Management of choroidal metastases from breast carcinoma.

Abstract

The purpose of this paper is to report six cases of choroidal metastases from breast primaries, which were referred to the Ophthalmic Clinic, Royal Infirmary of Edinburgh, between 1959 and I968. The emphasis is on the treatment of these patients, giving, where possible, quantitative assessment of visual function before and after conservative therapy. It is also the intention to show that the survival time, i.e. the time between the diagnosis of the choroidal metastases and death, may make such treatment worthwhile. Tables I and II. Three patients (Cases 2, 4, and 6) were noted to have widespread secondaries before the choroidal metastases were seen; one (Case 6) was seen terminally, and the eye was enucleated post mortem and confirmed the clinical diagnosis. Present study The clinical details of six patients are shown inFive patients received treatment. Four (Cases I, 2, 3, and 4) were treated conservatively with radiotherapy, two having endocrine treatment in addition. The fifth (Case 5) had the affected eye enucleated because of secondary glaucoma before the diagnosis was made. This was the only case with extraocular extension of the tumour and she subsequently received radiotherapy to the orbit.Only the two enucleated eyes already mentioned (Cases 5 and 6) had histological confirmation of the diagnosis. The four clinically diagnosed patients had flattish grey ill-defined choroidal lesions associated with shallow retinal detachments. They all had proven histories of breast carcinoma. Hogan (I964), discussing the differential diagnosis of metastatic intraocular tumours, stated that the principal method of establishing the diagnosis was based on observation of a primary tumour elsewhere in the body. These four patients (Cases I, 2, 3, and 4) had good functional results with conservative therapy and two of them (Cases i and 2) had deposits in both eyes. Of the six affected eyes in these four patients, one deteriorated, two remained unchanged, and three improved after therapy (Table II).

Treatment of choroid metastases

“…In their extensive study of 511 choroid metastases, Hollwich and Lemke (1965) reported that 88% of the cases were in females with breast cancer; in male patients, lung cancer was the primary site in 49% of cases with choroid metastases, followed by genitourinary (13%) and gastrointestinal tract (12.5%) tumours. Though choroid metastases are a grave sign in malignant disease, this report as well as others (MacMichael, 1969;Chu et al, 1977;Maor et al, 1977) shows that longer survival of as much as several years can be seen. Our study suggests that systemic treatment does not seem to prevent the occurrence of choroid secondaries, and therefore it seems doubtful that systemic treatment should be given as a first-line therapy, as proposed by Letson et al (1982) and Dieckert and Berger (1982).…”

Visual fields in metastatic choroidal carcinoma.

“…The beneficial effect of irradiation treatment on Visualfields inl metastatic choroidal carcinoma1 choroidal metastatic lesions has been amply documented (Gillet, 1971;Casanovas, 1966;Haye and Calle, 1972;MacMichael, 1969;Reese, 1963;Walker, 1974;Yaeger et al, 1971). In our case also the regression of the fundal lesion after irradiation therapy was reflected in the improvement of visual acuity and visual fields.…”