Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ophthalmology. 2014 Jan;121(1):352-357. doi: 10.1016/j.ophtha.2013.07.014. Epub 2013 Aug 26.
To evaluate the clinical features, treatment, and prognosis of patients with uveal metastasis from lung cancer.
Retrospective chart review.
There were 194 patients with a diagnosis of uveal metastasis from lung cancer.
Radiotherapy, chemotherapy, enucleation, or observation.
Ocular tumor control, final visual acuity, and tumor-related death.
There were 374 uveal metastatic tumors originating from primary lung cancer in 229 eyes of 194 patients. Tumor location included choroid (88%), ciliary body (2%), and iris (10%), with bilateral involvement in 18%. Diagnosis of uveal metastasis preceded the diagnosis of primary lung cancer in 44% of patients. The choroidal metastatic focus had a mean basal diameter of 8 mm and mean thickness of 3 mm, and were mostly located posterior to the equator (91%). The choroidal metastasis commonly had yellow or orange color (98%), had plateau (61%) or dome (38%) configuration, and displayed associated subretinal fluid (85%). Choroidal tumors were multifocal in 49 cases (23%). Ciliary body tumors were commonly dome shaped (75%) with an episcleral sentinel vessel (75%). Iris tumors were multifocal in 2 cases (13%), had visible intrinsic vessels (97%), and were associated with tumor seeding in the angle (38%) or on the iris stroma (25%). The uveal metastases were treated with teletherapy (31%), chemotherapy (18%), brachytherapy (9%), chemotherapy combined with teletherapy or brachytherapy (14%), enucleation (3%), or observation (21%). At last visit, eyes with follow-up showed tumor regression (66%), stability (12%), growth (14%), recurrence (3%), or new metastasis (5%). Visual acuity improved or remained stable in 59% eyes. One-year mortality from the time of detection of uveal metastasis was 54%.
Of 194 patients with uveal metastasis from lung cancer, 44% did not have a history of known lung cancer. Current methods of ocular treatment allow globe salvage in 92% of patients and improved/stable vision in 59% of patients. Systemic prognosis remains poor with tumor-related death in 54% of patients at 1 year.
评估肺癌眼转移患者的临床特征、治疗方法和预后。
回顾性病例分析。
共 194 例肺癌眼转移患者。
放疗、化疗、眼球摘除术或观察。
眼内肿瘤控制、最终视力和肿瘤相关死亡。
194 例患者的 229 只眼中共有 374 个源于原发性肺癌的眼转移瘤。肿瘤位置包括脉络膜（88%）、睫状体（2%）和虹膜（10%），18%的患者为双眼受累。在 44%的患者中，眼转移瘤的诊断先于原发性肺癌的诊断。脉络膜转移灶的基底直径平均为 8mm，厚度平均为 3mm，多位于赤道后（91%）。脉络膜转移瘤多呈黄色或橙色（98%），呈盘状（61%）或丘状（38%），伴有视网膜下积液（85%）。49 例（23%）脉络膜肿瘤为多灶性。睫状体肿瘤多为丘状（75%），伴巩膜哨兵血管（75%）。虹膜肿瘤有 2 例（13%）为多灶性，可见固有血管（97%），并伴有角部（38%）或虹膜基质（25%）肿瘤播散。眼内转移瘤采用远距离放射治疗（31%）、化疗（18%）、近距离放射治疗（9%）、化疗联合远距离放射治疗或近距离放射治疗（14%）、眼球摘除术（3%）或观察（21%）。末次随访时，有随访记录的眼内肿瘤消退（66%）、稳定（12%）、进展（14%）、复发（3%）或新发转移（5%）。视力提高或保持稳定的占 59%。从发现眼转移瘤到死亡的 1 年生存率为 54%。
194 例肺癌眼转移患者中，44%的患者无已知肺癌病史。目前的眼部治疗方法可使 92%的患者保留眼球，并使 59%的患者视力提高或保持稳定。但患者的全身预后仍较差，1 年时肿瘤相关死亡率为 54%。
