Choroidal metastases: Origin, features, and therapy

Abstract

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.

Ocular metastasis as initial presentation in breast cancer

“…Other primary sites are prostate, gastrointestinal tract, kidney and skin (melanoma). [6] The metastases usually present as unilateral disease. [2] However, bilateral disease does occur, with an incidence of 20%.…”

“…In women with widespread metastatic breast cancer, 28 -58% may have orbital metastases [1,6] that may be asymptomatic. The metastases generally present 4.5 -6.5 years after the initial diagnosis.…”

Diagnostic approach to choroidal metastases

“…К моменту выявления внутриглазных мета-стазов в 66-97% случаев имеет место диссеминация процесса [6][7][8], а по данным аутопсии, внутриглаз-ные метастазы обнаруживают у 4-12% пациентов, умерших от метастатической болезни [9,10].…”

“…По данным литературы, на момент выявления хориоидального метастаза только 30-44% пациен-тов имеют установленный первичный очаг опухоли [14], а у 11-34% больных отсутствует онкологиче-ский анамнез, что наиболее характерно для рака легкого [2,3,10,15].…”

“…Чаще всего в хориоидею метастазируют рак мо-лочной железы (до 75%) и рак легкого (2-7% -39,4%), на опухоли желудочно-кишечного тракта приходится до 4% случаев [2,4,5,8,10,13,14].…”