Título / Title

MELPHALAN INTRA-ARTERIAL CHEMOTHERAPY FOR CHOROIDAL MELANOMA CHEMOREDUCTION

Introdução / Purpose

In adult oncology, intra-arterial chemotherapy (IAC) has been used to treat multiple cancers including liver metastasis from uveal and cutaneous melanoma but not for primary tumor. In this report, we present an exploratory investigation for globe salvage using the first case of a choroidal melanoma submitted to chemoreduction with intra-arterial melphalan before ruthenium brachytherapy.

Material e Método / Methods

A retrospective study based on medical record review.

Resultados / Results

A 61-year-old female complained of decreased vision left eye for 1 month. Visual acuity was 20/20 OD and 20/125 OS. Anterior segment examination and intraocular pressure were normal in both eyes, as was fundus examination of OD. Fundus of OS revealed a brown, elevated lesion partially obscuring the nasal optic disc margin and extending to the equatorial fundus midzone. Serous retinal detachment was present over the lesion and around it. Ultrasonography revealed a solid choroidal tumor with a basal diameter of 13mm and thickness of 10.1mm. The tumor presented acoustic hollowness and a superimposing retinal detachment. After metastatic screening was negative, the patient underwent intra-arterial chemotherapy with melphalan. Three weeks later, her visual acuity was 20/200 and there was noticeable tumor regression to 12,4mm diameter by 7.9mm thick allowing brachytherapy to be performed. Three months after it her visual acuity was 20/100 and new measures were 9.6 mm diameter by 6.2mm thick.

Discussão e Conclusões / Conclusion

To our knowledge and based on a through PUBMED search, this is the first report of IAC using single agent melphalan as a bridge therapy for choroidal melanoma prior to brachytherapy. This current case report shows the feasibility of combining induction IAC prior to ruthenium brachytherapy for large choroidal melanoma. More studies are warranted to confirm these early preliminary findings.

Palavras Chave

Melanoma, uveal; Chemotherapy, Intra-arterial; Melphalan; Ruthenium-106

Area

CLINICAL RETINA