准，在29名SIRT患者中，有15名（52％）实现了SIRT后6个月的疾病控制，并预示了生存率。首次SIRT的总体生存中位数为18 mo（95％置信区间[95％CI]，8-28 mo）。在分析时，有5名患者（23％）仍然活着。在多变量分析中，最大病变大小（危险比[HR]为1.22； 95％CI为0.98–1.53]，肝肿瘤体积（HR为1.002； 95％CI为1.0004–1.003），随后的全身治疗（HR为0.04； 95％CI，0.006-0.24），和肝脏定向局部区域治疗（HR，0.204; 95％CI，0.04-0.94）为预测存活。结论：一线SIRT在葡萄膜黑色素瘤转移至肝脏的患者中是安全的，并产生了可喜的结果。随后的全身和肝脏定向局部疗法改善了生存率，突出了通过联合治疗改善预后的潜力。这项研究的结果表明，应考虑使用一线SIRT进行前瞻性试验。