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The effect of intravitreal bevacizumab and transpupillary thermotherapy on choroidal metastases and literature review.

Lin CJ, Tsai YY - Indian J Ophthalmol (2015)

Bottom Line: TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients.The antineoplastic properties of bevacizumab make it a viable adjunctive therapy.Studies with more cases and a longer follow-up period are warranted.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, China Medical University Hospital; Department of Ophthalmology, School of Medicine, China Medical University, Taichung; Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan.

ABSTRACT

Aims: To represent the effects of transpupillary thermotherapy (TTT) and intravitreal bevacizumab on choroidal metastases and review the literature.

Settings and design: A retrospective, interventional, noncomparative case series.

Materials and methods: A retrospective, interventional, noncomparative case series of five eyes in three patients with choroidal metastases was conducted. Fundus findings of choroidal metastases were divided into two types: Solitary or diffuse type. The size of the tumor was termed small (<10 mm diameter), medium (10-15 mm diameter) or large (>15 mm diameter). All eyes received one session of TTT followed by 3 weekly intravitreal bevacizumab injections as an adjuvant therapy. The parameters of treatment for TTT were 1.2-3 mm spot size, 150-300 mW, 60 s with the whole lesion covered confluently. The changes in preoperative and postoperative best-corrected visual acuity (BCVA) were recorded. Serial color fundus photography and optical coherent tomography were performed to measure the treatment efficacy.

Results: All eight choroidal metastases were solitary type. The size of six tumors was small, the size of one tumor was medium, and the size of one tumor was large. All five eyes of the three patients had improvement of BCVA after treatment. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71%. Optical coherence tomography revealed complete resolution of serous retinal detachment. There was no recurrence after 6 months follow-up.

Conclusions: TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients. Despite the retrospective nature of our study, the absence of control group and the size limitation that, of course, limit the statistical power, TTT combined with intravitreal bevacizumab seems to be efficient in providing another cost-reducing and time-saving treatment option for patients with choroidal metastases. The antineoplastic properties of bevacizumab make it a viable adjunctive therapy. Studies with more cases and a longer follow-up period are warranted.

No MeSH data available.


Related in: MedlinePlus

1(a) A mass (tumor I) OD; 1(b) The mass subsided. 2(a) One large mass over nasal quadrant (tumor II) and one small mass (tumor III) above the temporal-superior arch OS; 2(b) The masses subsided. 3(a) One tumor in the temporal quadrant (tumor IV) and the other with exudative RD (tumor V) in the upper posterior pole extending beneath the macula OD; (b) The tumors shrank. 4(a) Two masses in the nasal (tumor VI) and inferior (tumor VII) quadrants OS; 4(b) The tumors shrank. 5(a) A mass with exudative RD (tumor VIII) in the superior-temporal quadrant involving macula OS; 5(b) The mass shrank
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Figure 1: 1(a) A mass (tumor I) OD; 1(b) The mass subsided. 2(a) One large mass over nasal quadrant (tumor II) and one small mass (tumor III) above the temporal-superior arch OS; 2(b) The masses subsided. 3(a) One tumor in the temporal quadrant (tumor IV) and the other with exudative RD (tumor V) in the upper posterior pole extending beneath the macula OD; (b) The tumors shrank. 4(a) Two masses in the nasal (tumor VI) and inferior (tumor VII) quadrants OS; 4(b) The tumors shrank. 5(a) A mass with exudative RD (tumor VIII) in the superior-temporal quadrant involving macula OS; 5(b) The mass shrank

Mentions: From 2011 through 2012, five eyes of three patients (two males and one female) were recorded with the diagnosis of choroidal metastases. The mean age at the time of diagnosis was 40.33 years (range 34–47 years). The primary sites of carcinomas were breasts and lungs. All the patients were on concurrent systemic chemotherapy. In Case 2, choroidal metastases were found during the course of systemic chemotherapy. In Case 1 and 3, choroidal metastases were noted before the diagnosis and staging of the primary malignancy. TTT and the initial intravitreal bevacizumab injection were performed before the systemic chemotherapy. All eight choroidal metastases were solitary type [Fig. 1]. The size of 6 tumors (tumor I, III, IV, V, VI, VII) was small, the size of one tumor (tumor II) was medium, and the size of one tumor (tumor VIII) was large. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71% [Table 1]. OCT revealed complete resolution of serous retinal detachment. No ocular or systemic complications were observed at the end of follow-up.


The effect of intravitreal bevacizumab and transpupillary thermotherapy on choroidal metastases and literature review.

Lin CJ, Tsai YY - Indian J Ophthalmol (2015)

1(a) A mass (tumor I) OD; 1(b) The mass subsided. 2(a) One large mass over nasal quadrant (tumor II) and one small mass (tumor III) above the temporal-superior arch OS; 2(b) The masses subsided. 3(a) One tumor in the temporal quadrant (tumor IV) and the other with exudative RD (tumor V) in the upper posterior pole extending beneath the macula OD; (b) The tumors shrank. 4(a) Two masses in the nasal (tumor VI) and inferior (tumor VII) quadrants OS; 4(b) The tumors shrank. 5(a) A mass with exudative RD (tumor VIII) in the superior-temporal quadrant involving macula OS; 5(b) The mass shrank
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4363956&req=5

Figure 1: 1(a) A mass (tumor I) OD; 1(b) The mass subsided. 2(a) One large mass over nasal quadrant (tumor II) and one small mass (tumor III) above the temporal-superior arch OS; 2(b) The masses subsided. 3(a) One tumor in the temporal quadrant (tumor IV) and the other with exudative RD (tumor V) in the upper posterior pole extending beneath the macula OD; (b) The tumors shrank. 4(a) Two masses in the nasal (tumor VI) and inferior (tumor VII) quadrants OS; 4(b) The tumors shrank. 5(a) A mass with exudative RD (tumor VIII) in the superior-temporal quadrant involving macula OS; 5(b) The mass shrank
Mentions: From 2011 through 2012, five eyes of three patients (two males and one female) were recorded with the diagnosis of choroidal metastases. The mean age at the time of diagnosis was 40.33 years (range 34–47 years). The primary sites of carcinomas were breasts and lungs. All the patients were on concurrent systemic chemotherapy. In Case 2, choroidal metastases were found during the course of systemic chemotherapy. In Case 1 and 3, choroidal metastases were noted before the diagnosis and staging of the primary malignancy. TTT and the initial intravitreal bevacizumab injection were performed before the systemic chemotherapy. All eight choroidal metastases were solitary type [Fig. 1]. The size of 6 tumors (tumor I, III, IV, V, VI, VII) was small, the size of one tumor (tumor II) was medium, and the size of one tumor (tumor VIII) was large. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71% [Table 1]. OCT revealed complete resolution of serous retinal detachment. No ocular or systemic complications were observed at the end of follow-up.

Bottom Line: TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients.The antineoplastic properties of bevacizumab make it a viable adjunctive therapy.Studies with more cases and a longer follow-up period are warranted.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, China Medical University Hospital; Department of Ophthalmology, School of Medicine, China Medical University, Taichung; Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan.

ABSTRACT

Aims: To represent the effects of transpupillary thermotherapy (TTT) and intravitreal bevacizumab on choroidal metastases and review the literature.

Settings and design: A retrospective, interventional, noncomparative case series.

Materials and methods: A retrospective, interventional, noncomparative case series of five eyes in three patients with choroidal metastases was conducted. Fundus findings of choroidal metastases were divided into two types: Solitary or diffuse type. The size of the tumor was termed small (<10 mm diameter), medium (10-15 mm diameter) or large (>15 mm diameter). All eyes received one session of TTT followed by 3 weekly intravitreal bevacizumab injections as an adjuvant therapy. The parameters of treatment for TTT were 1.2-3 mm spot size, 150-300 mW, 60 s with the whole lesion covered confluently. The changes in preoperative and postoperative best-corrected visual acuity (BCVA) were recorded. Serial color fundus photography and optical coherent tomography were performed to measure the treatment efficacy.

Results: All eight choroidal metastases were solitary type. The size of six tumors was small, the size of one tumor was medium, and the size of one tumor was large. All five eyes of the three patients had improvement of BCVA after treatment. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71%. Optical coherence tomography revealed complete resolution of serous retinal detachment. There was no recurrence after 6 months follow-up.

Conclusions: TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients. Despite the retrospective nature of our study, the absence of control group and the size limitation that, of course, limit the statistical power, TTT combined with intravitreal bevacizumab seems to be efficient in providing another cost-reducing and time-saving treatment option for patients with choroidal metastases. The antineoplastic properties of bevacizumab make it a viable adjunctive therapy. Studies with more cases and a longer follow-up period are warranted.

No MeSH data available.


Related in: MedlinePlus