Management of choroidal metastasis using external beam radiotherapy: a retrospective study and review of the literature

Abstract

Aim: Choroidal metastases are rare in the evolution of solid cancers and constitute exceptional metastatic sites involving functional visual prognosis. The authors conducted a retrospective study to determine the interest of external radiotherapy for the treatment of choroidal metastases.

Methods: The authors reviewed the records of 28 patients with choroidal metastases who had breast (n = 15), lung (n = 9), ovarian (n = 1), kidney (n = 1), prostate (n = 1) cancer or carcinoma with unknown primitive at the moment of the diagnosis (n = 1). The median age was 58 years (extremes: 34-71 years). Tumor stage before the discovery of metastatic choroidal metastasis was 50% of patients. Ocular involvement was unilateral (n = 22) or bilateral (n = 6). The delivered doses ranged from 20 to 50 Gy fractionated with 3-5 Gy in 2D technique (n = 5), conformational (n = 21), intensity modulation (n = 2). The most widely used prescription scheme delivered 30 Gy in 10 fractions (64%) using two 6 MV photons beams.

Results: At the end of irradiation, 13 patients (46%) showed an improvement of eye symptoms. For the others, a stabilization in symptoms was noted (n = 15). No patient had visual degradation. No acute or late grade 2-3 toxicities were objectified. The histological type did not influence the response (P = 0.5). There was no dose relationship-response in our series.

Conclusion: External radiation therapy is a useful technique in the palliative treatment of choroidal metastases. Acute and late toxicities are acceptable.

Keywords

Radiotherapy / choroid / metastasis / ocular / tumors / visual / acuity

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