Ocular Melanoma Patient Guide

Transarterial Catheter-Directed Liver Therapies

REGIONAL LIVER-DIRECTED THERAPIES THAT AFFECT THE ENTIRE LIVER INCLUDE:

• Immunoembolization Immunotherapy drugs called cytokines are injected into the hepatic arteries (the arteries that supply the liver). This is combined with embolization of the hepatic artery. Embolization blocks off the blood supply to the tumors using injections into the arteries. The goal is to induce an inflammatory response in the tumor. This process may also stimulate the immune system outside the liver, which could help suppress tumor growth in other areas of the body. • Chemoembolization (TACE) A chemotherapy drug is injected into the hepatic arteries. The goal is to block off the blood supply to the tumors. • Radioembolization Small beads, embedded with a radioactive material, are injected into the hepatic arteries. These microspheres emit high doses of radiation to the tumor cells to destroy them. This treatment is sometimes referred to as Y-90 radioembolization, SIR-Spheres or TheraSpheres. Embolization treatments can be safely performed because the liver gets its blood supply from both the hepatic artery and a separate vein, called the portal vein. Tumors preferentially get their blood supply from the artery, and the healthy liver from the vein. That is why the blood supply can be cut off through the hepatic artery and not cause significant damage to the healthy liver. • Hepatic Arterial Chemoinfusion (HAI) Infusion of chemotherapy into the liver through a specialized infusion system in which a catheter is placed into the hepatic artery to directly and continuously deliver the chemotherapy to the liver. Before this procedure, patients must have a surgery to isolate the liver’s blood supply so the infused chemotherapy does not leak out of the liver. This direct infusion allows for fewer side effects of chemotherapy and allows high doses to be delivered. • Isolated Hepatic Perfusion (IHP) In IHP, a catheter is placed into the hepatic artery and another is placed into the vein that takes blood away from the liver. This temporarily separates the liver’s blood supply from blood circulating through the rest of the body and allows high doses of chemotherapy to be directed only to the liver. When this is done percutaneously, or through the skin, it is referred to as Percutaneous Hepatic Perfusion (PHP). This procedure is currently only available on clinical trials.

Treatments Targeting the Liver These treatments may be used in conjunction with systemic (full body, or through the bloodstream) treatments, so be sure to discuss them with your treatment team. Note: OM specialists are often asked if liver transplants are an option when the melanoma has metastasized. Unfortunately, this is not an option.

LOCALIZED TREATMENTS FOR INDIVIDUAL TUMORS IN THE LIVER AND OTHER ORGANS

• Resection Surgical removal of the tumor. Resection is mainly used when a single tumor is present. It is often reserved for patients who are several years out from a primary eye tumor diagnosis and repeated imaging studies show only one tumor. Since liver resection can sometimes remove some healthy tissue along with the tumor, it is reserved for select cases. • Ablation Ablation involves inserting small probes into tumors and heating (i.e., radio frequency ablation, microwave ablation) or freezing (cryoablation) the tumors to kill them. This can be done through the skin or surgically. Like resection, this is typically not recommended if multiple tumors are present. Ablation can be used in other areas of the body beyond the liver, such as the lung, kidney and soft tissue. • Radiation Targeted radiation can be used to treat liver disease. This includes treatments such as stereotactic radiosurgery (Gamma Knife and Cyber Knife) that can be used to target specific tumors while sparing normal tissue. Radiation can be used to treat other areas of the body including lung, bone and brain, and can be used to treat isolated metastases or to relieve symptoms caused by a specific lesion.

These treatments may be used in conjunction with other treatments.

These treatments may be used in conjunction with other treatments.

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