Surgeons are experimenting with Percutaneous Hepatic Perfusion to treat Ocular Melanoma. During the procedure, the liver is isolated from the rest of the body and saturated with high doses of chemo via a catheter for half an hour with a balloon used to capture outflow and preventing it from affecting the rest of the body. The blood containing the chemo drugs is then filtered, cleaned, and returned to the body via a catheter placed in the neck.
For patients to be considered for this treatment, they need to have healthy liver function and a modicum of tumors presenting — provided the ocular melanoma is confined to the eye then prognosis is excellent — but should the ocular melanoma have spread the success rate declines, there is a 50% rate of spread with this type of melanoma.
Ocular melanoma is the most common of all eye cancers. Melanoma is a cancer that is associated with cells that produce melanin, which is a skin pigment, hence the term “Skin cancer.” But melanin is found in other places throughout the body such as our hair, our organ linings, and our eyes.
Now, ocular melanoma affects some 2,500 adults in the US every year. It manifests as a malignant tumor with a 50% chance of spreading to other parts of the body — many times spreading to the liver. Ocular melanoma is unlike other forms of melanoma as it has no link to exposure to sunlight. The bulk of all ocular melanoma develops in the pigmented cells of the choroid, iris, and ciliary body.
Treatment regimens depend upon a variety of factors. Site and size of the tumor are taken into consideration but also the ability to see in the affected eye before and after treatment as well as the viability of the healthy eye. Ocular melanoma is resistant to systemic therapies, which use drugs which spread throughout the body to fight-destroy cancer cells wherever they are found == chemotherapy being a prime example. For this reason, early detection is imperative.
Radiation is used for the majority of small and medium sized tumors. Radiation used can include plaque radiotherapy, proton beam radiotherapy, and static radiotherapy. Treatment can also involve removal of the eye. Surgery is utilized for large tumors as well as used as an option if radiation is not successful. Should the ocular melanoma have spread to the liver, treatment is problematic.
Percutaneous hepatic perfusion (PHP) is a treatment which is minimally invasive and is being studied as per its effectiveness in treating ocular melanoma that has metastasized (spread). The procedure involves multiple needles puncturing the liver to deliver treatment rather than making an incision.
A catheter with balloons at either end is inserted. Then the balloons are inflated to isolate the liver from the rest of the body. Blood within the liver is removed, and the liver is permeated with a heated high dosage chemotherapy treatment. After the treatment, the chemotherapy is removed from the blood via running it through a charcoal filter and returning it to the body.
By using this treatment, individuals receive very specific and targeted therapy regimen to the liver. They also can receive much more aggressive and higher dosage chemo drugs, as those drugs will only be in the liver for a limited period of time and not introduced into the entire body. While percutaneous hepatic perfusion is still a new treatment being tested, it holds great promise for individuals with ocular melanoma and other cancers as well.