Choroidal Metastasis in the Systemic Targeted Therapy Era
Intraocular metastases are the most common malignant eye tumors in adults. Radiation has historically been the gold standard for controlling these tumors; however, recently, there has been good success in some instances using systemic targeted therapies. Given the heterogeneity of these tumors and t...
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| Published in: | International journal of radiation oncology, biology, physics Vol. 120; no. 2; p. e751 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier Inc
01-10-2024
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| Online Access: | Get full text |
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| Summary: | Intraocular metastases are the most common malignant eye tumors in adults. Radiation has historically been the gold standard for controlling these tumors; however, recently, there has been good success in some instances using systemic targeted therapies. Given the heterogeneity of these tumors and their treatment, there has not been a randomized controlled study to determine whether systemic targeted therapy could replace radiation and in which specific instances this should be considered first-line or adjuvant.
This is a single-center retrospective review of patients with choroidal metastasis who presented to the department of ophthalmology at the University of Iowa from 2018 to 2023. The University of Iowa Institutional Review Board (IRB) reviewed this work and granted an IRB exemption. The patient age at diagnosis, primary malignancy, treatment modality, radiation dosimetry, tumor response, final visual acuity, and mortality data were recorded for each patient. Statistical analysis was performed with SAS University edition software.
Twenty-six patients were identified who met inclusion criteria. The median age at the time of choroidal metastasis diagnosis was 63 years (range = 18 – 83 years). Fifty percent of the patients were female and 50% were male. Lung (30.8%) was the most frequent primary tumor followed by breast (26.9%), gastrointestinal tumors (19.2%) and other tumor types (23.1%), respectively. Patients were treated with hormone therapy (19.2%) alone, chemotherapy (15.4%) alone, immunotherapy (11.5%) alone, targeted biologic (3.9%) alone or with more than one therapy (50%). Fifteen patients were treated with radiation. Twelve of these patients showed a good ocular tumor response and had good final visual acuity (≤20/40). Of the 11 non-radiated patients, 3 had good ocular tumor responses. Sixteen patients died within 3 years of diagnosis (range = 3 – 147 weeks).
Overall, patients with choroidal metastases who received radiation therapy generally have good ocular tumor response with good visual acuity (≤20/40). Given the good visual acuity outcomes and typically short survival time following diagnosis of choroidal metastasis, most patients may not live long enough to develop radiation retinopathy as a side effect of radiation therapy. In patients where systemic targeted therapy does not resolve choroidal metastases, we recommend the addition of radiation therapy. |
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| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2024.07.1649 |