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Journal List > J Korean Ophthalmol Soc > v.49(11) > 1008132

Joo and Hyeong: Clinical Characteristics of Metastatic Choroidal Tumors in Korean Patients

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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jkos-49-1785f1.tif
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.
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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

* Intervals=time from the diagnosis of primary carcinoma to the diagnosis of choroidal metastases

Systemic metastases=presence of metastatic lesions elsewhere at the time of ocular diagnosis

BCVA=best corrected visual acuity

§ CM=choroidal metastases

When patients had no prior history of cancer at the time of ocular diagnosis

# EBRT=external beam radiotherapy

** CTx=chemotherapy

†† N/A=unavailable data.

Table 2.
Location of primary cancer for choroidal metastases in rank order by gender
Rank Female (n=13) (n) (%) Male (n=8) (n) (%) Overall (n=21) (n) (%)
1 Breast (5/13, 38%) Lung (5/13, 38%) Lung (6/8, 75%) Lung (11/21, 52%)
Ovary (1/13, 8%) Kidney (1/8, 13%) Breast (5/21, 24%)
2 Cervix (1/13, 8%) Bladder (1/8, 13%)
Stomach (1/13, 8%)
3 Others (5/21, 24%)
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%)

* CM=choroidal metastases.

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

* 1 eye treated with enucleation and 3 eyes with losses of follow-up were excluded

CR=complete response

PR=partial response

§ NC=no change

PD=progressive disease

# Fisher’s exact t-test

** EBRT=external beam radiotherapy

†† CT= chemotherapy.

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