Lens-sparing external beam radiotherapy of intraocular metastases: our experiences with twenty four eyes

Occurrence of uveal metastases is higher, than the number of clinically diagnosed cases, furthermore all cases are not amenable to therapy. Treatment of primary cancer is permanently improving, as a result life prospective is better, with an increasing number of late distant metastases in an unusual location, as e.g. intraocular metastasis. As surgical approach is not suitable, and chemo/hormonal therapy often has a limited effect on intraocular dissemination, other treatment modalities are needed for the maintenance of visual acuity, and prevention of further deterioration of the quality of life. The study was made to evaluate the efficacy of external beam radiotherapy (EBRT) with lens-sparing techniques in the management of patients developing intraocular metastases (IOM). Between March 1994 and March 2002, 24 eyes of 17 patients with tumors metastatic to the eye were treated by EBRT. The female:male ratio was 8.5:1, age ranged between 37 and 74 years (mean: 56 years). The site of the primary tumor was: breast (11), lung (4) and others (2). The visual acuity at the beginning of irradiation was between 0.1-0.7 (mean 0.5) and a mean KPS of 60% was detected. The mean time elapsed from the diagnosis of primary tumor and recognition of metastasis was 38.9 months in case of breast, and 6.7 months in lung cancer. Eyes were treated by 6 MV photon beams, using a modified technique of Schipper's lens-sparing retinoblastoma treatment method. The following parameters were studied: visual acuity changes, local response rate, survival times from irradiation and ocular complications. Mean follow-up time was 24 months. Mean visual acuity improved two lines on the Snellen chart. The mean survival time after treatment of IOM was 21 months in breast and 4.9 months in lung cancer patients. Local response rate was 78%. No radiation cataract was observed. Only one patient developed radiation retinopathy 32 months after the treatment. External beam radiotherapy is recommended for the treatment of intraocular metastases to improve quality of life. In selected cases--especially breast cancer patients--lens-sparing technique is the treatment of choice.

[Clinical outcome of stereotaxic radiosurgery of the brain]

Authors render an account of their four years clinical experiences with linac-based stereotaxic radiosurgery. The first Hungarian stereotaxic radiosurgery team have treated 166 patients between 01. 07. 1991 and 01. 11. 1995: 86 suffered from brain metastases, 13 of them had primary brain tumors 35, benign brain lesions and 32 arteriovenous malformations. The local control rate was found similar to presented in the literature (83, 77, 57 and 82%). During 9 months of median follow up 44% of brain metastatic cases are alive and only 12% died because of cerebral propagation. The primary brain tumors were mostly recurrences (77%) after surgery and/or conventional radiotherapy, 31% died in 11 months of median follow up. Treating benignomas and arteriovenous malformations there was no need for craniotomy at 68 patients. No fatal complications were observed, the rare side-effects seemed to be manageable. The method is an effective possibility for the non-invasive treatment of the above mentioned brain lesions.

[Heart disease caused by radiation]

The clinical forms of radiation-induced heart disease, its incidence and significance are reviewed from a practical point of view. Pathological and technical basis as well as prevention are also discussed.