Combined positron emission tomography/computed tomography (PET/CT) for imaging of orbital tumours and tumours extending into the orbit

Clinical and Imaging Characteristics of Metastatic Orbital Tumours in North China

Purpose

This study was designed to review the primary sites, clinical manifestations, imaging features, treatments, and outcomes of 36 patients with orbital metastasis in North China.

Methods

This was a retrospective review of 36 patients with orbital metastasis at Tianjin Eye Hospital between January 2010 and December 2020 in North China as well as a review of the literature.

Results

Thirty-six patients were included in the study; 17 were male, and 19 were female, with an age range of 1-82 years (average 54.9 ± 19.8 years). All the tumours were unilateral. The mean duration from the onset of orbital signs to presentation at the hospital was 2.4 months (range 1-10 months). Breast carcinoma, gastrointestinal tract carcinoma, and lung carcinoma were the most common histological types. Proptosis, ocular pain, and diplopia were the most common clinical manifestations. The superior orbit was the most common quadrant involved. All patients received comprehensive therapy, including surgery, radiotherapy, or chemotherapy. The average follow-up time was 2.45 years (range 7 months to 5.5 years). Ten patients in this study died as a result of disseminated metastasis from the primary tumour.

Conclusions

In North China, the most common primary cancer that metastasizes to the orbit is breast cancer, followed by gastrointestinal tract carcinoma and lung cancer. The increasing trend of orbital gastrointestinal tract metastases in North China in recent years is noteworthy. The survival rate of patients with orbital metastasis of neuroblastoma is low.

Radiation optic neuropathy and retinopathy in patients with presumed benign intraorbital tumours treated with fractionated stereotactic radiotherapy

PURPOSE

To assess the long-term effects of fractionated stereotactic radiotherapy (fSRT) for the treatment of (presumed) benign intraorbital tumours on visual acuity, visual fields, globe and eyelid position, and complications including radiation retinopathy and deviations of retinal nerve fibre layer (RNFL) on OCT.

METHODS

Multi-centre retrospective follow-up study of a consecutive series of 25 patients treated in the Rotterdam Orbital Center (collaboration between Erasmus Medical Center and Rotterdam Eye Hospital) between 2002 and 2018. Data on the dose of fSRT, visual acuity, Humphrey field analyser (HFA) perimetry, globe and eyelid position were obtained from the medical records.

RESULTS

In this retrospective consecutive series of 25 patients with a median follow-up of 104 months (range 48-215 months), 80.0% of the patients had presumed optic nerve sheath meningioma and 20.0 % presumed cavernous haemangioma with signs suggestive of recent growth. In most patients, a better visual acuity and RNFL thickness were observed after stereotactic radiotherapy. Improvement of the visual field defects was observed after treatment, with a mean deviation of -14.98 dB (12.9 SD) before treatment versus -4.56 dB (10.8 SD) after treatment, respectively. Significant, but small changes in exophthalmometry values were observed with a mean of 14.92 mm (7.9 SD) versus 13.79 mm (7.3 SD) after treatment, respectively. Only 3 patients (15.0%) developed radiation retinopathy after stereotactic radiotherapy. All patients with radiation retinopathy had presumed optic nerve sheath meningioma.

CONCLUSIONS

Based on our results, fSRT is an effective treatment modality for this subset of orbital tumours with few complications and good long-term visual and cosmetic outcomes. FSRT is non-invasive and safer than surgery for lesions in the posterior orbit or around the optic nerve.

Extrapulmonary Small Cell Carcinoma Presenting as an Orbital Mass: A Case Report

Extrapulmonary small cell carcinomas (ESCCs) are poorly differentiated neuroendocrine tumors that are characterized by an aggressive course and poor survival rates. While these tumors can be found anywhere in the body, presentations of lesions in the orbit are exceedingly rare. We present the case of a 47-year-old man who presented with blurry vision, lacrimation, and tenderness of his right eye, as well as a small but palpable temporal mass. Upon workup, he was diagnosed with ESCC in the orbit as well as lesions in the liver and spine. He received systemic chemotherapy but unfortunately proceeded to have rapid spread of his disease and succumbed to this cancer only a year after presentation. This patient illustrates the importance of developing optimal treatment strategies, which have yet to be delineated, and especially the impact of newer immunotherapy agents remains to be seen.

Multidisciplinary Management of Orbital Metastasis and Survival Outcomes

PURPOSE

To study the multidisciplinary management and survival outcomes of orbital metastasis (OM).

METHODS

All patients with a diagnosis of OM treated during 1999-2019 were included. Clinical data were retrospectively collected and analyzed.

RESULTS

The study included 118 patients, 71 females and 47 males, with a median age of 61 years. The most common primary tumor types were breast carcinoma (43 patients), melanoma (17), and lung (13), thyroid (7), renal cell (6), and neuroendocrine carcinoma (6). Ninety-six patients had a known history of cancer at OM diagnosis. The median time from diagnosis of primary cancer to OM was 31 months (range, 0-304). In 22 patients, OM was the first sign of cancer. In 47 patients, the orbit was the only site of metastasis. The most common presenting features were restricted by extraocular motility (77 patients) and proptosis (61). Eight patients had enophthalmos. OM was diagnosed based on clinical history and imaging studies in 81 patients and orbital biopsy in 37. One hundred nine patients were treated with chemotherapy and immunotherapy, 75 with radiation, and 21 with palliative surgical resection. Eighty-two patients died during follow up. The median overall survival (OS) time after diagnosis of OM was 17 months (95% CI: 12-28). OM from renal cell carcinoma was associated with the best and OM from thyroid cancer with the worst OS. Patients with breast cancer had longer median survival (28 months; 95% CI: 15-60) than patients with lung, melanoma, neuroendocrine, or thyroid cancer.

CONCLUSION

In this large series, breast cancer and melanoma were the most common causes of OM. Most patients had a known history of cancer at OM diagnosis and did not require orbital biopsy to confirm the diagnosis. Patients with renal cell carcinoma and breast carcinoma had the best prognosis after diagnosis of OM.

Case report 68Ga-DOTATATE of optic nerve sheath meningioma

We report a patient with an optic nerve sheath meningioma whose diagnosis and management were guided by using Gallium-68 DOTA-Tyr³-octreotatate (⁶⁸Ga-DOTATATE).

Positron Emission Tomography-Computed Tomography (PET-CT).

Combined positron emission tomography/computed tomography for diagnosis and monitoring of orbital adnexal lymphoma

PURPOSE

Combined whole-body F-18-fluoro-2-deoxyglucose positron emission tomography / computed tomography ([18F]FDG-PET/CT) gives precise information about tumour morphology and metabolism. The standardized uptake value (SUV) allows quantification of tumour metabolism. The diagnostic value of PET/CT in patients with suspected orbital adnexal lymphoma (OAL) was evaluated.

METHODS

Of 21 patients with suspected OAL who underwent combined whole-body PET/CT between 07/2002 and 11/2016, 16 were scanned before and five after orbital biopsy. Histological tumour determination was performed in all cases via biopsy. Correlation between SUV_max and therapeutic status, lymphoma stage (Ann Arbor classification) and histological grading was tested.

RESULTS

All lesions could be depicted by combined whole-body PET/CT. Histology confirmed two malignant T-cell and 18 malignant B cell non-Hodgkin lymphomas as well as one patient suffering from systemic lymphoma with chronic polypoid sinusitis. SUV_max levels of orbital findings were significantly lower after therapy (p < 0.001; Fisher's exact test). Higher stage lymphomas (Ann Arbor classification) expressed significantly higher SUV_max levels (p = 0.014; Fisher's exact test). There was no significant correlation of SUV_max values and histologic grading in this patient collective.

CONCLUSION

Positron emission tomography/computed tomography (PET/CT) depicted vital tumour metabolism of OALs accurately. In cases scanned after orbital biopsy and under systemic therapy, no elevated tumour metabolic activity was expressed. This underlines the reasonable application of PET/CT for therapy monitoring besides whole-body staging. Higher-stage OALs show higher metabolic activity. Yet, for adequate therapy initiation, histology remains indispensable.