Eye metastasis from carcinoma of the breast: diagnosis, radiation treatment and results

Ratanatharathorn, Vaneerat; Powers, William E.; Grimm, J.; Steverson, Norma; Han, Ihn; Ahmad, Khurshid; Lattin, Paul

doi:10.1016/0305-7372(91)90017-t

Cited by 85 publications

(70 citation statements)

References 17 publications

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“…If the contralateral eye was not primarily irradiated, metachronous metastases occurred in three out of 26 patients, whereas none were observed when bilateral irradiation was given (0/10). On the basis of these results and contrary to the results of Ratanatharathorn et al [14], it seems reasonable to recommend bilateral irradiation whenever CM are to be treated, given the lack of contralateral complication and technical ease of this RT technique.…”

Section: Discussionmentioning

confidence: 62%

“…The differential diagnosis with ocular melanoma or other ocular lesions can be made by clinical evaluation, including a previous cancer history, ophthalmoloscopic examination, ultrasonography, computer tomography and fluorescein angiography. Some investigators advocate needle aspiration biopsy to improve the diagnosis [14,17]. We feel, however, that it should only be done in very exceptional and difficult diagnostic situations because of a significant risk of a seeding along the biopsy track, which may preclude efficient radiotherapy or cause other complications.…”

Section: Discussionmentioning

confidence: 99%

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Radiotherapy of choroidal metastases

Rosset

Zografos

Coucke

et al. 1998

Radiotherapy and Oncology

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Purpose: This retrospective study was undertaken to clarify the role of high energy external beam radiation therapy (EBRT) and to determine its safety and efficacy on local control and visual acuity in patients suffering from choroidal metastases (CM).Materials and methods: The records of 58 consecutive patients treated with EBRT between 1970 and 1993 were analyzed. The female to male ratio was 2.9 and the median age was 59 years (range 40-81 years). Thirty-six patients (62%) had unilateral CM and 22 patients had bilateral CM. The mean number of lesions per eye was two. Retinal detachment was present in 65% of cases. The primary tumour (PT) was breast carcinoma for 38 patients (75%), lung carcinoma for 10 patients (17%) and gastrointestinal, genitourinary or unknown PT for the remaining 10 patients. The median interval of time between the PT and the CM was 55 months (range 0-228 months). All patients were treated with megavoltage irradiation. The median prescribed dose was 35.5 Gy (range 20-53 Gy) normalized at a 2 Gy per fraction schedule with an a/b value of 10 Gy. Various techniques were used and whenever possible the lens was spared. Ten patients with unilateral disease were treated in both eyes.Results: The tumour response was slow. When assessed after 3 months or more, the complete response rate was 53% with significantly better results for doses higher than 35.5 Gy (72 versus 33%; P = 0.009). Visual acuity was improved or stabilized in 62% of patients, with also significantly better results when doses higher than 35.5 Gy (P = 0.014) were administered. Amongst 26 patients with unilateral CM who had no elective contralateral irradiation, three developed metastasis in the opposite eye versus none of the 10 patients who had bilateral irradiation. Five complications occurred (three cataracts, one retinopathy and one glaucoma).Conclusion: Radiation therapy is an efficient and safe palliative treatment for choroidal metastases and it helps the preservation of vision. Thus, there is a major impact on the quality of life in a group of patients with an almost uniformly fatal prognosis. Both tumour response and visual acuity are significantly improved if doses higher than 35.5 Gy are administered. Whenever possible, a lens sparing technique should be used.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Radiotherapy of choroidal metastases

Rosset

Zografos

Coucke

et al. 1998

Radiotherapy and Oncology

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“…After a diagnosis of ocular metastasis has been established, it is important to image the brain for metastatic involvement, because simultaneous metastatic involvement to the brain is common. The median time from diagnosis of breast cancer to development of choroidal metastasis is 4 years [94]. Presenting symptoms include worsened visual acuity, blind spot, diplopia, and image distortion.…”

Section: Ocular Metastasesmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Chang

2003

The Oncologist

146

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The brain, cranial nerves, leptomeninges, spinal cord, and eye compose the central nervous system (CNS) and are at risk for the development of metastases from breast cancer. Such metastases are diagnosed on the basis of clinical suspicion and substantiated by neuroimaging, resection when indicated, and sampling of cerebrospinal fluid when leptomeningeal metastasis (LM) is suspected. Treatment is aimed at palliation of symptoms and preservation of neurologic function. Historically, conventional radiation therapy has been the mainstay of palliative treatment for brain, cranial nerve, spinal cord, and ocular metastases. However, additional treatment options for brain metastases have been brought about by technological advances in surgery to resect brain metastases, and stereotactic radiosurgery (SRS) to focally irradiate metastases, both of which have been substantiated by data from randomized trials. Ongoing research is aimed at refining criteria to select which patients with brain metastases should undergo surgery and SRS and how these focal therapies should be optimally integrated with whole-brain radiotherapy. Therapy for LM must carefully balance the potential risks and perceived benefits associated with CNS-directed therapies. Despite advances in neuroimaging, surgery, and radiation therapy, novel treatments are needed to improve the effectiveness of treatments for CNS metastases, especially LM, while reducing attendant neurotoxicity.

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“…So these patients should be evaluated for synchronous metastasis so that if continuous metastatic deposits present; they can be included in same treatment plan during radiotherapy. [12] Prognosis of these patients depends upon type of the primary tumor, treatment-response of primary, systemic involvement by tumor and clinical condition of patients. Char et al have shown 1.3 yrs of overall survival in their series with 27% cases survived for 2 years.…”

Section: Discussionmentioning

confidence: 99%