Orbital Metastases from Breast Cancer: Retrospective Analysis at an Academic Cancer Center

Abstract

Orbital metastases from breast cancer (BC) are rare, but often debilitating. BC accounts for nearly half of metastases to the orbit. Orbital metastases may be discovered years after the initial diagnosis of BC, and are rare at initial presentation. A search of the institutional data base at an academic cancer center identified BC patients who developed or presented with orbital metastases from 2000 to 2013. Baseline characteristics, treatment modalities, survival and treatment responses were collected from the electronic medical record. There were 20 patients identified with orbital metastases (0.7% of all BC cases). The median age at diagnosis of BC was 49 years; 80% had estrogen positive disease. The interval between the initial diagnosis of BC and the presentation of orbital metastases was 8.5 years (0-19 years). Orbital disease was the initial presentation of BC in two cases. Three patients developed bilateral orbital metastases and seven had accompanying brain metastases. The most common presentation was decreased vision (55%), followed by diplopia (25%). The median survival after orbital metastases was 24 months. Thirteen patients (65%) received local radiation therapy. Of those radiated, 90% reported improvement of orbital symptoms. Other treatments included intraocular bevacizumab, surgery, and systemic therapy. Orbital metastases tend to occur in estrogen receptor positive disease and are often found years after BC onset. Orbital metastases may be associated with the development of brain metastases. Radiotherapy is the preferred local therapy and had high symptom control in this cohort. Oncologists should be aware of the signs of orbital metastases and the treatment options.

Orbital Metastasis from Triple-Negative Breast Cancer: Case Report and Literature Review

“…Pierson et al [15] reported in a retrospective study 20 cases of orbital metastases of breast cancer; the majority (80%) were ER-positive and Her2-negative and had a more favorable survival under treatment with hormone therapy. The frequency of metastases of breast cancer overexpressing ER can be explained biologically by the presence of estrogen receptors in hormone acting as target choroid tissue steroids for lacrimal secretion [16].…”

“…Radiotherapy gives objective response rates of more than 70% according to various studies [15]. It may be used in doses of 30-50 Gy as a single treatment or in combination with chemotherapy and hormone therapy [8].…”

Late orbital metastasis from colon cancer complicated by multiple tumors in the breast, lung, liver, and spine

“…Cancers arising from the lung, breast, and adrenal gland are thought to be frequent primary foci, whereas those from the colon have been only sporadically documented [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] . Even in breast cancers, orbital metastasis is estimated to occur in only 0.7% of cases, and its treatment strategy is yet to be determined [ 6 , 9 ]. Late metastasis is a very rare manifestation of cancers that can present more than 20 years after the initial diagnosis [10] .…”

CyberKnife radiotherapy for orbital metastases: A single-center experience on 24 lesions

“…Metastases of solid tumors to the ocular and periocular structures are rare, yet they are estimated to account for approximately 1%–13% of all neoplasms found in the orbit. 1,2 Patients affected by these localizations of metastases usually have an abrupt onset of blurred vision, limited ocular motility, diplopia, and pain with important deterioration in their quality of life. Due to poor prognosis of patients affected by orbital metastases, primary aims of the treatment are symptom relief and preservation of visual functions.…”