A case of presumed choroidal metastasis from carcinoid tumor treated by photodynamic therapy with verteporfin

Kawakami, Setsuko; Wakabayashi, Yoshihiro; Gotô, Hiroshi

doi:10.2147/opth.s51196

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…18 PDT has been reported as an effective alternative treatment of choroidal metastatic lesions, with the advantages of a localized, outpatient treatment of low duration. 7,9,19,20 PDT involves the use of the photosensitive drug verteprofin to specifically target the tumour's vascular endothelial cells and create reactive oxygen singlets that lead to necrosis and infarction. 21 In a recent case series by Ghodasra et al, PDT was found to provide complete resolution of subretinal fluid in 18 of 21 tumours (86%) and 9 eyes (69%) had stable or improved visual acuity after 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…Given his overall poor functional status, PDT was recommended over external beam radiotherapy as a single treatment session can result in a sustained regression of small metastatic choroidal lesions and it was felt that this approach would be better tolerated. [7][8][9] Following one session of full-fluence PDT, a reduction in subretinal fluid and a decrease in tumour thickness to 1.1 mm was achieved ( Figure 2G-I). Vision improved subjectively and by a few letters in Snellen acuity, and visual field in his left eye remained stable on subsequent neuro-ophthalmic exams despite eventual development of moderate compressive optic nerve pallor and RNFL/GCIPL thinning from the pituitary tumour.…”

Section: Case Reportmentioning

confidence: 99%

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Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

Selby

Stiefel

Skalet

et al. 2018

Neuro-Ophthalmology

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A 62-year-old male with a history of metastatic clear cell renal cell carcinoma (ccRCC) presented with decreased vision to 20/50 in the left eye. Fundus examination revealed an elevated, amelanotic mass lesion in the superotemporal macula, without involvement of the central macula by subretinal fluid or tumour. Given incongruity between the fundus findings and the degree of visual impairment, visual field testing was obtained, revealing a bitemporal hemianopia. Magnetic resonance imaging demonstrated optic chiasm compression by a pituitary mass, which had previously been overlooked on computed tomography imaging. Biopsy confirmed metastatic ccRCC to the pituitary, which presented simultaneously with the presumed choroidal metastasis.

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

Selby

Stiefel

Skalet

et al. 2018

Neuro-Ophthalmology

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“…[ 3 ] PDT has been successfully used as either primary or secondary treatment of choroidal metastases. [ 57 58 59 60 61 62 ] Kaliki et al . documented tumor regression in 7 of 9 patients, with stable or improved vision in all but one case over an average follow-up period of 17 months.…”

Section: Photodynamic Therapymentioning

confidence: 99%

Choroidal metastases: Origin, features, and therapy

Arepalli¹,

Kaliki²,

Shields³

2015

Indian J Ophthalmol

140

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The choroid is the most common ocular site for metastatic disease, owing to abundant vascular supply. The primary cancers that most commonly lead to choroidal metastases include breast cancer (40-47%) and lung cancer (21-29%). Bilateral, multifocal metastases are most often secondary to breast cancer, whereas unilateral, unifocal metastasis are more commonly found with lung cancer. The treatment of choroidal metastasis depends on the systemic status of the patient and number, location, and laterality of the choroidal tumors. Treatment options include observation in patients with poor systemic status or those with resolved or asymptomatic disease; systemic chemotherapy, immunotherapy, hormone therapy, or whole eye radiotherapy if the metastases are active, multifocal and bilateral; plaque radiotherapy, transpupillary radiotherapy, or photodynamic therapy for active, solitary metastasis; and enucleation for those with blind painful eye. A database search was performed on PubMed, using the terms “choroidal metastasis,” or “choroidal metastases,” in combination with terms such as “treatment,” “features,” or “diagnosis.” Relevant articles were extracted and reviewed.

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“…With risk of macular involvement of the lesion in the left eye and subsequent vision loss, photodynamic therapy with verteporfin could be taken into consideration, since this showed a significant decrease in tumor volume [11, 12]. Although external radiotherapy showed regression of choroidal carcinoid metastases [5], this treatment approach carries a considerable risk of visual loss due to radiation injury to the eye.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Choroidal Metastases from Endobronchial Carcinoid Treated with Somatostatin Analogues

Bruyn¹,

Lamont²,

Vanderstraeten³

et al. 2016

TOOPHTJ

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Objective:To describe a patient with bilateral multifocal choroidal metastases from an endobronchial carcinoid treated with a somatostatin analogue.Method:A 60-year-old woman presenting with photopsia in the left eye underwent an extensive ophthalmic examination, including fluorescein angiography, OCT and ultrasound.Results:Fundoscopy revealed a small retinal tear in the left eye, for which she received laser treatment. In addition, choroidal masses were detected in both eyes. Her medical history of a pneumectomy for a bronchial carcinoid six years earlier together with recent elevated chromogranin A blood levels prompted a diagnosis of choroidal metastases. Subsequently, a Gallium-68 DOTANOC positron emitting tomography/computer tomography scan revealed a spinal cord metastasis and mediastinal as well as mesenterial lymph node invasion. Systemic treatment with Sandostatin®, a somatostatin analogue was started. Up until two years after the initial presentation and treatment, these choroidal lesions remained stable without any signs of growth.Conclusion:Endobronchial carcinoid tumors have an indolent nature and long-term follow-up is recommended for early detection of metastases. Although treatment with somatostatin analogues rarely induces complete tumor regression, tumor stabilization and prevention of symptoms related to hormone secretion is achieved. This well-tolerated systemic treatment provides a worthy alternative treatment for choroidal metastasis compared to classic radiotherapy without any risk of radiation or laser-related visual loss.

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A case of presumed choroidal metastasis from carcinoid tumor treated by photodynamic therapy with verteporfin

Cited by 12 publications

References 21 publications

Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

Choroidal metastases: Origin, features, and therapy

Bilateral Choroidal Metastases from Endobronchial Carcinoid Treated with Somatostatin Analogues

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