Choroidal metastasis: Radiation and bevacizumab at presentation

Area of Science:

• Ophthalmology
• Radiation Oncology

Background:

• Choroidal metastasis is a significant cause of secondary eye malignancy.
• Early intervention is crucial for managing visual impairment and improving outcomes.

Purpose of the Study:

• To evaluate the efficacy of external beam radiation therapy (EBRT), with or without intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, as an early intervention for choroidal metastasis.
• To assess outcomes including tumor response, visual acuity, and complications.

Main Methods:

• A retrospective case series of 27 eyes from 22 patients with choroidal metastasis treated with EBRT.
• Treatments included EBRT alone or combined with intravitreal anti-VEGF injections.
• Outcomes measured: tumor thickness, subretinal fluid, visual acuity, radiation oculopathy, and survival.

Main Results:

• Local tumor control was achieved in all cases, with a mean tumor height reduction from 2.7 mm to 1.5 mm.
• Vision improved in eyes with extrafoveal tumors (mean acuity improved to 20/32).
• Complications included radiation retinopathy (37%), keratoconjunctivitis sicca (15%), and cataract development (17%).

Conclusions:

• EBRT, with or without anti-VEGF injections, is a safe and effective treatment for choroidal metastasis.
• The treatment facilitates local tumor control, reduces retinal detachments, and preserves vision.
• This multimodal approach offers a favorable risk-benefit profile for managing choroidal metastasis.