Multimodal imaging and functional outcomes of choroidal metastases from non-small cell lung cancer treated with...

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Choroidal metastases (CMs) are a significant cause of visual impairment in patients with advanced non-small cell lung cancer (NSCLC).
• Traditional treatments for CMs have limited efficacy and can cause significant ocular toxicity.
• Next-generation tyrosine kinase inhibitors (TKIs) offer targeted therapy for specific NSCLC mutations, but their long-term ocular outcomes are not well-established.

Purpose of the Study:

• To evaluate the long-term anatomical and visual outcomes of next-generation TKI therapy in patients with choroidal metastases (CMs) secondary to non-small cell lung cancer (NSCLC).

Main Methods:

• Case series of three patients with stage IV NSCLC and CMs.
• Multimodal imaging including fundus photography, angiography, OCT, and ultrasonography.
• Systemic evaluation for ALK rearrangement or EGFR mutations.
• Treatment with first-line Alectinib or Osimertinib.
• Long-term follow-up (24-36 months) with OCT, OCT angiography (OCTA), and microperimetry.

Main Results:

• All patients experienced visual loss; two had bilateral choroidal lesions.
• Complete resolution of CMs and photoreceptor restoration occurred within 6 months of TKI therapy.
• At long-term follow-up, OCT showed residual outer retinal granularity, and OCTA revealed persistent choriocapillaris flow voids.
• Microperimetry indicated distinct functional alterations based on lesion location.

Conclusions:

• Next-generation TKIs demonstrate favorable long-term outcomes for NSCLC patients with CMs.
• Multimodal imaging and functional assessments are crucial for monitoring treatment response.
• Early targeted TKI therapy is important for optimizing visual outcomes in these patients.