[en] Purpose: Metastatic deposits are the most common intraocular malignancies, and their incidence may be as high as 4-12% in patients with solid tumors. We evaluated the efficacy of external beam radiotherapy (EBRT) in the palliation of posterior uveal metastases in terms of functional vision, tumor response, and globe preservation. Pre-radiotherapy tumor and patient characteristics which correlate best with vision restoration and preservation were identified. Patients and Methods: 483 consecutive patients (pts) (578 eyes) were diagnosed with intraocular metastatic disease between 1972-1995. Of these, 233 eyes (188 pts) had lesions of the posterior uveal tract and received EBRT. Pts with metastatic deposits from solid tumors were selected for analysis. Best corrected visual acuity (VA) was documented pre- and post-EBRT in 155 eyes. Visual function was 'excellent' if VA≤ (20(50)); 'navigational' if (20(60))-(20(200)); and 'legally blind' if ≥ (20(400)). Most patients received 30.0-40.0 Gy in 2.0-3.0 Gy fractions to the posterior or entire globe. Median follow up time was 5.8 mo (0.7-170.0) from the start of EBRT. Results: 57% ((89(155))) of all evaluable eyes had improved visual function or maintained at least navigational vision following EBRT. Specifically, 43% maintained ((46(69))) or achieved ((21(86))) excellent vision, and 26% maintained ((15(39))) or achieved ((7(47))) navigational vision. 36% of blind eyes regained useful vision. 93% ((217(233))) experienced no clinical evidence of tumor progression and globe preservation rate was 98%. The following characteristics were predictive of improvement to or maintenance of excellent vision on univariate analysis: excellent vision (vs navigational or legally blind) prior to EBRT (p 0.001), age < 55 yrs (p = 0.004), Caucasian race (vs African-American/Hispanic) (p 0.003), duration of symptoms < 3.25 mo. (p 0.03), bilateral metastases (vs unilateral) (p = 0.02), tumor base diameter < 15 mm (p < 0.001), and tumor thickness < 6 mm (p = 0.01). Multivariate analysis is shown: Conclusions: EBRT effectively restores and preserves useful vision in most patients with choroid metastases from all solid tumors, with a globe preservation rate of 98%. Patients < 55 years with pre-treatment visual acuity better than (20(60)) and tumor diameter < 15 mm benefit most significantly

[en] Purpose: To improve overall quality of life, palliative treatments should attempt to minimize associated complications while effectively controlling specific symptoms. We reviewed our experience treating posterior uveal metastases with external beam radiotherapy (EBRT) to determine the complication rate and to identify the relationship between patient, tumor, or treatment-related factors and the development of ocular complications. Methods and Materials: 483 consecutive patients (pts) (578 eyes) were diagnosed with intraocular metastatic disease from solid tumors between 1972-1995. Of these, 233 eyes (188 pts) had lesions of the posterior uveal tract and received EBRT. Median follow-up time was 5.8 months (range: 0.7-170.0 months). Follow-up information regarding the development of complications was documented for 230 eyes. Complete EBRT details were available for 189 eyes. Seventy-two percent of the patients received 30.0-40.0 Gy in 2.0-3.0 Gy fractions. Biologically effective dose (BED) was calculated to allow meaningful comparisons between various fractionation regimens and total doses. Concurrent chemotherapy and/or hormonal therapy was used for 101 eyes (44%). Results: Median BED was 61 Gy₃ (range, 6.7-105 Gy₃), and 80% of treated eyes received BED 50-70 Gy₃. EBRT energies included photons (70%), ⁶⁰Co (19%), electrons (6%), mixed energies (3%), and orthovoltage (2%). Lens-sparing techniques were used in 136 eyes (71%). At last follow-up 28 eyes (12%) developed one or more significant complications, including cataracts (16 eyes), radiation retinopathy (6 eyes), optic neuropathy (5 eyes), exposure keratopathy (5 eyes), and neovascularization of the iris (4 eyes). Two eyes developed narrow-angle glaucoma, and one of these required enucleation. On univariate analysis, Caucasian race (vs. Black/Hispanic, p = 0.03), increased intraocular pressure at diagnosis (>21 mmHg, p = 0.02), and diagnosis by biopsy (vs. no biopsy, p = 0.03) predisposed toward the development of complications. Factors not correlated with complications included BED (p = 0.18), energy type (p 0.81), lens-sparing technique (versus whole globe, p = 0.57), and concurrent systemic treatment (p = 0.60). The small number of complications did not support a multivariate analysis. Conclusions: Despite the employment of a variety of EBRT treatment techniques and the proximity of choroidal metastases to radiosensitive structures, significant complications of palliative EBRT were infrequent. Although complications do occur, they are related to host factors and do not appear to be a function of irradiation parameters. We conclude that the potential benefits of vision and globe preservation after palliative EBRT outweigh the small risk of treatment induced complications

[en] ARMD is the leading cause of visual loss in the 55 and older population. Recent data suggests that low dose external beam irradiation seems to have a beneficial effect in stabilizing the central visual acuity, by arresting or delaying the progression of the central scotoma. The authors decided to use a newly designed Strontium-90 Macular Applicator in a pilot study to ascertain its effectiveness in controlling exudative, age related macular degeneration. Two groups of 10 patients each were treated. The first group received a total dose of 10 Gy at 1.5 mm depth in a total time of 4 minutes and 20 seconds, fractionated in 4 applications of 1 minute and 5 seconds with 1 minute rest in between to allow blood perfusion. The second group was treated with 15 Gy at the same depth of 1.5 mm in a total time of 6 minutes, in 5 fractions of 1 minute and 20 seconds and 1 minute rest. The first group of patients had a mean follow-up time of 6.7 months, the visual acuity improved at least two Snellen gradations in one eye (10%), stabilized in six eyes (60%) and worsened in three eyes (30%). Among the nine eyes with fluorescein angiographic documentation at four and six months post treatment, the choroidal neovascular membrane remained stable in eight eyes (85%). Strontium-90 brachytherapy appears to be an effective treatment for stabilizing the extent of choroidal neovascular membrane growth on a short term basis. Whether this therapy stabilizes or improves visual acuity, as compared to the natural history of the untreated disease, remains uncertain. The second group will complete six months follow-up soon and the results will be discussed at the time of this presentation

[en] Purpose: To analyze treatment results and patterns of failure following external beam radiation for retinoblastoma and propose treatment guidelines according to specific clinical variables. Methods and Materials: We analyzed 27 patients (34 eyes) with retinoblastoma who received external beam radiation as initial treatment at Hahnemann University Hospital from October 1980 to December 1991 and have been followed for at least 1 year. Of the 34 eyes, 14 were Groups I-II (Reese-Ellsworth classification), 7 were Group III, and 13 were Groups IV-V. Doses ranged from 34.5-49.5 Gy (mean 44.3 Gy, median 45 Gy) in 1.5-2.0 Gy fractions generally delivered through anterior and lateral wedged pair fields. Results: At a mean follow up of 35.2 months (range 12-93 months), local tumor control was obtained in 44% (15 out of 34) of eyes with external beam radiation alone. Salvage therapy (plaque brachytherapy, cryotherapy, and/or photocoagulation) controlled an additional 10 eyes (29.5%), so that overall ocular survival has been 73.5%. Local tumor control with external beam radiotherapy alone was obtained in 78.5% (11 out of 14) of eyes in Groups I-II, but in only 20% (4 out of 20) of eyes in Groups III-V. A total of 67 existing tumors were identified prior to treatment in the 34 treated eyes and local control with external beam radiation alone was obtained in 87% (46 out of 53) of tumors measuring 15 mm or less and in 50% (7 out of 14) of tumors measuring more than 15 mm. When analyzing patterns of failure in the 19 eyes that relapsed, a total of 28 failure sites were identified and consisted of progression of vitreous seeds in seven instances (25% of failure sites) recurrences from previously existing tumors in 10 instances (36% of failure sites) and development of new tumors in previously uninvolved retina in 11 instances (39% of failure sites). Conclusions: 1) We find that external beam radiation to a dose of 45 Gy in fractions of 1.5 to 2.0 Gy provides adequate tumor control in retinoblastoma eyes Groups I-II (Reese-Ellsworth classification) or tumors measuring 15 mm in diameter or less. Eyes in more advanced group staging or containing tumors larger than 15 mm seem to require higher radiation doses. We propose treatment guidelines for external beam radiation of retinoblastoma that specifically take into account the important clinical variables of tumor stage and patient age. 2) External beam radiation does not prevent the appearance of new tumors in clinically uninvolved retina. Therefore, the traditional belief that external beam radiation can treat the retina 'prophylactically' should be seriously questioned. Due to this finding and their significant less morbidity, focal treatment modalities (plaque brachytherapy, photocoagulation and/or cryotherapy), when clinically feasible, should be considered the treatment of choice for intraocular retinoblastoma. External beam radiation should be considered only when focal treatment modalities are not clinically indicated.