Jasmine H Francis1,2, Christopher A Barker3, Vivian T Yin1,2, Richard D Carvajal4, Paul Chapman2,5, David H Abramson1,2, Y Pierre Gobin2. 1. Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 2. Weill-Cornell Medical Center, New York, New York, USA. 3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 4. Department of Medicine, Columbia University Medical Center, New York, New York, USA. 5. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Abstract
BACKGROUND/AIMS: The treatment of orbital melanoma poses a management challenge. This case explores the delivery of high-dose melphalan to an orbital recurrence of uveal melanoma via intra-arterial delivery of melphalan to the orbit. A 62-year-old man developed recurrent orbital disease 7 months after enucleation for a large uveal melanoma. He received 6 monthly intra-arterial infusions of melphalan to the orbit, ranging in dose from 20 to 30 mg per infusion. Following the last infusion, mild temporary erythema was noted on the forehead along the distribution of the supratrochlear artery. The orbital recurrence was reduced in size by 66% in the longest dimension as measured by magnetic resonance imaging (MRI). However, 9 months following intra-arterial melphalan, tumor regrowth was detected on MRI, and additional treatment options were pursued. CONCLUSION: This case demonstrates that intra-arterial melphalan can result in nonsustained tumor regression of recurrent orbital uveal melanoma. It suggests that local delivery of high-dose melphalan may be helpful as a neoadjuvant treatment for uveal melanoma, and future studies will be useful to confirm the value of this approach in additional cases of recurrent and possibly in primary uveal melanoma.
BACKGROUND/AIMS: The treatment of orbital melanoma poses a management challenge. This case explores the delivery of high-dose melphalan to an orbital recurrence of uveal melanoma via intra-arterial delivery of melphalan to the orbit. A 62-year-old man developed recurrent orbital disease 7 months after enucleation for a large uveal melanoma. He received 6 monthly intra-arterial infusions of melphalan to the orbit, ranging in dose from 20 to 30 mg per infusion. Following the last infusion, mild temporary erythema was noted on the forehead along the distribution of the supratrochlear artery. The orbital recurrence was reduced in size by 66% in the longest dimension as measured by magnetic resonance imaging (MRI). However, 9 months following intra-arterial melphalan, tumor regrowth was detected on MRI, and additional treatment options were pursued. CONCLUSION: This case demonstrates that intra-arterial melphalan can result in nonsustained tumor regression of recurrent orbital uveal melanoma. It suggests that local delivery of high-dose melphalan may be helpful as a neoadjuvant treatment for uveal melanoma, and future studies will be useful to confirm the value of this approach in additional cases of recurrent and possibly in primary uveal melanoma.
Entities:
Keywords:
Intra-arterial chemotherapy; Neoplasia; Orbit; Orbital tumor; Uveal melanoma
Authors: H R Alexander; S K Libutti; D L Bartlett; M Puhlmann; D L Fraker; L C Bachenheimer Journal: Clin Cancer Res Date: 2000-08 Impact factor: 12.531
Authors: H Richard Alexander; Steven K Libutti; James F Pingpank; Seth M Steinberg; David L Bartlett; Cynthia Helsabeck; Tatiana Beresneva Journal: Clin Cancer Res Date: 2003-12-15 Impact factor: 12.531