J Korean Neurosurg Soc.  2018 Jan;61(1):60-65. 10.3340/jkns.2016.0606.003.

Gamma Knife Radiosurgery for Cancer Metastasized to the Ocular Choroid

• Cho KR
• Lee KM
• Han G
• Kang SW
• Lee JI

• KMID: 2403524
• DOI: http://doi.org/10.3340/jkns.2016.0606.003

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.

Keyword

Gamma knife radiosurgery; Choroid; Metastasis; Orbit

MeSH Terms

Carcinoma, Renal Cell
Choroid*
Female
Follow-Up Studies
Humans
Lung Neoplasms
Male
Neoplasm Metastasis
Orbit
Pathology
Radiosurgery*
Stomach Neoplasms
Visual Acuity

Figure

• 

  Fig. 1 Magnetic resonance image findings before (A, C, F, H, J) and after gamma knife radiosurgery (B, D, G, I, K). Complete tumor remission was seen in cases 1, 3 and 4 (B, G, I). In case 2, complete remission was noted with a new choroidal metastasis (D and E). A recurrent tumor was found in case 7 (L).

• 

  Fig. 2 Funduscopic exam of case 4. A : Choroidal mass with exudative retinal detachment is seen on the inferior side of the macula. B : Mass disappearance and fluid collection with retinal flattening are shown. Elevated retina due to tumor is marked with a short dashed line, and fluid collection is marked with a dot and dash line.

• 

  Fig. 3 Funduscopic exam of case 7. A : Mass with subretinal fluid collection is found on the superolateral side of the macula. B : Flattening of retinal detachment and decrease in mass size are seen after 5 months. C : After 9 months, increasing size of metastases with subretinal fluid collection was noted.

Reference

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