Abstract
Purpose
To study the clinical characteristics and treatment outcomes of choroidal metastatic carcinoma in Korean patients.
Methods
The records of 25 eyes of 21 patients with choroidal metastatic carcinoma were retrospectively analyzed. Primary tumor origins, the time from the diagnosis of primary carcinoma to the diagnosis of choroidal metastases, other metastatic lesions elsewhere in the body, ocular features, symptoms, and treatment outcomes were analyzed.
Results
The most common primary tumor sites were the lungs (52%) and breasts (24%). Common metastatic lesions besides choroid included central nervous system, bone, lungs, and the liver. The mean time from the diagnosis of primary carcinoma to the diagnosis of choroidal metastases was 36 months. The mean life expectancy was 16 months, but relatively shorterfor lung cancer (13.3 months) than for breast cancer (22.7 months). Fifty-four percent of cases resulted in clinically evident shrinkage of the tumor after palliative treatment for the choroidal mass. Vision improved or stabilized in 46% of cases, and retinal reattachment was achieved in 47% of cases. Concurrent external beam radiotherapy and chemotherapy produced higher response rates than chemotherapy alone for the shrinkage of tumors ( p=0.05) and retinal reattachment ( p=0.04).
Conclusions
In Korean patients, the lungs and breasts are the two most common primary tumor sites for chorodial maetastatic carinoma, though metastatic lesions elsewhere are very common. Palliative treatment for choroidal metastases is efficient for tumor shrinkage, retinal reattachment, and the preservation of vision. However, the prognosis for patients with choroidal metastases remains poor.
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![]() | Figure 1.(A) An elevated creamy yellow lesion in the macular area accompanying large subretinal hemorrhage near the inferotemporal arcade. The patient has a known history of lung cancer. (B) The tumor has regressed completely 3 years after external beam radiation therapy (EBRT) and chemotherapy (CT) leaving atrophic, flattened scar. (C) In the late angiogram, multiple lobulated hyper fluorescent lesions with leakage were detected in the superotemporal area involving the macula. The patient has a known history of breast cancer. (D) After EBRT and CT, the tumor has much flattened. (E) In the late angiogram, hyper fluorescent mass at the superior arcade with large serous retinal detachment was detected. The patient has a known history of breast cancer. (F) Serous retinal detachment was much decreased after EBRT and CT. |
Table 1.
Clinical characteristics of patients with choroidal metastatic tumor
case | Sex/Age (year) | Primary site | Intervals*(months) | Systemic metastases† | Laterality | Treatment | (Rt, Lt) Initial BCVA‡ | Final BCVA (Rt, Lt) | Life span after CM§ (months) |
---|---|---|---|---|---|---|---|---|---|
1 | F/46 | Lung | 0∏ | + | Right | EBRT#+CTx** | 20/30 | 20/20 | 4 |
2 | F/52 | Lung | 0 | + | Right | EBRT+CTx | 20/40 | 20/40 | 10 |
3 | F/47 | Lung | 0 | + | Right | Enucleation | 20/300 | 0 | N/A†† |
4 | M/63 | Lung | 1 | + | Bilateral | CTx | 20/70, 20/50 | 20/40, 20/40 | 16 |
5 | M/34 | Lung | 2 | + | Right | EBRT+CTx | 20/30 | 20/200 | 6 |
6 | M/39 | Lung | 3 | + | Right | EBRT | N/A | N/A | 3 |
7 | M/31 | Lung | 3 | + | Left | EBRT+CTx | 20/200 | FC | 10 |
8 | M/50 | Lung | 4 | + | Right | EBRT+CTx | 20/100 | NA | 5 |
9 | M/64 | Lung | 13 | + | Left | CTx | 20/800 | LS+ | 3 |
10 | F/36 | Lung | 16 | + | Right | EBRT+CTx | 20/100 | LS+ | 7 |
11 | F/60 | Lung | 57 | + | Right | EBRT+CTx** | FC | FC | 69 |
12 | F/39 | Breast | 37 | - | Right | EBRT+CTx | 20/70 | 20/20 | 17 |
13 | F/45 | Breast | 54 | + | Bilateral | EBRT+CTx | 20/70, 20/70 | 20/50, 20/20 | 7 |
14 | F/41 | Breast | 65 | - | Left | EBRT+CTx | 20/400 | 20/50 | 27 |
15 | F/30 | Breast | 81 | + | Bilateral | CTx | 20/100, 20/20 | LS+, 20/20 | N/A |
16 | F/62 | Breast | 100 | + | Left | EBRT+CTx | 20/200 | 20/40 | 40 |
17 | F/73 | Stomach | 0 | - | Right | EBRT+CTx | 20/70 | 20/40 | 35 |
18 | M/34 | Kidney | 3 | + | Bilateral | EBRT | 20/40, 20/20 | N/A | 1 |
19 | F/73 | Cervix | 12 | + | Right | EBRT | FC | 20/200 | 39 |
20 | M/37 | Bladder | 65 | + | Right | CTx | 20/20 | 20/400 | 7 |
21 | F/66 | Ovary | 100 | - | Left | CTx | 20/50 | 20/100 | N/A |
Table 2.
Location of primary cancer for choroidal metastases in rank order by gender
Table 3.
Metastatic lesions associated with choroidal metastases
Metastatic lesions | Before CM* (n=14) (n) (%) | Concurrent with or after CM* (n=14) (n) (%) | Overall (n=19) (n) (%) |
---|---|---|---|
CNS | 6 (43%) | 9 (64%) | 13 (78%) |
Lung | 2 (14%) | 4 (29%) | 6 (33%) |
Bone | 4 (29%) | 6 (43%) | 10 (56%) |
Liver | 2 (14%) | 3 (22%) | 5 (28%) |
Others | 1 (7%) | 2 (14%) | 3 (16%) |
Table 4.
Treatment results of chemotherapy and external beam radiotherapy in the eye
Results | * No follow up data (n) | † CR or ‡ PR (n) (%) | §NCor ∏PD (n) (%) | # P-value |
---|---|---|---|---|
Clinical response | ||||
Overall | 4 | 13 (54%) | 8 (33%) | |
EBRT** | 3 | 1 (100%) | 0 (0%) | |
CT†† | 0 | 2 (29%) | 5 (71%) | 0.05 |
CT+EBRT | 0 | 10 (77%) | 3 (23%) | 0.05 |
Retinal detachment | ||||
Overall | 0 | 7 (44%) | 9 (56%) | |
EBRT | 0 | 1 (100%) | 0 (0%) | |
CT CT+EBRT | 0 0 | 0 (0%) 6 (60%) | 5 (100%) 4 (40%) | 0.04 |
Vision | Stable or improved | Worse | ||
Overall | 4 | 11 (46%) | 10 (42%) | |
EBRT | 3 | 1 (100%) | 0 (0%) | |
CT | 0 | 2 (29%) | 5 (71%) | |
CT+EBRT | 0 | 8 (62%) | 5 (38%) | 0.175 |