Lipid Dominant Toxic Tumor Syndrome

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Toxic Tumor Syndrome (TTS) can occur after radiation therapy for choroidal melanoma.
• Lipid-dominant TTS is a specific subtype characterized by lipid exudates.
• Episcleral plaque brachytherapy (EPB) is a common treatment for choroidal melanoma.

Purpose of the Study:

• To describe the clinical features of lipid-dominant TTS following EPB for choroidal melanoma.
• To evaluate the outcomes of intravitreal steroid treatment for this condition.

Main Methods:

• Retrospective review of 13 patients with lipid-dominant TTS post-EPB.
• Assessment of clinical features including lipid exudates, macular edema, and subretinal fluid.
• Evaluation of treatment response to intravitreal steroids (triamcinolone) versus observation.

Main Results:

• Lipid-dominant TTS occurred a median of 22 months post-EPB, often associated with dyslipidemia.
• Intravitreal steroids were administered to 8 patients, with 7 (88%) showing significant improvement.
• Positive responses included reduction in lipid exudates, subretinal fluid, and cystoid macular edema; however, cataracts and ocular hypertension were noted side effects.

Conclusions:

• Lipid-dominant TTS around the tumor base is a chronic variant of TTS.
• Intravitreal steroids can effectively manage this condition, stabilizing or improving vision and potentially preventing enucleation.
• Further prospective studies are needed to validate these findings.