(P44) Visual Outcomes in Patients With Metastatic Disease to the Eye

Abstract

30,000 to 100,000 cancer patients develop ocular metastasis each year, yet clinical data remains limited. Historically, the most common primary tumors resulting in ocular metastasis are breast and lung, with radiotherapy as the most predominant palliative treatment. The purpose of this study was to report clinical features of ocular metastasis and the results of using external beam radiotherapy as treatment. A retrospective chart review was performed on 18 patients at Hahnemann University Hospital and Wills Eye Institute in Philadelphia, Pennsylvania from 2011 to 2016. Treated Patients were selected solely on prior diagnosis of ocular metastasis and treatment by external beam radiation therapy. Patients were treated using four-field 3D conformal radiotherapy in the majority of cases. The cohort included 10 females and 8 males. Median age was 58 (38-85) with 78% Caucasian and 22% African American. The most common source for ocular metastasis was lung (39%), followed by breast (33%), unknown primary (16%), esophageal (6%), and renal (6%). Additional systemic metastases were present in 67% of patients. Ocular metastasis was present in the left eye of 6 patients (33%) and the right eye of 4 patients (22%), with bilateral metastasis in 8 patients (45%). A change in visual acuity with blurring or field of vision loss was the most common presenting symptom, occurring in 15/18 patients, followed by pain, floaters, retinal detachment, and photophobia occurring in the remainder of the group. The median dose was 30.75 Gy (17.5 – 46), with a median daily dose of 2.1 Gy (2 – 2.7). The median treatment duration was 23 days (13-35). The location of ocular metastasis was the choroid (82%), retina (6%), ciliary body (6%), and the orbit (6%). The short-term side effect profile consisted of skin erythema and conjunctivitis (67%), eyelash loss (5%) with 28% of patients asymptomatic. The long-term side effect profile consisted solely of dry eye (5%). The majority of patients completing treatment developed a cataract. 9 patients (50%) experienced improvement of visual acuity and 5 patients (28%) had stable vision post-treatment. One patient died during treatment and was not able to be evaluated (6%), 2 patients (10%) had local disease progression and one patient (6%) experienced improved pain post-treatment. The most common source of the choroidal metastasis was related to lung and breast cancer, with the majority of patients presenting with other metastatic sites as well. Bilateral metastasis was as common as unilateral metastasis and a change in visual acuity with blurring was the most common symptom in this cohort of patients. The treatment course was a median of 23 days with most patients tolerating treatment with minimal sequelae. The most common acute side effects were erythema and conjunctivitis. The majority of patients experienced a favorable response to radiation treatment. External beam radiation is an important palliative modality to consider in patients with choroidal metastasis due to a low side effect profile, overall short treatment time, and stable or improved vision in the majority of patients.