Selective internal radiotherapy and chemosaturation show equivalent survival in metastatic uveal melanoma: a retrospective multicenter study

Background Metastatic uveal melanoma (UM) primarily affects the liver, and due to low response rates to systemic therapies, liver-directed therapies (LDT) are commonly used for hepatic tumor control. Direct head-to-head trials comparing these LDTs are still lacking. Methods A retrospective multicenter explorative analysis was conducted to evaluate the clinical outcomes of transarterial chemoembolization (TACE), selective internal radiotherapy (SIRT), and percutaneous hepatic perfusion (PHP, chemosaturation). Results The present analysis was conducted on a cohort of 121 patients who had been treated for metastatic UM with LDT at five different skin cancer centers. A total of n = 15 patients received TACE (12.4%), n = 51 SIRT (42.1%), and n = 55 PHP (45.5%). The estimated median overall survival (OS) for SIRT was 25.1 months (95% confidence interval [CI], 15.3–34.8), for TACE, 11.4 months (95% CI, 7.8–14.9), and for PHP, 24.9 months (95% CI, 13.7–36.0). In the multivariate analysis that included LDH and additional systemic therapies, there was no significant difference in OS between SIRT and PHP (HR 1.14, 95% CI 0.67–1.93, p = 0.63), whereas TACE was found to be associated with a substantially reduced in OS compared to PHP (HR 3.25, 95% CI 1.31–8.04, p = 0.01). Adverse events occurred in 41.6% of patients undergoing SIRT, 64.3% of patients receiving TACE, and 84.6% of patients receiving PHP. Conclusion The findings of this study indicate that SIRT and PHP demonstrate equivalent survival rates in a real-world setting.