Radiotherapy of choroidal metastases: Breast cancer as primary site

Maor, Moshe; Chan, Rafael C.; Young, Sue Ellen

doi:10.1016/0360-3016(77)90546-6

Cited by 15 publications

(21 citation statements)

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“…In previously published analyses, the effect of radiation therapy on CM was assessed only on the basis of subjective or objective visual improvement [7,10,15,16,19,20]. Hoogenhout et al [6] reported their results both in terms of visual improvement and tumour regression or retinal reattachment.…”

Section: Discussionmentioning

confidence: 99%

“…Even if the mechanism of retinal reattachment is quite complex, we feel that irradiation plays a major role. It should be emphasized that after irradiation of CM, the lesions become progressively flatter, with a typical pigment epithelial proliferation over the surface of the lesions [10]. This partially atrophic surface is considered as a 'scar', which can even be larger than the metastasis prior to treatment.…”

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: 99%

Section: Discussionmentioning

confidence: 99%

Radiotherapy of choroidal metastases

Rosset

Zografos

Coucke

et al. 1998

Radiotherapy and Oncology

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“…For patients with synchronous brain metastases, the field includes the entire cranial contents and the posterior halves of the globes. Fractionation schemes of 20 Gy in 2 weeks, 25 Gy in 1-2 weeks, 30 Gy in 2 weeks, and 50 Gy in 5 weeks have been described, with the majority demonstrating a response rate of greater than about 60% [96][97][98][99]. Reported complications include retinopathy, keratopathy, optic neuropathy, and glaucoma [100].…”

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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“…Tumour emboli enter the choroid via the internal carotid arteries, the ophthalmic arteries, and the short posterior ciliary arteries. 6 On B-mode ultrasonography choroidal metastases reveal an irregular lumpy contour, irregular internal structure with medium to high int ernal reflectivity with no internal vascularity. 7 FFA shows diffuse or multifocal hypo fluorescence and hyper fluorescence at the retinal pigment epithelium (RPE) level overlying the lesion (due to the damaging effects of the expanding choroidal tumour on the overlying retinal pigment epithelium), pinpoint hyperfluorescent foci at the RPE level, over the surface of the tumour by the late phase (due to microcystic RPE degeneration).…”

Section: Discussionmentioning

confidence: 99%

“…Choroidal metastases are located between the macula and equator (80%), within the confines of the macula (12%) and anterior to the equator (8%). 6 The highly vascular nature of the choroid makes it a likely site for the haematogenous spread of tumour deposits. Tumour emboli enter the choroid via the internal carotid arteries, the ophthalmic arteries, and the short posterior ciliary arteries.…”

Section: Discussionmentioning

confidence: 99%

Choroidal metastasis as initial presentation of squamous cell carcinoma lung in a patient who had undergone treatment for carcinoma hypopharynx

Jilla¹,

Prathipati²,

B³

et al. 2016

JCSR

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Choroidal metastasis is the most common intraocular malignancy followed by ocular melanoma. This presentation is reported commonly in breast and lung malignancies with multifocal involvement of one eye, or involvement of both eyes. In lung cancer, it is seen in 50-60 year old males with histopathological diagnosis of adenocarcinoma. Here we report the rare occurrence of squamous cell carcinoma lung in 35 year-old female with choroidal metastasis as initial presentation in a patient who had undergone treatment for carcinoma hypopharynx as metachronous second primary. Key word: Secondary choroidal neoplasm, Squamous cell carcinoma, Lung, Ophthalmoscopy

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Radiotherapy of choroidal metastases: Breast cancer as primary site

Cited by 15 publications

References 0 publications

Radiotherapy of choroidal metastases

Radiotherapy of choroidal metastases

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Choroidal metastasis as initial presentation of squamous cell carcinoma lung in a patient who had undergone treatment for carcinoma hypopharynx

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