Orbital metastases from neuroendocrine neoplasms: clinical implications and outcomes

Kamieniarz, Lukasz; Armeni, Eleni; O’Mahony, Luke Furtado; Leigh, Charlotte; Miah, Lukon; Narayan, Akshay; Bhatt, Ankit; Cox, Nicholas; Mandair, Dalvinder; Navalkissoor, Shaunak; Caplin, Martyn; Toumpanakis, Christos

doi:10.1007/s12020-019-02130-5

Cited by 29 publications

(40 citation statements)

References 45 publications

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“…The prognosis of patients with orbital metastases is poor with one-year survival rates, (40%) lower than patients with choroidal metastases (52%) and comparable to patients with brain metastases (39–46%), implying that their occurrence is more frequent at the very advanced disease stages, which call for an effective improvement in current systemic therapeutic strategies [ 22 , 50 , 70 , 71 ]. In line with previous reports, we found significant survival differences amongst primary tumors ( p < 0.001), with one-year survival rates highest in breast cancer (57%) and carcinoid (53%), and lowest in lung (14%), liver (27%), and melanoma (29%) cancers, likely attributed to their underlying aggressiveness and responsiveness to treatments [ 3 , 5 , 8 , 9 , 39 ]. Hence, our findings further substantiate that the current treatments for orbital metastases are palliative and should be aimed at improving symptoms while preserving patient quality of life.…”

Section: Discussionsupporting

confidence: 91%

“…This likely explains the lower rates of primary lung cancers (5.6%) compared to other tumors such as carcinoid (6.6%). Indeed, carcinoids are less common malignancies, but they often show better prognoses and slower disease courses, with rare concurrent systemic metastases [ 5 , 8 ]. We also found that the median time interval between primary tumor diagnosis and the onset of orbital metastases was 12 months, further reflecting the long-lasting process of metastatic seeding into the orbit.…”

Section: Discussionmentioning

confidence: 99%

“…Orbital metastases can often be detected in those with no previous history of cancer due to their common presenting of symptoms of visual disturbance, thus preceding the diagnosis of primary tumors [ 4 , 6 ]. Common presenting symptoms include diplopia, ocular pain, and vision loss, coupled with globe displacement and palpable orbital masses [ 7 , 8 ]. Metastases frequently appear on imaging as irregular and contrast-enhancing lesions in the anterior orbit involving bones and extraocular muscles [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Common presenting symptoms include diplopia, ocular pain, and vision loss, coupled with globe displacement and palpable orbital masses [ 7 , 8 ]. Metastases frequently appear on imaging as irregular and contrast-enhancing lesions in the anterior orbit involving bones and extraocular muscles [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

Palmisciano

Ferini²,

Ogasawara

et al. 2021

Cancers

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Background: Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. Results: We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0–420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). Conclusions: Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

Palmisciano

Ferini²,

Ogasawara

et al. 2021

Cancers

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“…NPC has a lower risk of EM than bone and lung metastases, but the rate for EM is increasing. EMs occur with different cancers and are usually considered as a sign of a poor prognosis [24][25][26]. In the late stage, NPC invades the optic nerve that is close to the normal optic chiasm, causing vision loss, nasal or temporal hemianopia, and blindness in one or both eyes.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of serum lipids for eye metastases in male nasopharyngeal carcinoma patients

Xie

Shao

2020

Bioscience Reports

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Background: Nasopharyngeal carcinoma (NPC) is a tumor that is commonly found in southern China. NPC has several risk factors, such as infection with the Epstein–Barr virus. However, we know little about the risk factors for eye metastasis (EM) in male patients with NPC. Serum lipids are well recognized as risk factors for cardiovascular disease, and recent studies show that they also have a relationship with the development of NPC. Purpose: We designed the present study to determine whether they were relevant with the development of EM in male NPC patients by detecting the levels of several serum lipids. Methods: A total of 1140 male patients with NPC were enrolled in this retrospective study and we divided them into two groups: the metastasis (EM) group and non-eye metastasis (NEM) group. A variety of serum lipids between the two groups were tested and compared. Results: There were statistical differences in the levels of serum TG and TC between these two groups. Binary logistic regression showed that TG and TC were independent risk factors for EM in male NPC patients with P=0.004 and P<0.001, respectively. The area under the curve of TG and TC were 0.764 and 0.681, respectively, using cutoff values of 0.975 and 3.425 mmol/l, respectively. We found that TG had higher sensitivity and specificity values with 87.5% and 62.7%, respectively, than TC which were 50.0% and 87.2%. Conclusion: TG and TC are potential risk factors for eye metastases in male NPC patients.

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Extended orbital exenteration, epithetic restoration, and patient supply: A cross‐sectional study of a historic cohort

Ritschl,

Schwarz,

Klinger

et al. 2023

Head & Neck

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BackgroundThe aim of this study was to investigate the clinical course and to redefine an optimized algorithm for OE cases until epithetic restoration.MethodsIndication, defect type according to Kesting, reconstructive technique, incidence of postoperative complications and peri‐implantitis, patients' quality of life, timing of periorbital implant insertion, incidence of and interval to implant loss, and time until epithetic restoration were analyzed in 43 patients.ResultsA significant correlation was detected between wound dehiscence and defect type. Out of 24 patients, 7 were implanted secondarily with a median time interval of 399 days (270–2015) after OE. Eleven out of 83 placed implants were lost in 8 patients with a median time interval of 586 days (264–4485) after insertion. The majority of epithesis carriers had no or few restrictions in their quality of life.ConclusionsWe recommend our modified treatment algorithm to further improve and shorten the clinical course.

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Orbital metastases from neuroendocrine neoplasms: clinical implications and outcomes

Cited by 29 publications

References 45 publications

Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

The predictive value of serum lipids for eye metastases in male nasopharyngeal carcinoma patients

Extended orbital exenteration, epithetic restoration, and patient supply: A cross‐sectional study of a historic cohort

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