Lens-sparing external beam radiotherapy of intraocular metastases: our experiences with twenty four eyes

Occurrence of uveal metastases is higher, than the number of clinically diagnosed cases, furthermore all cases are not amenable to therapy. Treatment of primary cancer is permanently improving, as a result life prospective is better, with an increasing number of late distant metastases in an unusual location, as e.g. intraocular metastasis. As surgical approach is not suitable, and chemo/hormonal therapy often has a limited effect on intraocular dissemination, other treatment modalities are needed for the maintenance of visual acuity, and prevention of further deterioration of the quality of life. The study was made to evaluate the efficacy of external beam radiotherapy (EBRT) with lens-sparing techniques in the management of patients developing intraocular metastases (IOM). Between March 1994 and March 2002, 24 eyes of 17 patients with tumors metastatic to the eye were treated by EBRT. The female:male ratio was 8.5:1, age ranged between 37 and 74 years (mean: 56 years). The site of the primary tumor was: breast (11), lung (4) and others (2). The visual acuity at the beginning of irradiation was between 0.1-0.7 (mean 0.5) and a mean KPS of 60% was detected. The mean time elapsed from the diagnosis of primary tumor and recognition of metastasis was 38.9 months in case of breast, and 6.7 months in lung cancer. Eyes were treated by 6 MV photon beams, using a modified technique of Schipper's lens-sparing retinoblastoma treatment method. The following parameters were studied: visual acuity changes, local response rate, survival times from irradiation and ocular complications. Mean follow-up time was 24 months. Mean visual acuity improved two lines on the Snellen chart. The mean survival time after treatment of IOM was 21 months in breast and 4.9 months in lung cancer patients. Local response rate was 78%. No radiation cataract was observed. Only one patient developed radiation retinopathy 32 months after the treatment. External beam radiotherapy is recommended for the treatment of intraocular metastases to improve quality of life. In selected cases--especially breast cancer patients--lens-sparing technique is the treatment of choice.