Quality of life after melphalan percutaneous hepatic perfusion for patients with metastatic uveal melanoma.

BACKGROUND: Recent studies indicate that melphalan percutaneous hepatic perfusion (M-PHP) for liver metastases from ocular melanoma (mUM) improves survival. Importantly, this benefit must be carefully balanced with changes in a patient's quality of life (QoL). This study examines the QoL changes post-M-PHP. METHODS: Retrospective analysis of the change in QoL using the Functional Assessment of Cancer Therapy-General (FACT-G) with mUM patients receiving M-PHP ( n  = 20). The FACT-G scores, which comprise physical (PWB), social (SWB), emotional (EWB) and functional (FWB) wellbeing were measured pre-procedure and at day 1, day of discharge (mean = 2.4 days), 7, 14 and 28 days after M-PHP therapy. Wilcoxon signed-rank test gauged QoL domain changes. RESULTS: Baseline FACT-G median (IQR) scores were 101.8 (21.8). QoL scoring significantly decreased immediately after the procedure [day 1; 85 (27.5); P  = 0.002] and gradually improved over time. By day 28, QoL almost returned to pre-procedure levels [100.3 (13.8); P  = 0.31]. Subscore analysis revealed that the initial drop in QoL at day 1 post-procedure was attributable to the PWB (28 vs. 24; P  = 0.001) and FWB domains (26 vs. 18.5; P  < 0.001). By day 28 there was a statistically significant improvement in EWB ( P  = 0.01). CONCLUSION: QoL following M-PHP decreases immediately after therapy and is not significantly different from baseline by the day of discharge. By day 28 there is improved emotional well-being. This study could help to optimize the time between treatment cycles when combined with toxicity data and blood count recovery.

Interventional radiology training in the UK: a view from within-a national survey.

OBJECTIVE: Interventional radiology (IR) training in the UK has evolved since recognition as a subspecialty in 2010 and introduction of a new curriculum in 2021. The changing landscape, increasing workload and COVID-19 have affected training. The purpose of this study was to review trainees' perspectives on training and develop strategies to further improve training. METHODS: Online survey approved by the British Society of Interventional Radiology Council distributed to British Society of Interventional Radiology Trainee members between 9 March 22 and 25 March 2022. The survey was open to all UK based ST4-6 IR trainees and fellows. Descriptive and thematic analysis was undertaken. RESULTS: 43 responses were received from 17/19 UK training regions. Females represented 10% (4/41) and 5% (2/43) less than full time (LTFT) trainees. 82% (31/38) felt their curriculum was suitable for their training and 28/38 (74%) were satisfied with IR training. Vascular IR, Interventional Oncology, paediatrics and stroke thrombectomy were identified as areas of training desiring improvement. 45% (18/40) stated exposure to IR led clinics and 17.5% (7/40) to IR led ward rounds. Only 6/38 (15.7%) received structured IR teaching at least once a month. Approximately, a third of respondents (13/38) stated training opportunities were significantly compromised secondary to COVID-19. CONCLUSION: This survey shows overall good satisfaction with IR training. However, improved training opportunities in vascular IR, interventional oncology, paediatric IR and stroke thrombectomy are required. In addition, access to clinics, ward rounds and protected time for research is needed to improve training quality. ADVANCES IN KNOWLEDGE: New national UK IR training survey.

Chemosaturation with percutaneous hepatic perfusion of melphalan for metastatic uveal melanoma.

Uveal melanoma, the most common primary ocular malignancy in adults, carries a poor prognosis: 50% of patients develop the metastatic disease with a 10-25% 1-year survival and no established standard of care treatment. Prior studies of melphalan percutaneous hepatic perfusion (M-PHP) have shown promise in metastatic uveal melanoma (mUM) patients with liver predominant disease but are limited by small sample sizes. We contribute our findings on the safety and efficacy of the procedure in the largest sample population to date. A retrospective analysis of outcome and safety data for all mUM patients receiving M-PHP was performed. Tumour response and treatment toxicity were evaluated using RECIST 1.1 and Common Terminology Criteria for Adverse Events v5.03, respectively. 250 M-PHP procedures were performed in 81 patients (median of three per patient). The analysis demonstrated a hepatic disease control rate of 88.9% (72/81), a hepatic response rate of 66.7% (54/81), and an overall response rate of 60.5% (49/81). After a median follow-up of 12.9 months, median overall progression-free (PFS) and median overall survival (OS) were 8.4 and 14.9 months, respectively. There were no fatal treatment-related adverse events (TRAE). Forty-three grade 3 (29) or 4 (14) TRAE occurred in 23 (27.7%) patients with a significant reduction in such events between procedures performed in 2016-2020 vs. 2012-2016 (0.17 vs. 0.90 per patient, P < 0.001). M-PHP provides excellent response rates and PFS compared with other available treatments, with decreasing side effect profile with experience. Combination therapy with systemic agents may be viable to further advance OS.

Renal colic caused by mycotic iliac artery aneurysm.

A 33-year-old female presented with acute colicky left loin-to-groin pain and microscopic haematuria, with a background of 6 months of muscle and joint pains and diplopia. A CT kidneys/ureters/bladder demonstrated fat stranding surrounding the left ureter, as it passed over the left common iliac vessels. Arterial and delayed phase imaging revealed an obstructed ureter secondary to a left common iliac artery aneurysm, later found to be mycotic. No previous descriptions of a mycotic aneurysm presenting as renal colic have been found in the literature. The diagnosis and management of infective endocarditis and mycotic aneurysm are discussed, with a review of the literature. This serves as a good example of a common presenting complaint occurring secondary to a rare and serious pathology.