Radiation Dose Aspects of Hepatic Artery Infusion Chemotherapy in Uveal Melanoma Patients with Liver Metastases

Purpose In uveal melanoma patients, liver metastases can be treated by hepatic artery infusion chemotherapy (HAIC). During this procedure, melphalan or, less frequently, fotemustine is infused into the hepatic artery or the hepatic lobe arteries in regularly repeated interventions to achieve local tumor control. The aim of this study was to investigate the radiation exposure of HAIC. Material and methods In this retrospective study, dose data from 841 procedures in 140 patients (mean age 65.3 +/- 9.9 years, 74 female) who underwent HAIC between 06/2017 and 10/2021 at one of three different angiography systems were analyzed. Results In the overall population, dose area product (DAP) (median (IQR)) was 1773 cGy center dot cm(2) (884-3688). DAP was significantly higher in the first intervention, where a complete diagnostic workup of the vasculature was performed, than in follow-up interventions: 5765 cGy center dot cm(2) (3160-8804) versus 1502 cGy center dot cm(2) (807-2712) (p < 0.0001). DAP also increased significantly with the number of infusion positions (median, (IQR)): one position 1301 cGy center dot cm(2) (633-2717), two positions 1985 cGy center dot cm(2) (1118-4074), three positions 6407 cGy center dot cm(2) (2616-11590) (p < 0.0001). Conclusion In uveal melanoma patients with liver metastases undergoing HAIC, radiation exposure is significantly higher both at the first intervention compared to follow-up interventions, but also with increasing number of infusion positions. Level of evidence: 3