For patients with small to medium-size choroidal metastatic tumors, photodynamic therapy (PDT) may be an effective treatment option, a study in Ophthalmology Retina suggests. A team of researchers from Wills Eye Hospital found 78% of patients in their study achieved tumor control following treatment with photodynamic therapy using verteporfin alone, and 66% of eyes had visual acuity of between 20/20 and 20/40.

The investigation included 58 choroidal metastatic tumors that were treated with standard-fluence PDT using verteporfin.

Patients in the study were approximately 61 years old. The originating cancer varied, with 39% beginning in the lung, 37% in the breast, 8% in the kidneys, 6% in the thyroid and 10% in other sites.

Ocular symptoms included decreased visual acuity (53%), visual field defect (5%), floaters (16%) and flashes (7%), while 19% were asymptomatic. The average visual acuity at baseline was 20/40. The median tumor diameter was 5mm, and median thickness by ultrasonography was 2mm. The median distance to the optic disc was 3mm and 2mm to the foveola.

Of the 43 patients, 35 received follow up (40 eyes, 45 tumors). PDT achieved tumor control with one session in 71% and two sessions in another 7%. However, 22% failed to achieve regression and were further managed with other radiotherapy, chemotherapy or observation (patient preference).

A comparison of clinical features for tumor control (PDT alone vs. PDT plus additional therapy) revealed those controlled with photodynamic therapy alone were more likely adenocarcinoma (73% vs. 30%) and were more likely to achieve final visual acuity of 20/20-20/40 (66% vs. 30%,) with better median acuity (20/30 vs. 20/70, which researchers noted was not significant). Neither the primary cancer site nor the ocular tumor features—size, location, color, shape or related subretinal fluid—impacted tumor control, the study noted.

In the entire group of 40 eyes, visual acuity improved or remained stable in 70% and decreased in 30% related to subfoveal scar, persistent subretinal fluid, reactive exudation, radiation maculopathy and brain metastasis. 

Shields CL, Khoo CTL, Mazloumi M, et al. Photodynamic therapy for choroidal metastasis: Tumor control and visual outcome in 58 cases The 2019 Burnier International Ocular Pathology Society (BIOPSY) Lecture. Ophthalmol Retina. October 28, 2019. [Epub ahead of print].