Singh Navneet, Kulkarni Pandurang, Aggarwal Ashutosh N, Mittal Bhagwant Rai, Gupta Nalini, Behera Digambar, Gupta Amod
From Departments of Pulmonary Medicine (NS, ANA, DB), Ophthalmology (PK, AG), Nuclear Medicine (BRM), and Cytology and Gynecological Pathology (NG), Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India.
Medicine (Baltimore). 2012 Jul;91(4):179-194. doi: 10.1097/MD.0b013e3182574a0b.
Symptomatic choroidal metastasis is a rare presenting manifestation of lung cancer. We describe here 3 patients with non-squamous non-small cell lung cancer who presented with choroidal metastasis and who were diagnosed and treated by the authors. We performed a systematic literature review of the previously reported patients with choroidal metastasis from lung cancer in the English-language literature. We excluded case series lacking individual patient data and identified 75 patients. In 23 of these patients, choroidal metastasis was not the presenting manifestation of lung cancer. Therefore, we included 55 patients (3 index and 52 previously reported) in the analysis. We present the demographic profile, histology, disease stage, ocular and lung lesions, diagnostic and treatment (systemic and ocular) modalities, and treatment outcomes. The majority of patients were male (67.3%) and were current or ex-smokers (78.3%); the mean age was 55.1 (standard deviation 11.2) years. Adenocarcinoma (n = 23) was the most common histologic type followed by squamous (n = 11) and small cell (n = 8). Left eye (n = 32) involvement was more common than right eye (n = 19) or bilateral (n = 4). Among patients for whom the location of primary lesion was specified, the left upper lobe (n = 13) was the most common site. The most common diagnostic modalities were bronchoscopic lung biopsy (n = 15) and enucleation (n = 13), while the liver (30.9%) was the most common extraocular metastatic site identified. Systemic chemotherapy was given in 56.4% of cases, and disease progression was the most common outcome among evaluable patients. Ocular treatment modalities included radiation (n = 23), enucleation (n = 14), and systemic steroids (n = 8). Regression of choroidal metastases with treatment was observed in 66.7% of patients who did not undergo enucleation as the primary treatment modality. Of the 3 index patients, 2 each received pemetrexed-cisplatin (as first-line therapy), gefitinib or erlotinib (as second- or third-line therapy), and intravitreal bevacizumab; and 1 patient received systemic bevacizumab. Two patients had partial response radiologically with systemic treatment, and all 3 patients had regression of choroidal metastases with ocular treatment. Recommendations regarding systemic and local (ocular) management of patients with choroidal metastasis as the presenting manifestation of lung cancer are provided.
有症状的脉络膜转移是肺癌罕见的首发表现。我们在此描述3例非鳞状非小细胞肺癌患者，他们以脉络膜转移为表现，由作者进行诊断和治疗。我们对英文文献中先前报道的肺癌脉络膜转移患者进行了系统的文献综述。我们排除了缺乏个体患者数据的病例系列，确定了75例患者。在这些患者中，有23例脉络膜转移不是肺癌的首发表现。因此，我们纳入55例患者（3例索引病例和52例先前报道的病例）进行分析。我们展示了患者的人口统计学特征、组织学类型、疾病分期、眼部和肺部病变、诊断和治疗（全身和眼部）方式以及治疗结果。大多数患者为男性（67.3%），目前或曾经吸烟（78.3%）；平均年龄为55.1（标准差11.2）岁。腺癌（n = 23）是最常见的组织学类型，其次是鳞癌（n = 11）和小细胞癌（n = 8）。左眼受累（n = 32）比右眼（n = 19）或双眼受累（n = 4）更常见。在明确原发性病变位置的患者中，左上叶（n = 13）是最常见的部位。最常见的诊断方式是支气管镜肺活检（n = 15）和眼球摘除术（n = 13），而肝脏（30.9%）是最常见的眼外转移部位。56.4%的病例接受了全身化疗，疾病进展是可评估患者中最常见的结局。眼部治疗方式包括放疗（n = 23）、眼球摘除术（n = 14）和全身使用类固醇（n = 8）。在未将眼球摘除术作为主要治疗方式的患者中，66.7%观察到脉络膜转移灶经治疗后消退。在3例索引病例中，2例分别接受培美曲塞 - 顺铂（作为一线治疗）、吉非替尼或厄洛替尼（作为二线或三线治疗）以及玻璃体内注射贝伐单抗；1例患者接受了全身使用贝伐单抗。2例患者经全身治疗后影像学上有部分缓解，所有3例患者经眼部治疗后脉络膜转移灶均消退。本文提供了关于以脉络膜转移为肺癌首发表现患者的全身和局部（眼部）管理的建议。
