Clinical Outcomes of Hypofractionated Radiotherapy for Choroidal Metastases: Symptom Palliation, Tumor Control and Survival

Publication date: Available online 29 June 2017
Source:Practical Radiation Oncology
Author(s): Ezra Hahn, Normand Laperriere, Hatem Krema, Juan P. Velazquez-Martin, Sohel Somani, John Waldron, Rand Simpson, David Payne, Caroline Chung
PurposeExternal beam radiotherapy (RT) is an effective palliative treatment for choroidal metastases aimed at preserving vision and obtaining local tumor control. Delivery of 30–40Gy in 2Gy daily fractions is a standard approach in many centers. This study reports the outcomes of a hypofractionated schedule of 20Gy in 5 fractions in this palliative setting.MethodsWe conducted a retrospective review of patients treated with RT (20Gy in 5 fractions) for choroidal metastases between January 1999 and November 2012. Primary outcome measures were change in visual acuity and tumor response. Secondary outcomes included toxicities of RT, tumor control, and overall survival (OS) from diagnosis of choroidal metastases. Univariate and multivariable cox regression modeling was used to investigate predictors for OS.ResultsFifty-five patients with 71 involved eyes were included. Decreased vision was the presenting symptom in 43 eyes (61%). Visual acuity improved from a median of 20/70 at baseline to 20/40 at last follow-up, and remained stable or improved in 56 eyes (80%). Tumor regression was observed in 64 eyes (91%) with complete response in 47 eyes (67%). Local progression occurred in 4 eyes (6%). Median survival after diagnosis of choroidal metastases was 13months. No acute complications were observed in 49 patients (89%). Mild acute toxicities included transitory dryness in 5 patients and episcleritis in 1 patient. Cataracts, retinopathy, optic neuropathy, pigmentary maculopathy, and neovascular glaucoma developed in 4 (6%), 1, 7 (10%), 5 (7%), and 1 eyes, respectively. No variables were statistically significantly associated with OS.ConclusionsA short fractionation schedule of 20Gy in 5 fractions is a well-tolerated treatment that effectively preserves vision and gains local tumor control for many patients with choroidal metastases. This hypofractionated approach would help reduce the burden of a longer treatment course in this palliative patient population.



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