Frameless radiosurgery for intraocular metastatic tumor: Case report

Cárdenas, Jose Ramón Villarreal; Penella, Agustin Del Valle; Ibarra, Erick Cardona

doi:10.1016/j.rpor.2019.10.001

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…There is no consensus on an optimal radiotherapy regime for choroidal metastases [8], but we prefer a shorter hypofractionated regime of 20 Gy over 5 days. It is important that the radiotherapy course not be protracted as choroidal metastases are usually part of the disseminated systemic disease.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Choroidal Metastases In Triple-Negative Breast Cancer: Radiotherapy And Eribulin For Vision Preservation And Prolong Survival

Hasbullah

Zulkiffli²,

Dicken

2021

Indonesian Journal of Cancer

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Introduction: Choroidal metastases are infrequent in breast cancer, but if they present, they usually signify the disseminated disease and poor prognosis. The challenges in treating choroidal metastases are not only to prolong survival but also to preserve vision, improving the quality of life. Case Presentation: Our patient was firstly diagnosed with stage-three triple-negative breast cancer at the age of 32 years. She had surgery, adjuvant chemotherapy with anthracycline regime, as well as adjuvant radiotherapy. Her disease firstly recurred two years later with pleural effusion, but it was controlled with six cycles of docetaxel. She was in remission until ten years later when she presented with a worsening dry cough and progressive blurring of vision in both eyes. CT restaging showed multiple sub-centimeter bilateral lung nodules, singular pleural metastases, and multiple bone metastases. Choroidal metastases were also confirmed with the ophthalmological assessment which includes CT of the orbit. She received short-course palliative radiotherapy followed immediately by eribulin. Then, she started monthly bisphosphonates. She was able to read again four months after radiotherapy, and her vision remains normal to date. The latest PET scans showed no FDG avid disease in the lungs with pleural metastases significantly reduced in size. Bone metastases remain stable and asymptomatic. It has been nearly four years since the diagnosis of choroidal metastases. She is still on eribulin at an adjusted dose and interval. She remains asymptomatic from her bone, lung, and choroidal metastases. Conclusions: Short-course radiotherapy to the orbit, followed by continuous administration of eribulin, can lead to prolonged survival with a good quality of life in triple-negative breast cancer with choroidal metastases

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Section: Discussionmentioning

confidence: 99%

“…However, this treatment is only available at the specialized radiotherapy center and is quite costly. Furthermore, an unwanted side effect of central retinal vein occlusion has been reported six months after radiosurgery [8].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Choroidal Metastases In Triple-Negative Breast Cancer: Radiotherapy And Eribulin For Vision Preservation And Prolong Survival

Hasbullah

Zulkiffli²,

Dicken

2021

Indonesian Journal of Cancer

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“…Advances in diagnostic tools and improved survival for breast cancer patients contribute to the increased occurrence of ocular metastasis. However, recent cases indicate improved treatment outcomes with the use of CDK4/6 inhibitors and stereotactic body radiotherapy (SBRT) [30]. External beam radiotherapy, with a typical dose ranging from 20 to 50 Gy, stabilizes or restores vision in up to 86% of patients [9,11,21,[31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Ocular and Periocular Metastasis in Breast Cancer: Clinical Characteristics, Prognostic Factors and Treatment Outcome

Yousef,

Mohammad,

Khalil

et al. 2024

Cancers

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Background: Breast cancer remains a leading cause of cancer-related mortality and morbidity worldwide. Ocular and periocular metastasis present as a rare but clinically significant manifestation. This study aims to explore demographics and clinical aspects of ocular and periocular metastasis in breast cancer patients. Methods: A retrospective cohort study comprising 45 breast cancer patients with ocular or periocular metastasis treated between 2013 and 2023. Patient demographics, tumor characteristics, diagnostic methods, treatment modalities, visual outcomes, and survival data were analyzed. Results: Among 9902 breast cancer patients, 0.5% developed ocular or periocular metastasis, constituting 2.4% of metastatic cases. The median age was 50 years. Ocular metastasis timing varied: 5% before breast cancer, 24% concurrent, 22% within a year, and 49% after. The most common presentations included incidental MRI findings (42%) and vision decline (31%). Metastasis involved the orbit (47%), choroid (40%), optic nerve (11%), and iris (2%), with 44% having bilateral involvement. Predictive factors included invasive lobular carcinoma (ILC) (p < 0.0001) and brain metastasis (p < 0.0001), with ILC exhibiting a sixfold higher likelihood of ocular metastasis than invasive ductal carcinoma (IDC). Primary treatment was radiation therapy (89%), yielding a 55% maintenance of excellent vision (<0.5), with 93% developing dry eye disease. Patients with ocular metastasis faced an increased risk of disease-related mortality (p < 0.0001), with 71% succumbing within 10 months post-diagnosis. Conclusions: Ocular metastasis in breast cancer is rare (0.5%) but signifies poor outcome. It is linked to ILC and concurrent brain metastasis. Primary treatment involves radiation therapy, with a favorable visual prognosis.

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“…Recently published cases [ 20 , 22 , 23 ] showed improvement in treatment outcomes secondary to the implementation of CDK4/6 inhibitors in combination with new RTH techniques like Stereotactic Body Radiotherapy (SBRT) [ 24 ]. Wiegel et al [ 26 ] showed that external beam radiotherapy (EBRTH) leads to stabilised or restored vision in up to 86% of patients; the typical dose varies between 20 and 50 Gy [ 3 , 5 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Eye metastasis in breast cancer: case report and review of literature

Saad¹,

Bakri²,

Ryan³

et al. 2022

ecancer

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The paradigm of breast cancer management has been revolutionised, resulting in prolonged survival that echoes an increasing incidence of metastasis in uncommon sites. With orbital metastases -despite being rare -the incidence scales up to 13% of breast cancer cases with no specific management guidelines. We report a case of a 31-yearold luminal B breast cancer patient who initially presented with T2N2M0 disease and received six cycles of adjuvant chemotherapy (5-Fluorouracil (5-FU) 600 mg/m² IV, Doxorubicin 60 mg/m² IV, Cyclophosphamide 600 mg/m² IV), followed by radiotherapy (RTH) and adjuvant Tamoxifen. Two years later, the patient experienced successive bone metastasis, so she received several lines of endocrine therapy as Fulvestrant and aromatase inhibitors in combination with luteinizing hormone-releasing hormone (LHRH) analogues. Later on, she presented with right eye ptosis and magnetic resonance imaging (MRI) showed a soft tissue mass in the superior and lateral rectus muscles. The patient received six cycles of chemotherapy with no improvement. Further disease progression occurred 3 months later, so the patient received palliative RTH resulting in no response. One month later, the patient was deceased, secondary to progressive disease. With the rising incidence of ocular metastasis due to breast cancer, oncologists should be aware of symptoms and use the proper diagnostic modalities. Here we provide a literature review on similar cases and discuss possible treatment modalities for those patients. The main concern is to evaluate the need for chemotherapy in such cases in the presence of highly effective endocrinal treatment.

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Frameless radiosurgery for intraocular metastatic tumor: Case report

Cited by 5 publications

References 23 publications

Bilateral Choroidal Metastases In Triple-Negative Breast Cancer: Radiotherapy And Eribulin For Vision Preservation And Prolong Survival

Bilateral Choroidal Metastases In Triple-Negative Breast Cancer: Radiotherapy And Eribulin For Vision Preservation And Prolong Survival

Ocular and Periocular Metastasis in Breast Cancer: Clinical Characteristics, Prognostic Factors and Treatment Outcome

Eye metastasis in breast cancer: case report and review of literature

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