Radiotherapy of choroidal metastases in patients with disseminated cancer

Background: Choroidal metastasis is the most common ocular tumor, in most c ases related to breast and lung cancer. Radiotherapy (RT) mostly is the the rapy of choice. However, there is a lack of data about the results of unifo rmly, prospective treated patients. Patients and Methods: Between November 1994 and September 1997 37 patients with 49 metastatic eyes were enrolled i nto the study. 25 patients (68%) had unilateral and 12 patients (32%) had b ilateral metastases. 21 patients had breast cancer as primary tumor, 12 pat ients lung cancer, and 4 patients other tumors. 3 patients were excluded fr om analysis, 34 patients with 46 involved eyes were available for analysis. 29 of those patients had symptomatic metastases, 5 patients had asymptomat ic choroidal metastases. RT was performed with bi- or unilateral asymmetric fields, total dose was 40 Gy with a single dose of 2 Gy, 5 fractions per w eek. 12 patients (35%) had a chemotherapy following RT due to diagnosis of general tumor progression. Endpoints of the study were visual acuity (VA), local tumor control, survival, and side effects. Results:The median follow up was 6 months, 22 out of 34 patients died of metastatic disease. In 17 of symptomatic eyes (53%) an increase of VA and in 11 of symptomatic eyes (34 %) a 'no change' was achieved. The local tumor control rate after 18 months was 83%. One patient with asymptomatic metastasis (1/14 eyes) developed sy mptoms until death. The median survival time was 15 months. Altogether, in 2 patients late side effects (6%) were observed (1 patients with bilateral retinopathy, 1 patient with optic nerve atrophy). Conclusions: RT with 40 G y is highly effective in the treatment of symptomatic and asymptomatic chor oidal metastases, VA was stable or improved in almost 90% of treated eyes. The rate of side effects is low.