Management Of Choroidal Metastases Research Articles

New concepts in the diagnosis and management of choroidal metastases.

The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.

Transpupillary thermotherapy in the management of choroidal metastases.

To report the authors experience in the use of infrared diode laser transpupillary thermotherapy in the management of selected posterior choroidal metastatic tumors. Seven eyes of seven patients were treated using 810 nm infrared diode laser. Spot sizes of 0.5 to 3 mm were selected, each lasting 1 minute. When necessary, the treatment was repeated at 8- to 10-week intervals. Disappearance of the tumor was the main outcome measure. The primary sites of carcinomas were breast, prostate, and lungs. The largest basal diameters of ocular tumors varied between 5 mm and 10 mm and the thickness ranged between 2 mm and 4.5 mm. A mean power of 612 mW was used in one to four treatment sessions. In six eyes the tumors were reduced into flat scars whereas in one case the tumor continued to grow necessitating external beam radiotherapy. In three eyes the visual acuity decreased and in three eyes the vision became better. In one eye the vision was restored after external beam radiotherapy with the disappearance of extensive subretinal fluid. There were no immediate postoperative complications. Transpupillary thermotherapy can be a reliable, convenient, and cost-cutting option in the management of small, solitary choroidal metastatic tumors with a thickness of less than 3.5 mm and which have minimal subretinal fluid. Although successful in terms of tumor control, treatment close to the fovea or optic nerve head may cause a permanent decrease in visual acuity. (Eur J Ophthalmol 2004; 14: #-9).

Management of choroidal metastasis using external beam radiotherapy: a retrospective study and review of the literature

Journal of Cancer Metastasis and Treatment is an open access journal, focusing on basic and clinical studies related to cancer cell, cell biology, oncology, radiation therapy and radiology, obstetrics and gynecology, pediatrics, surgery, hematology, neuro-oncology, etc.

Management of choroidal metastases.

Choroidal metastases (CM) are the most common malignant intraocular lesion observed in up to 4-12% of necropsy series of patients with solid cancer. The spectrum of presentations varies from prevalent CM in disseminated cancer to isolated CM. CM are responsible for visual deterioration. Depending on the primary cancer, estimated life expectancy, overall cancer presentation and ocular symptoms, the management of CM varies widely. We address the multidisciplinary management of CM and technical aspects of radiotherapy. A systematic review of literature was performed from 1974 to 2014. Choroidal metastases occur preferentially in breast and lung carcinomas but are reported in all cancer types. The standard treatment remains external beam radiotherapy, applying 30Gy in 10 fractions or 40Gy in 20 fractions. The reported complete response and improved visual acuity rates are 80% and 57% to 89%, respectively. Some chemotherapy or new targeted therapy regimens yield promising CM response rates. Radiation therapy consistently shows rapid symptom alleviation, yield excellent local control and functional outcomes. However, there are only few reports on late toxicities after 6months given the unfavorable prognostic of CM patients. Selected patients may live more than two years, underlying the need to better assess mean and long term outcomes. Some authors have favored exclusive systemic strategies with omission of irradiation. The current literature suffers from the scarcity of prospective trials. Duration of tumor response following systemic therapy is rarely reported but appears less favorable as compared to radiotherapy. Systemic treatments may be proposed for pauci-symptomatic CM in a polymetastatic context while radiation therapy remains necessary in symptomatic CM either upfront or as an alternating treatment. Focalized radiation like brachytherapy and proton therapy may be proposed for isolated CM with long disease-free interval between primary and CM, as these techniques have the potential to yield better tumor and functional outcomes in patients with long life expectancy.

Prolonged survival in a patient with choroidal metastases from urothelial bladder cancer

Choroidal metastases secondary to urothelial carcinoma are extremely rare and are usually associated with an extremely poor prognosis. We present a case of an 88-year-old man with newly diagnosed urothelial carcinoma of the bladder who presented with acute loss of vision before commencing definitive concurrent chemoradiotherapy to the bladder. Ophthalmological examination demonstrated bilateral choroidal metastases. He received palliative radiotherapy to the orbits and completed his planned radiotherapy to the bladder. He remained disease-free at last follow-up 4 years after the completion of treatment. We review the literature particularly with regard to diagnosis and management of choroidal metastases. Choroidal metastases should be considered in a patient with a history of urothelial cancer presenting with new onset of eye symptoms.

Successful Management of Choroidal Metastasis With Intravitreal Ranibizumab Injections

Uveal metastases are the most frequent intraocular malignancy in adults. Among various treatment modalities, previous studies have described intravitreal injections of bevacizumab to suppress tumor vascularity. Because of its smaller molecular size, compared to bevacizumab, ranibizumab may offer better tissue penetration and be more efficient in suppressing neovascularization in choroidal lesions. This report presents two cases of choroidal metastases from bronchial and nasopharyngeal carcinoma that were treated as a series of three intravitreal ranibizumab injections (0.5 mg each), showing definite signs of regression. The encouraging results imply that intravitreal ranibizumab may be effective in the management of choroidal metastases, but this finding will have to be confirmed by larger prospective studies.

Métastases choroïdiennes de néoplasme bronchopulmonaire traitées par radiothérapie externe et cures de polychimiothérapie : étude de quatre cas cliniques

To report the efficacy of external local radiotherapy in the treatment of choroidal metastases. The study reports four cases of patients with choroidal metastases of lung neoplasm confirmed by the bronchial biopsy. Polychemotherapy was associated with external radiotherapy of the ocular metastases. The external radiotherapy dose of 30 Gy to the posterior segment of the eye in 10 fractions was effective and seemed to be the most appropriate management of choroidal metastasis despite the use of the newest molecules in chemotherapy.

Metastatic cancer presenting with ocular symptoms: a series of cases

Abstract Purpose Choroidal metastasis is the most frequent intraocular tumour. Lung cancer in men and breast cancer in women are the most common primary sources, followed by the digestive tract. The incidence of uveal metastasis is much higher after authopsy than in clinical series so its impact is underestimated. We present a series of cases of choroidal metastasis as the initial presentation of malignant disease. Methods We collected 5 patients in our hospital from August 2006 to April 2009 of choroidal metastasis as initial presentation of malignant disease. Primary sources, clinical and therapeutic management were analysed. Results 3 of the 5 patients were women (60%). Ophthalmological symptoms were decreased visual acuity in 2 patients (40%) and metamorphopsia in 3 (60%). As primary source were found lung cancer in 2 cases ( 1 adenocarcinoma and 1 oat cell carcinoma), pancreas adenocarcinoma in 2 cases and 1 unknown origin. Only one of the patients was considered candidate to receive brachytherapy. Conclusion Metastasis to the uvea is not a rare event due to the prolonged survival time of many cancer patients. Ophthalmologist should be aware of incidence, clinical features and management of choroidal metastasis as well as the prognosis for affected patients.

Management of choroidal metastases from breast carcinomas using aromatase inhibitors

The outcome of patients diagnosed with uveal metastases from breast carcinoma, all of whom were treated with one of the new generation of hormone therapies named aromatase inhibitors, is reported. Charts of all patients with uveal metastases from breast cancer seen at Wills Eye Hospital between 1995 and 2005 are reviewed. Seventeen patients were diagnosed with uveal metastases from estrogen-receptor-positive breast cancer and subsequently treated with one of the aromatase inhibitors (anastrozole, letrozole, exemestane). The interval between initial diagnosis of breast cancer and choroidal metastases ranged from 1 month to 17 years. Thirteen patients had received tamoxifen either at the time of breast surgery or as part of the metastases treatment. In 10 cases, both the systemic and choroidal metastases remained regressed over a mean of 20 months follow-up (4-50 months). There was no toxicity or intolerance to the medication. Aromatase inhibitors represent a new generation of hormone therapy for metastatic breast cancer. They were effective in 59% of the patients with estrogen-receptor-positive breast cancer, many of them nonresponding to prior treatment with tamoxifen. Aromatase inhibitors avoid the need for external beam radiation therapy as a treatment for the ocular metastases.

Transpupillary Thermotherapy in the Management of Choroidal Metastases

Purpose To report the authors' experience in the use of infrared diode laser transpupillary thermotherapy in the management of selected posterior choroidal metastatic tumors. Methods Seven eyes of seven patients were treated using 810 nm infrared diode laser. Spot sizes of 0.5 to 3 mm were selected, each lasting 1 minute. When necessary, the treatment was repeated at 8- to 10-week intervals. Disappearance of the tumor was the main outcome measure. Results The primary sites of carcinomas were breast, prostate, and lungs. The largest basal diameters of ocular tumors varied between 5 mm and 10 mm and the thickness ranged between 2 mm and 4.5 mm. A mean power of 612 mW was used in one to four treatment sessions. In six eyes the tumors were reduced into flat scars whereas in one case the tumor continued to grow necessitating external beam radiotherapy. In three eyes the visual acuity decreased and in three eyes the vision became better. In one eye the vision was restored after external beam radiotherapy with the disappearance of extensive subretinal fluid. There were no immediate postoperative complications. Conclusions Transpupillary thermotherapy can be a reliable, convenient, and cost-cutting option in the management of small, solitary choroidal metastatic tumors with a thickness of less than 3.5 mm and which have minimal subretinal fluid. Although successful in terms of tumor control, treatment close to the fovea or optic nerve head may cause a permanent decrease in visual acuity.

Management of choroidal metastasis: a report.

Cancers metastatic to the eye are the most common intraocular malignancy, the choroid being the most common site of affection. Breast and lung cancers are the two most common malignancies metastatic to the eye. Patients usually present with diminished visual acuity of field loss. Management of these cases is very gratifying with a large majority of patients showing resolution and maintenance of useful vision in the involved eye. This communication presents our experience in management of a case of choroidal metastasis from a breast primary. A combination of radiotherapy and chemotherapy lead to complete resolution of the lesion with no recurrences in a follow-up of over 6 months.

146 Choroidal metastases: To treat or not to treat

The role of external beam radiation therapy (EBRT) in the management of choroidal metastases (CM) was evaluated retrospectively. From 1970 to 1993 58 patients with CM of 80 eyes underwent EBRT with doses ranging from 20 to 53 Gy. The female to male ratio was 2.9, median age 59 years. The results of treatment measured by complete response, visual acuity improvement, retinal reattachment and eye conservation was respectively 63%, 75%, 65% and 100%. Patient characteristics (primary tumor, histology, details of CM) will be presented. Post-irradiation complications and related technical characteristics of the treatment will be highlighted as well as the relationship between overall survival and primary site. From our data, EBRT is a very efficient and safe palliative treatment for CM and helps preserving a good vision, thus the quality of life in patients who have a poor overall prognosis.

Management of choroidal metastases from breast carcinoma.

Management of choroidal metastases from breast carcinoma.