• Ocular Pathology/Oncology

    The authors assessed outcomes of ocular stereotactic radiosurgery (SRS) in 3 patients with uveal metastases and found that this underutilized technique offers good tumor control and visual improvement with minimal side effects.

    Gamma Knife SRS is a nonsurgical radiation therapy that delivers targeted radiation in a few high-dose treatments, helping to preserve healthy tissue. Although a proven minimally invasive technique for intracranial metastases, it has received little attention in the literature for the management of uveal metastasis.

    The success of SRS in this small case series suggests it is a promising treatment option for the management of patients with uveal metastasis. The technology also offers patients a treatment early after diagnosis in an outpatient setting, using a multidisciplinary approach without interruption of systemic oncologic care.

    All 3 patients in this case study underwent a retrobulbar anesthetic block for globe immobilization followed by MRI to detect the target. Tumors were treated in a single outpatient session using the Perfexion Gamma Knife or 4C, with each patient receiving a tumor dose of 14, 16, or 20 Gy for metastatic neuroendocrine lung carcinoma, melanoma, or papillary thyroid cancer respectively. Additional SRS was used to treat intracranial metastases in 2 patients.

    At follow-up performed between 4 and 15 months, all 3 patients demonstrated a reduction in uveal tumor volume.

    One patient developed decreased visual acuity secondary to exudative retinal detachment caused by the tumor’s response to radiation. Follow-up time was short (4, 5, and 15 months), and was likely inadequate to assess the presence of radiation retinopathy.

    Unfortunately, given the nature of the systemic implications in patients with uveal metastasis, it may be difficult to have longer follow-up periods since patients may succumb to the underlying disease within months.

    Key take-home points

    • Stereotactic radiosurgery was effective in treating 3 patients with uveal metastases
    • SRS offers good tumor control and visual improvement with minimal side effects