Palliative radiation therapy for patients with orbital and ocular metastases

Patients with cancer may develop metastases to the orbit causing distressing symptoms. External beam radiation therapy (RT) is an effective palliative treatment for patients with orbital and ocular metastases. The aim of treatment is to preserve vision and to reduce pain. Delivery of 30 to 40 Gy in 2 Fr fractions is a practice in many oncology centres. The aim of this study is to evaluate the outcome of shortcourse palliative radiotherapy in the management of orbital and ocular metastases.

A retrospective study to review all patients with orbital metastases treated in 2016 to 2018 were performed. The primary outcomes were a change in visual acuity and tumor response. Secondary outcomes included toxicities of radiotherapy, symptomatic response and survival.

Fifteen patients with 19 eyes were included. The most common presenting symptoms were decreased vision, periorbital swelling, and pain. The median follow-up period was 8 months. Visual acuity improved in 11 out of 13 (84.6%) of patients and remained stable in the remaining 2 patients. Partial and complete response (CR) of tumor was observed in 14 out of 15 (93.3%) of patients while one (6.6%) patient had stable disease. The overall response rate (ORR) was 100%. Two (13.3%) patients had grade 2 conjunctivitis. There were no grade 3-4 toxicities and no long-term toxicities observed. The median survival was 9.1 months from diagnosis of choroidal metastases.

Short course palliative RT is effective and well tolerated in patients with orbital and ocular metastases. The current review showed that it effectively preserves vision and improves orbital symptoms with minimal radiation-induced toxicity. Short course radiotherapy will help to minimize the traveling time to the hospital and relieve the burden of a long treatment course in this palliative patient population.