Lung cancer and intraocular metastasis in gestation: Clinical experiences of a rare case.

Lung cancer in pregnancy combined with intraocular metastasis rarely occurs and has a poor prognosis. Here, we report an extremely rare case of a 31-year-old non-smoking pregnant female who was diagnosed with lung adenocarcinoma with multiple metastasis including choroidal metastasis. Whole exon sequencing was performed but no appropriate therapeutic target was identified. The patient received standard pemetrexed plus carboplatin for first-line treatment after delivery. Ophthalmic treatment including transpupillary thermotherapy and intravitreal ranibizumab injections were administered and the patient responded very well to treatment. Her visual acuity was restored, indicating systemic therapy combined with ophthalmic treatment was an appropriate choice of therapy. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: The case reported here of a pregnant female diagnosed with lung cancer with choroidal metastasis highlights the aggressive characteristics of the disease. WHAT THIS STUDY ADDS: Systemic therapy in combination with ocular therapy is an appropriate choice of treatment.

Intraocular Metastases--A Review.

Intraocular metastases almost invariably arise in the uveal tract, mostly in the posterior choroid. They are the most common type of intraocular malignancy and often the first sign of tumor dissemination. Choroidal metastases generally appear as a creamy white or pale yellow mass associated with subretinal fluid and may be multifocal and bilateral. The most common primary sites are breast and lung. Diagnosis is aided by a variety of tests, particularly ultrasonography and optical coherence tomography. Intraocular biopsy is useful in patients with clinical suspicion of uveal metastasis but no evidence of primary malignancy despite systemic evaluation. If systemic treatment fails to control the ocular tumor, a good response is usually achieved with local therapies such as external beam radiation therapy, photodynamic therapy, and transpupillary thermotherapy. The life expectancy of patients with choroidal metastases is generally poor but has been improving thanks to the therapeutic advances taking place.

Diagnosis and management of retinoblastoma.

BACKGROUND: Retinoblastoma is a highly malignant tumor of the eye that manifests most often in the first 3 years of life. METHODS: Published articles were reviewed to evaluate the clinical features and current methods of diagnosis and to assess the trends in management. RESULTS: This malignancy leads to metastatic disease and death in 50% of children worldwide but in less than 5% of children in the United States and other developed nations with advanced medical care. Over the past decade, there has been a trend away from enucleation and external beam radiotherapy and toward chemoreduction followed by focal therapies. This is largely due to more effective chemotherapeutic regimens, improved focal treatment modalities, and the desire to avoid loss of the globe and/or exposure to radiotherapy. Chemoreduction and focal therapies are most successful for eyes with minimal to moderate retinoblastoma, with enucleation needed in less than 15% of cases. Eyes with very advanced retinoblastoma require enucleation in approximately 50% of cases. CONCLUSIONS: Progress in the clinical recognition and management of retinoblastoma has led to high survival rates. Improved methods of treatment using chemoreduction and focal treatments without the need for external beam radiotherapy allow preservation of the eye in some cases, often with visual function.

[Treatment of intraocular metastatic tumors]. / Leczenie wewnatrzgalkowych guzów przerzutowych.

PURPOSE: Analysis of the clinical picture of intraocular metastatic tumors and the results of the treatment with various methods. MATERIAL AND METHODS: Between 1994-1997 intraocular metastatic tumors were diagnosed in 14 patients (19 eyes). There were 13 females and 1 male, aged 28 to 69 years (average 50). The primary tumor in 8 patients developed in the breast, in 4 cases in the lungs, 1 in the brain, and 1 in the kidney. In all patients the primary tumor was excised, then chemotherapy was applied in 9 cases, radiotherapy in 3 cases, and hormonal treatment in 2 cases. In 7 patients the metastatic process concerned also other organs: bones, liver, lungs, hypophysis, and lymphatic glands. Metastases developed in 10 months to 11 years since the diagnosis and treatment of the primary tumor. Intraocular tumors were the most often located near the optic disc (8 cases), or near the macula (4 cases). There were usually flat tumors (in 12 cases < 5 mm in thickness), creamy white, sometimes with pigment clamping. In order, to confirm the diagnosis of the tumor, USG was always performed and in 8 cases fluorescein angiography. In all cases topical treatment was applied, which consisted of irradiation with ruthenium (106Ru) in 6 eyes (in 1 case two times), laser coagulation in 3 eyes, and thermotherapy (TTT) with diode laser in 4 eyes, combined treatment (106Ru + TTT) in 2 eyes, 106Ru and 125I brachytherapy in one eye. The dose of radiation for the apex of the tumor was 60-90 Gy (av. 65). The eyeball was enucleated in 3 patients, 4 patients received chemotherapy. 2 patients received hormonal therapy, applied together with the topical treatment. RESULTS: In the majority of cases (14 eyes), a flat scar or the significant decrease of the volume of the tumor was obtained. 8 patients died, two are currently observed, the remaining 4 do not come to the control examination, and there is no information as to their fate. CONCLUSIONS: Good results of the treatment encourage further application of brachy and thermotherapy in the treatment of intraocular metastatic tumors. It allows for the conservative treatment of the eyeball, and also useful visual acuity is retained often.

Factors predictive of recurrence of retinal tumors, vitreous seeds, and subretinal seeds following chemoreduction for retinoblastoma.

OBJECTIVE: To identify the clinical features of eyes with retinoblastomas that predict the recurrence of retinal tumors, vitreous seeds, and subretinal seeds following treatment with chemoreduction. DESIGN: Prospective nonrandomized single-center clinical trial. SETTING: Ocular oncology service at Wills Eye Hospital of Thomas Jefferson University (Philadelphia, Pa) in conjunction with the division of oncology at Children's Hospital of Philadelphia. PARTICIPANTS: There were 158 eyes with 364 tumors in 103 consecutive patients with retinoblastoma managed with chemoreduction between June 1994 and August 1999. INTERVENTION: All patients received treatment for retinoblastoma with 6 cycles of chemoreduction using vincristine, etoposide, and carboplatin combined with focal treatment (cryotherapy, thermotherapy, or plaque radiotherapy) for each retinal tumor. MAIN OUTCOME MEASURES: The 3 main outcome measures included recurrence of retinal tumors, recurrence of vitreous seeds, and recurrence of subretinal seeds. The clinical features at the initial examination were analyzed for their association with the main outcome measures using a series of Cox proportional hazards regressions. RESULTS: All retinal tumors, vitreous seeds, and subretinal seeds showed an initial favorable response of regression during this treatment regimen. Using Kaplan-Meier estimates, at least 1 retinal tumor recurrence per eye was found in 37% of eyes at 1 year, 51% at 3 years, and no further increase at 5 years. By multivariate analysis, the only factor predictive of retinal tumor recurrence was the presence of tumor-associated subretinal seeds at the initial examination. Of the 54 eyes that had vitreous seeds at the initial examination, vitreous seed recurrence was found in 26% of eyes at 1 year, 46% at 3 years, and 50% at 5 years. By univariate analysis, the only factor predictive of vitreous seed recurrence was the presence of tumor-associated subretinal seeds at the initial examination. Of the 71 eyes that had subretinal seeds at the initial examination, subretinal seed recurrence was detected in 53% of eyes at 1 year, 62% at 3 years, and no further increase at 5 years. By multivariate analysis, factors predictive of subretinal seed recurrence included a tumor base greater than 15 mm and a patient age of 12 months or younger at diagnosis. There were no patients who developed retinoblastoma metastasis, pinealoblastoma, or second malignant neoplasms. CONCLUSIONS: Chemoreduction combined with focal therapy is effective for selected eyes with retinoblastomas. Eyes with subretinal seeds at initial examination are at particular risk for recurrence of retinal tumor and vitreous seeds. Younger patients with large tumors are at risk for recurrence of subretinal seeds. Retinal tumor and subretinal seed recurrence seems to manifest within 3 years of follow-up. Close follow-up of all patients treated with chemoreduction is warranted.

Regression of metastatic breast cancer in a patient treated with the anti-angiogenic drug TNP-470.

BACKGROUND: Solid tumors in general, and breast cancer in particular, depend on angiogenesis to grow and metastasize. Multiple agents have been developed in order to inhibit this phenomenon of tumor-induced angiogenesis. TNP-470 is one of the most potent of these drugs. We report here a case of regression of metastatic lesions from breast cancer due to the administration of the anti-angiogenic drug TNP-470. METHODS: A 44-year-old woman with a history of stage 2 breast cancer developed metastases at four sites: eye, lung, liver, and bone. She had been treated with radiation, megace, adriamycin, cytoxan, and 5-fluorouracil with disease stabilization. After she completed her radiation and chemotherapy, she was started on TNP-470. RESULTS: In response to TNP-470, her disease showed a partial response at the three-month follow-up and stabilization at the five-month follow-up. There were no side effects, and her quality of life was good. CONCLUSIONS: To our knowledge, this patient is the first reported case of regression of breast cancer metastases as a result of treatment with TNP-470. Anti-angiogenic drugs hold promise for the future therapy of breast cancer, and possibly of many other solid tumors as well.