Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Gamma Knife Radiosurgery for Cancer Metastasized to the Ocular Choroid

  • Cho, Kyung Rae (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung Min (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Han, Gyule (Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Se Woong (Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung-Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2016.06.15
  • Accepted : 2017.03.27
  • Published : 2018.01.01
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Abstract

Objective : Choroidal metastases (CMs) are the most common intraocular tumor. Management is mainly radiation therapy with goals of pain control and visual improvement. However, many radiation-related complications are reported. Since gamma knife radiosurgery (GKS) for CM was first reported in 1995, few cases have been reported. We report 7 cases of CMs treated with GKS. Methods : From April 2011 to November 2014, 7 patients with CM underwent GKS. Their median age at treatment was 64 years (range, 51-71 years). Four males and three females were treated. Lung cancer was the most common primary pathology, followed by renal cell carcinoma and stomach cancer. Four patients had multiple cerebral lesions and were treated simultaneously for choroidal lesions. The median marginal dose of 20 Gy (range, 15-25 Gy) was administered at the 50% isodose line. Results : Median follow-up period after GKS was 8 months (range, 2-38.3 months). Four patients expired due to underlying malignancy progression. Except for two patients who were not followed with magnetic resonance image after GKS, all patients showed size reduction in the treated lesions, but a new choroidal lesion appeared in one patient and one recurred. Six of seven patients reported subjectively improved visual symptoms. Visual acuity improved in 2 patients, and 2 were stable upon objective examination. One patient showed no improvement in visual acuity, but ocular pain was relieved; another patient showed improved vision and tumor remission, but visual deterioration recurred. Conclusion : GKS was shown to be safe and effective and should be considered for CM treatment.

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References

  1. Arepalli S, Kaliki S, Shields CL : Choroidal metastases: origin, features, and therapy. Indian J Ophthalmol 63 : 122-127, 2015 https://doi.org/10.4103/0301-4738.154380
  2. Bloch RS, Gartner S : The incidence of ocular metastatic carcinoma. Arch Ophthalmol 85 : 673-675, 1971 https://doi.org/10.1001/archopht.1971.00990050675005
  3. Brady LW, Shields JA, Augsburger JJ, Day JL : Malignant intraocular tumors. Cancer 49 : 578-585, 1982 https://doi.org/10.1002/1097-0142(19820201)49:3<578::AID-CNCR2820490330>3.0.CO;2-A
  4. Chen CJ, McCoy AN, Brahmer J, Handa JT : Emerging treatments for choroidal metastases. Surv Ophthalmol 56 : 511-521, 2011 https://doi.org/10.1016/j.survophthal.2011.05.001
  5. Cutler C, Gragoudas ES : Choroidal metastases. Case 2: lung cancer. J Clin Oncol 17 : 3358-3359, 1999 https://doi.org/10.1200/JCO.1999.17.10.3358
  6. Fakiris AJ, Lo SS, Henderson MA, Witt TC, Worth RM, Danis RP, et al. : Gamma-knife-based stereotactic radiosurgery for uveal melanoma. Stereotact Funct Neurosurg 85 : 106-112, 2007 https://doi.org/10.1159/000098525
  7. Finger PT : Radiation therapy for choroidal melanoma. Surv Ophthalmol 42 : 215-232, 1997 https://doi.org/10.1016/S0039-6257(97)00088-X
  8. Foster BS, Samy CN, Gragoudas ES : Choroidal metastasis in Guyer, Yanuzzi, Change, in Guyer DR, Yannuzzi LA, Chang S, Shields JA, Green WR (eds) : Retina-Vitreous-Macula. Philadelphia : Saunders, 1999, pp1103-1109
  9. Lally DR, Duker JS, Mignano JE, Martin S, Witkin AJ : Regression of choroidal metastasis from breast carcinoma treated with gamma knife radiosurgery. JAMA Ophthalmol 132 : 1248-1249, 2014 https://doi.org/10.1001/jamaophthalmol.2014.1974
  10. Letson AD, Davidorf FH, Bruce RA Jr : Chemotherapy for treatment of choroidal metastases from breast carcinoma. Am J Ophthalmol 93 : 102-106, 1982 https://doi.org/10.1016/0002-9394(82)90707-3
  11. Maor M, Chan RC, Young SE : Radiotherapy of choroidal metastases: breast cancer as primary site. Cancer 40 : 2081-2086, 1977 https://doi.org/10.1002/1097-0142(197711)40:5<2081::AID-CNCR2820400515>3.0.CO;2-O
  12. Marchini G, Babighian S, Tomazzoli L, Gerosa MA, Nicolato A, Bricolo A, et al. : Gamma knife stereotactic radiosurgery of ocular metastases: a case report. Stereotact Funct Neurosurg 64 Suppl 1 : 67-71, 1995 https://doi.org/10.1159/000098765
  13. Modorati G, Miserocchi E, Galli L, Picozzi P, Rama P : Gamma knife radiosurgery for uveal melanoma: 12 years of experience. Br J Ophthalmol 93 : 40-44, 2009 https://doi.org/10.1136/bjo.2008.142208
  14. Odell KR : Review of the poster "Dosimetric comparison of gamma knife radiosurgery vs. 125I plaque brachytherapy in a cohort of choroidal melanomas". Med Dosim 34 : 107-109, 2009 https://doi.org/10.1016/j.meddos.2008.05.002
  15. Rudoler SB, Corn BW, Shields CL, De Potter P, Hyslop T, Shields JA, et al. : External beam irradiation for choroid metastases: identification of factors predisposing to long-term sequelae. Int J Radiat Oncol Biol Phys 38 : 251-256, 1997 https://doi.org/10.1016/S0360-3016(97)00050-3
  16. Sawaya R : Intracranial Metastases: Current Management Strategies, ed 3 : John Wiley & Sons, 2008
  17. Shields CL, Shields JA, De Potter P, Quaranta M, Freire J, Brady LW, et al. : Plaque radiotherapy for the management of uveal metastasis. Arch Ophthalmol 115 : 203-209, 1997 https://doi.org/10.1001/archopht.1997.01100150205010
  18. Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE : Survey of 520 eyes with uveal metastases. Ophthalmology 104 : 1265-1276, 1997 https://doi.org/10.1016/S0161-6420(97)30148-1
  19. Wackernagel W, Holl E, Tarmann L, Mayer C, Avian A, Schneider M, et al. : Local tumour control and eye preservation after gamma-knife radiosurgery of choroidal melanomas. Br J Ophthalmol 98 : 218-223, 2014 https://doi.org/10.1136/bjophthalmol-2013-304031
  20. Wen JC, Oliver SC, McCannel TA : Ocular complications following I-125 brachytherapy for choroidal melanoma. Eye (Lond) 23 : 1254-1268, 2009 https://doi.org/10.1038/eye.2009.43
  21. Wiegel T, Bornfeld N, Kreusel KM, Guttenberger R, Hinkelbein W : Radiotherapy for choroidal metastases: interim analysis of a prospective study of the ARO(ARO 95-08). Front Radiat Ther Oncol 30 : 154-159, 1997

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