External beam radiotherapy of choroidal metastases--final results of a prospective study of the German Cancer Society (ARO 95-08).
OBJECTIVE
In 1994 a prospective study of the 'Arbeitsgemeinschaft Radiologische Onkologie' of the German Cancer Society was initiated to examine the results of a standardized radiation therapy for choroidal metastases with 40 Gy. Recommendations in the literature vary from 21 to 50 Gy of total dose and from 2 to 5 Gy per single fraction. To date, no larger series treated with both a standardized technique and dose has been reported.


METHODS
Between 1994 and 1998, 56 patients were enrolled and 50 patients with 65 involved eyes were available for analysis. Thirty-five patients (70%) had unilateral and 15 patients (30%) had bilateral choroidal metastases. Fifty eyes (77%) were symptomatic and 15 eyes (23%) were asymptomatic. Thirty-one patients (62%) had breast cancer and 13 patients (26%) lung cancer as the primary tumor. Patients were treated with 40 Gy in 20 fractions with bilateral asymmetric fields for bilateral or a unilateral field for unilateral choroidal metastasis. Seventeen patients had additional chemotherapy after radiotherapy for general tumor progression.


RESULTS
With a median follow-up of 5.8 months (1-44 months) 41 out of 50 patients were dead. The median survival of all patients was 7 months and for patients with breast cancer 10 months. Of the 50 symptomatic eyes visual acuity increased for two or more lines in 36% (18/50), was stabilized in 50% (25/50 eyes), and decreased in 14% (7/50). No patient with asymptomatic metastasis (n = 15 eyes) developed ocular symptoms during follow-up. No patient with unilateral tumor and unilateral irradiation developed contralateral metastasis. Severe side effects, possibly related to tumor progression, occurred in three eyes (5%).


CONCLUSIONS
Radiation therapy with 40 Gy is an effective and safe palliative treatment for symptomatic and asymptomatic choroidal metastases to preserve vision in the majority of the patients. A unilateral field for unilateral metastasis seems to be sufficient to prevent contralateral disease. Side effects of radiotherapy are acceptable: 50% of patients developed a mild skin erythema and conjunctivitis (RTOG I). Late side effects were seen in three eyes (5%).
Department of Radiotherapy, University-Hospital Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.
Thomas
T
Wiegel
Dirk
D
Bottke
Klaus-Martin
KM
Kreusel
Stephanie
S
Schmidt
Norbert
N
Bornfeld
Michael H
MH
Foerster
Wolfgang
W
Hinkelbein
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology; D002830:Choroid Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy; D015996:Survival Rate