Choroid metastases: Clinical features and treatments in 123 patients

BACKGROUND The current study was performed to analyze the effects of radiotherapy and chemotherapy on visual improvement in patients with choroid metastases (CM), and to determine the clinical factors potentially related to the risk of death. METHODS One hundred twenty‐three consecutive patients were diagnosed with CM at the Institut Gustave‐Roussy between 1966 and 1992. Treatment failure was defined as the absence of tumor regression or choroid tumor progression documented at the time of last ophthalmologic examination. The Cox proportional hazards model was used to estimate the risk of treatment failure associated with analyzed covariates. RESULTS Approximately 81% of the patients were women. The most frequent primary tumors were breast carcinoma (71%) and lung carcinoma (9%). Bilateral CM were found in 25% of patients. Sequential vinca alkaloid‐based chemoradiotherapy was reported to be significantly associated with a decreased rate of treatment failure compared with radiotherapy alone (relative risk [RR] = 0.3; 95% confidence interval [95% CI], 0.03–2.2). However, when considered separately, each type of treatment also decreased the risk of treatment failure (RR = 0.5 [95% CI, 0.3–0.8] for radiotherapy and RR = 0.4 [95% CI, 0.3–0.7] for chemotherapy). The total dose of radiotherapy (< 30 grays [Gy] vs. ≥ 30 Gy) was not found to modify treatment results. The 2‐year overall survival rate was 25% (95% CI, 17–34%). The risk of death was found to be correlated with the presence of metastases in the liver ( P = 0.02) or lung pleura ( P = 0.04) at the time of the diagnosis of CM. CONCLUSIONS Sequential combination radiotherapy and vinca alkaloid‐based chemotherapy appear to be the most beneficial treatment modality. However, because treatments were not prescribed randomly, the results of the current study should be interpreted with caution. Cancer 2003;98:1232–8. © 2003 American Cancer Society. DOI 10.1002/cncr.11622