Percutaneous hepatic perfusion treatment for liver-dominant metastatic uveal melanoma: the updated experiences from the Scandinavian referral center

Abstract Introduction Uveal melanoma has a high inclination to primarily metastasize to the liver. Percutaneous hepatic perfusion (PHP) is an effective, minimally invasive treatment that allows selective intrahepatic delivery of high dose melphalan while reducing systemic toxicity through hemofiltration of the hepatic venous outflow. The aim of this study was to investigate the safety and response of PHP in patients with liver-dominant metastatic uveal melanoma. Method Between December 2023 and April 2025, a total of 25 PHP treatments was performed in 13 patients with liver-dominant metastatic uveal melanoma. Procedures were performed at Sahlgrenska University Hospital; the singular referral center within the Nordic countries. Peri- and postprocedural adverse events were registered, as well as tumor response. Result For 6/13 (46%) patients, PHP was the first-line treatment. In 4/13 (31%) patients, limited extrahepatic disease was present before PHP-treatment. Early follow-up was performed in 12 patients, where 8/12 (67%) showed stabile disease, 3/12 (25%) partial response and 1/12 (8%) complete response. 11 patients received a second PHP-treatment; 1 patient received a third PHP-treatment. Two out of 13 (15%) patients developed progressive disease during follow-up. Two patients passed away during follow-up. Recorded adverse events include: periprocedural anaphylaxis (n=1), temporary leukopenia (n=5), temporary thrombocytopenia (n=11), acute gout exacerbation (n=1), postprocedural neutropenic fever (n=1), minor splenic infarction (n=1). Discussion Despite the small study population, these preliminary results indicate that PHP with melphalan is a safe treatment for selected patients with liver-dominant metastatic uveal melanoma and potentially offers a good intrahepatic disease control. Adverse events were mainly minor and potentially managed clinically.