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Uveal metastasis from lung cancer has high mortality rate
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PHILADELPHIA — Uveal metastatic cancer from lung cancer had a high globe salvage rate but a poor systemic prognosis, according to a study presented at the Wills Eye Alumni Conference.
Jerry Shields
Additionally, Jerry A. Shields, MD, said that uveal metastatic tumors helped diagnosticians find lung cancer in 44% of patients.
“It’s up to you as the clinician to be able to recognize these features and diagnose this important problem,” Shields said.
The study included 374 uveal metastatic tumors in 229 eyes of 194 patients.
Tumors were located in the choroid (88%), iris (10%) and ciliary body (2%). Globe salvage was achieved in 92% of patients, and visual acuity improved in 59%.
However, systemic prognosis was poor, with a tumor-related mortality rate of 54% at 1 year.
Typical features of choroidal metastasis include a yellow choroidal mass in the posterior pole. One tumor typically appears in one eye, but two can appear.
Bilateral lesions produce orange masses in the posterior pole.
Atypical presentations are not rare; uveal metastatic tumors may simulate other tumors or mimic inflammation, Shields said. “You must have a high index of suspicion,” he said.
“Sometimes the metastasis is hidden beneath a total non-rhegmatogenous retinal detachment, and in these cases, ultrasound is helpful in making the diagnosis,” Shields said.
Like lymphoma, uveal metastatic cancer is a “great masquerader,” he said.
Treatments for choroidal metastatic tumors include chemotherapy, external beam radiotherapy, plaque radiotherapy and photodynamic therapy.
Disclosure: Shields reports no relevant financial disclosures.