Treatment of Liver Metastases from Uveal Melanoma with Percutaneous Hepatic Perfusion

Uveal melanoma frequently metastasizes to the liver, with over 90% of metastatic cases involving hepatic spread. Despite systemic therapy advances, prognosis remains poor in hepatic-dominant disease. Percutaneous hepatic perfusion (PHP) with melphalan, now U.S. Food and Drug Administration (FDA)-approved via the Hepzato Kit, delivers high-dose chemotherapy directly to the liver while reducing systemic toxicity through extracorporeal filtration. This review outlines PHP's rationale, technique, patient selection, and institutional requirements. Ideal candidates have multifocal, bilobar liver metastases and limited extrahepatic disease. PHP requires coordinated care across interventional radiology, anesthesia, perfusion, and pharmacy. Clinical data show encouraging survival and disease control with manageable hematologic toxicity and rapid recovery. Research into improved filtration, optimized dosing, and immunotherapy integration may further improve outcomes.