Photodynamic Therapy for Choroidal Metastasis Tumor Control and Visual Outcomes in 58 Cases: The 2019 Burnier International Ocular Pathology Society Lecture.

Abstract

PURPOSE:

To determine outcomes after photodynamic therapy (PDT) for choroidal metastasis.

DESIGN:

Retrospective interventional case series.

PARTICIPANTS:

Forty-three patients with 40 eyes harboring 58 choroidal metastases.

METHODS:

Treatment with standard fluence PDT using verteporfin.

MAIN OUTCOME MEASURES:

Tumor control and visual outcomes.

RESULTS:

The primary cancer originated in the lung (n = 17 [39%]), breast (n = 16 [37%]), kidney (n = 3 [8%]), thyroid (n = 2 [6%]), and other sites (n = 5 [10%]). The mean patient age at entry was 61 years. Ocular symptoms included decreased visual acuity (n = 23 [53%]), visual field defect (n = 2 [5%]), floaters (n = 7 [16%]), flashes (n = 3 [7%]), and asymptomatic (n = 8 [19%]). The median entering visual acuity (Snellen equivalent) was 20/40. The median tumor diameter was 5.0 mm, and median thickness by ultrasonography was 2.0 mm. The median distance to the optic disc was 3.0 mm, and that to the foveola was 2.0 mm. Of the 43 patients, 35 maintained follow-up (40 eyes, 45 tumors), and PDT achieved tumor control with 1 session (n = 32 tumors [71%]) or 2 sessions (n = 3 tumors [7%]) and failed to achieve regression (n = 10 tumors [22%]). The 10 metastases for which treatment failed were managed further with plaque radiotherapy (n = 3), proton beam radiotherapy (n = 1), external beam radiotherapy (n = 1), systemic chemotherapy (n = 4), and observation (patient preference; n = 1). A comparison of clinical features for tumor control (PDT alone vs. PDT plus additional therapy) revealed those controlled with PDT alone were more likely to be adenocarcinoma (73% vs. 30%; P = 0.02) and those eyes were more like to achieve final visual acuity of 20/20 to 20/40 (66% vs. 30%; P = 0.03), with better median final Snellen visual acuity (20/30 vs. 20/70; not significant). Primary cancer site or ocular tumor features (size, location, color, shape, related subretinal fluid) did not impact tumor control. In the entire group of 40 eyes, visual acuity improved or remained stable in 28 (70%) and decreased in 12 (30%), related to subfoveal scar, persistent subretinal fluid, reactive exudation, radiation maculopathy, and brain metastasis. At last follow-up (mean, 20 months), of the entering 43 patients, 9 (21%) were alive and 34 (79%) had died of systemic metastasis.

CONCLUSIONS:

Photodynamic therapy with verteporfin is an effective outpatient method for small to medium choroidal metastatic tumors, providing tumor control in 78% of eyes and visual outcome of 20/20 to 20/40 in 66% of eyes.

• Authors: Carol L Shields, Chloe T L Khoo, Mehdi Mazloumi, Arman Mashayekhi, Jerry A Shields
• Journal: Ophthalmology. Retina (Ophthalmol Retina) Vol. 4 Issue 3 Pg. 310-319 (03 2020) ISSN: 2468-6530 [Electronic] United States
• PMID: 31953111 (Publication Type: Lecture, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Photosensitizing Agents
• Verteporfin

Topics

• Adult
• Aged
• Aged, 80 and over
• Choroid (diagnostic imaging)
• Choroid Neoplasms (diagnosis, drug therapy, secondary)
• Female
• Fluorescein Angiography
• Fundus Oculi
• Humans
• Male
• Middle Aged
• Ophthalmology
• Photochemotherapy (methods)
• Photosensitizing Agents (therapeutic use)
• Retrospective Studies
• Societies, Medical
• Treatment Outcome
• Ultrasonography
• Verteporfin (therapeutic use)
• Visual Acuity