Uveal metastasis from breast cancer in 264 patients

doi:10.1016/S0002-9394(03)00192-2

American Journal of Ophthalmology

Volume 136, Issue 2, August 2003, Pages 264-271

Presented, in part, at the annual meeting of the American Academy of Ophthalmology, Orlando, Florida, October 2002.

https://doi.org/10.1016/S0002-9394(03)00192-2 Get rights and content

Abstract

Purpose

Breast cancer is an increasingly important health problem in women and is the most common tumor to metastasize to the uvea. This study was designed to evaluate the clinical features, management, and prognosis of patients with uveal metastasis from breast cancer.

Design

Retrospective interventional case series.

Methods

We retrospectively reviewed 264 consecutive patients with uveal metastasis from breast cancer. We assessed the clinical features of the patient and tumor at the time of presentation, management, and prognosis. Kaplan-Meier survival estimates were used to analyze the probability of death as a function of time.

Results

Uveal metastasis was the initial manifestation of breast cancer in seven patients (3%) and the first systemic metastatic site of previously diagnosed breast cancer in 43 (16%). Associated with uveal metastasis, optic disk metastasis was found in 13 patients (5%), eyelid metastasis in one patient (1%), and conjunctival and orbital in one patient (<1%). Of 264 patients with uveal metastasis, 225 (85%) had choroidal metastasis, eight (3%) iris metastasis, two (<1%) ciliary body metastasis, and 29 (11%) had metastasis in multiple uveal sites. In the 264 patients with uveal metastasis, the most common symptom was blurred vision in 197 patients (88%), floaters in 15 (5%), photopsia in 12 (5%), and 19 (7%) were asymptomatic. The uveal metastases were bilateral in 99 patients (38%) and unilateral in 165 (62%). In 55 (56%) of the 99 bilateral cases, a uveal metastasis was found in the asymptomatic fellow eye during follow-up examination. External beam radiotherapy was used in 137 patients with uveal metastasis (52%), providing tumor control in 116 patients (85%) at a mean follow-up of 21 months. Using Kaplan-Meier estimates, survival rates of all patients with uveal metastasis from breast cancer was 65% at 1-year, 34% at 3-year, and 24% at 5-year follow-up.

Conclusions

Patients with uveal metastasis from breast cancer presented to ophthalmologists with visual symptoms in 93% of cases. However, asymptomatic metastases were commonly detected in the fellow eye. Local ocular tumor control was excellent with current therapies. However, systemic prognosis for all patients, including those who had been treated with different management options, was poor with survival rates of 65% at 1-year and 24% at 5-year follow-up.

Section snippets

Methods

The medical records of all patients with the diagnosis of uveal metastatic tumor evaluated on the Ocular Oncology Service at Wills Eye Hospital, Philadelphia, Pennslyvania, between January 1974 and September 2001 were identified. Those patients in whom the primary cancer was proven to be of breast origin were selected for further analysis and included in this study. The criteria for the clinical diagnosis of metastasis have been published.1, 14 The diagnosis was made with clinical findings and

Results

The mean age at the initial diagnosis of primary breast cancer was 56 years (median, 57 years; range, 23–84 years). There were 261 (99%) females and 3 (1%) males. Of 264 patients, 242 (92%) were Caucasian, 19 (7%) African American, 2 (<1%) Asian, and 1 (<1%) Hispanic. The affected breast was right in 132 patients (50%), left in 119 patients (45%), and both in 13 patients (5%). The initial treatment of breast cancer was radical or modified mastectomy in 218 patients (83%), systemic chemotherapy

Discussion

Breast cancer is the most common cancer in women and second leading cause of cancer death among women in developed countries.8, 15 The age-adjusted incidence of breast cancer has increased by 35% during the 1980s, rising from a rate of 85/100,000 women in 1980 to a rate of 121/100,000 in 1998.16 In the United States, a woman’s lifetime risk of developing breast cancer has also increased dramatically from one of 14 women in the 1970s to one of every eight women in the 2001.17 According to

References (27)

C.L. Shields et al.
Survey of 520 eyes with uveal metastases
Ophthalmology
(1997)
R.F. Stephens et al.
Diagnosis and management of cancer metastatic to the uveaA study of 70 cases
Ophthalmology
(1979)
J.A. Shields et al.
Metastatic tumors to the iris in 40 patients
Am J Ophthalmol
(1995)
D.M. Albert et al.
Tumor metastases to the eye. Part I. Incidence in 213 patients with generalized malignancy
Am J Ophthalmol
(1967)
P.M. Lantz et al.
The social construction of the breast cancer epidemic
Soc Sci Med
(1998)
L. Mewis et al.
Breast carcinoma metastatic to the eyeAnalysis of 67 patients
Ophthalmology
(1982)
C.C. Nelson et al.
A histopathologic study of 716 unselected eyes in patients with cancer at the time of death
Am J Ophthalmol
(1983)
R.J. Black et al.
Cancer incidence and mortality in the European UnionCancer registry data and estimates of national incidence for 1990
Eur J Cancer
(1997)
N. Thatcher et al.
Choroidal metastases from breast carcinomaA survey of 42 patients and use of radiation therapy
Clin Radiol
(1975)
V. Ratanatharathorn et al.
Eye metastasis from carcinoma of the breastDiagnosis, radiation treatment and results
Cancer Treatment Rev
(1991)

F.C.H. Chu et al.

Radiation therapy of choroid metastasis from breast cancer

Int J Radiat Oncol Biol Phys

(1977)

S.B. Rudoler et al.

External beam irradiation for choroidal metastasesIdentification of factors predisposing to long-term sequelae

Int J Radiat Oncol Biol Phys

(1997)

A.D. Letson et al.

Chemotherapy for treatment of choroidal metastases from breast carcinoma

Am J Ophthalmol

(1982)

Cited by (192)

Malignancies with a tendency to metastasize to the eyelid or ocular structures
2024, Clinics in Dermatology
Metastatic tumors to the eye and eyelid are generally seen in patients with disseminated metastases in the setting of advanced disease. Occasionally, they can present as the first sign of occult malignancy. The choroid is the most common site of intraocular metastases secondary to its dense vascular supply. Similar to the eye, metastatic tumors to the eyelid can present with a variety of clinical findings and are most often seen in patients with a known history of cancer. The most common skin malignancy that can spread to ocular structures is cutaneous melanoma, whereas the most common noncutaneous malignancy is breast cancer followed by lung cancer. In pediatric patients, metastatic disease to the eye is rare and can be seen in neuroblastoma and Ewing sarcoma. The overall prognosis of metastatic lesions involving the eye and eyelid is typically poor, with a mean survival of months. Ophthalmologists play an important role in the diagnosis of metastatic disease of the eye and eyelid; therefore, it is imperative for patients to undergo a complete ophthalmic examination and systemic workup if they have new-onset vision changes and a known history of cancer. Early diagnosis and management with systemic and local therapies can maximize quality of life and preserve vision.
Neurological complications of breast cancer
2022, Neurological Complications of Systemic Cancer and Antineoplastic Therapy
Breast cancer is the second most common malignancy in the world, the most common malignancy in women, and an important cause of global cancer-related morbidity and mortality. Nearly one in eight women living in the United States will be diagnosed with breast cancer in their lifetime. Neurological complications are quite common in this population and can arise from the cancer itself or the various treatment modalities, i.e., surgery, radiation, or chemotherapy. Ironically, with the continued refinement of anticancer therapies and consequently improved survival afforded patients, the incidence of central nervous system (CNS) metastasis has increased, likely reflecting the sanctuary site that the central nervous system provides cancer cells. CNS metastases typically occur in patients with disseminated systemic malignancy, but the CNS may also be the first or isolated site of relapse after systemic disease control is achieved. Metastases in the central and peripheral nervous systems usually carry a poor prognosis, but when breast cancer is the primary cancer, treatment is more likely to afford local control.
Clinical Spectrum of Uveal Metastasis in Korean Patients Based on Primary Tumor Origin
2021, Ophthalmology Retina
To describe the clinical features and prognosis of patients with uveal metastasis in Korea.
Retrospective, observational case series.
Patients diagnosed at 2 tertiary high-volume centers between November 2005 and November 2019.
Evaluation of multimodal imaging and electronic medical records.
The clinical features and outcomes were assessed based on the primary cancer site.
A total of 134 uveal metastases (128 choroidal, 3 iris, and 3 ciliary body tumors) were diagnosed in 95 eyes of 80 patients. Mean age at diagnosis was 56 years (median, 55 years; range, 24–86 years), with a minor preponderance of women (61%). Tumors were bilateral in 15 patients (19%) and the primary origin was established in 49 patients (61%) before ocular detection. The primary tumor originated in the lung (48%), breast (24%), gastrointestinal tract (10%), liver (3%), pancreas (3%), kidney (1%), cervix (1%), and nasopharynx (1%), with some remaining unknown (10%). The overall 5-year survival rate was 21%. Kaplan-Meier analysis revealed that the worst survival was found in pancreatic cancers (mean survival, 5.9 months; P = 0.045), and the best survival was found in gastrointestinal tract cancers (mean survival, 44.5 months).
The primary tumor origins in Korean patients with uveal metastases differed from those reported in primarily population-based studies of White patients, with a higher prevalence of lung and gastrointestinal tract cancers.
Diagnostic and Therapeutic Management of Primary Orbital Neuroendocrine Tumors (NETs): Systematic Literature Review and Clinical Case Presentation
2024, Biomedicines
Posterior segment manifestations of ocular metastasis
2023, Current Opinion in Ophthalmology
Choroidal metastasis in breast cancer
2023, Surgical Practice

View all citing articles on Scopus

^☆: InternetAdvance publication at ajo.com Feb 6, 2003.

View full text

Uveal metastasis from breast cancer in 264 patients☆

Abstract

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Soc Sci Med

Ophthalmology

Am J Ophthalmol

Eur J Cancer

Clin Radiol

Cancer Treatment Rev

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Am J Ophthalmol