title: Radiotherapy of unilateral choroidal metastasis: unilateral irradiation or bilateral irradiation for sterilization of suspected contralateral disease?
abstract: Radiotherapy is the highly effective standard in the treatment of choroidal metastasis. Visual acuity can be stabilized or increased in about 70-80% of eyes treated, thus prevailing the quality of life in these worse prognostic patients. In about 30-40% bilateral macroscopic disease is found at diagnosis. The best treatment for unilateral metastasis remains controversial: unilateral or bilateral irradiation for sterilization of suspected contralateral metastasis or unilateral irradiation without irradiation of the contralateral choroidea. In the analysis of a prospective study (ARO 95-08) 35 out of 50 patients with choroidal metastasis had unilateral disease and received unilateral irradiation with a lateral field using 6 MeV-photons (40 Gy in 20 fractions) without sparing the contralateral choroidea. Therefore the posterior contralateral choroidea received 50-70% of the total dose (20-28 Gy) for suspected micrometastasis. None of these patients developed contralateral choroidal metastasis during the median follow up time of 11.5 months. A unilateral field with 40 Gy for unilateral choroidal metastasis without sparing the contralateral choroidea seems to be effective in destroying contralateral micrometastasis with a lower risk of late side effects compared with bilateral fields.
authors.affiliation: Department of Radiotherapy, University Hospital Benjamin Franklin, Freie Universität Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wiegel
authors.forename: K M
authors.initials: KM
authors.lastname: Kreusel
authors.forename: S
authors.initials: S
authors.lastname: Schmidt
authors.forename: N
authors.initials: N
authors.lastname: Bornfeld
authors.forename: M H
authors.initials: MH
authors.lastname: Foerster
authors.forename: W
authors.initials: W
authors.lastname: Hinkelbein
mesh_terms: D000328:Adult; D000368:Aged; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy