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Management of metastatic carcinoma of the uveal tract: an evidence-based analysis.
- Source :
-
Clinical & experimental ophthalmology [Clin Exp Ophthalmol] 2007 Aug; Vol. 35 (6), pp. 553-65. - Publication Year :
- 2007
-
Abstract
- Uveal metastasis from carcinoma is the most common cause of ocular malignancy in adults and represents an increasing problem in the context of an ageing population and enhanced survival of stage IV cancer patients. The reported prevalence of clinically evident uveal metastases in carcinoma patients ranges from 2% to 9%, with breast and lung cancer together accounting for between 71% and 92% of cases. Most patients (66-97%) have a known history of cancer and, although the majority have metastatic lesions elsewhere, up to 33% may present with an isolated ocular metastasis. These lesions may progress rapidly and are potentially sight-threatening. Early diagnosis and appropriate timely treatment are therefore of paramount importance to maintain patients' quality of life. The diagnosis is usually clinical and detailed descriptions of symptomatology and physical characteristics are provided. In 21-50% of patients, involvement is bilateral. External beam radiotherapy (EBRT), chemotherapy, hormone and biological therapies, brachytherapy, transpupillary thermotherapy, laser photocoagulation/photodynamic therapy and enucleation are therapeutic modalities described in the literature for the management of uveal metastases. The strongest evidence favours timely EBRT for the management of sight-threatening uveal metastases. The published evidence supporting EBRT for sight-threatening uveal metastases was given a grade B (strong support for recommendation). Newer alternative therapies are emerging and may have a role in selected patients; however, there are unfortunately few large studies examining such treatments for carcinoma metastatic to the eye. The role of these modalities will be further clarified with the results of larger comparative trials.
- Subjects :
- Adult
Aged
Aged, 80 and over
Antineoplastic Agents therapeutic use
Brachytherapy
Breast Neoplasms pathology
Carcinoma secondary
Eye Enucleation
Female
Humans
Hyperthermia, Induced
Laser Coagulation
Lung Neoplasms pathology
Male
Middle Aged
Photochemotherapy
Practice Guidelines as Topic
Radiotherapy, High-Energy
Uveal Neoplasms secondary
Breast Neoplasms therapy
Carcinoma therapy
Evidence-Based Medicine methods
Lung Neoplasms therapy
Uveal Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1442-6404
- Volume :
- 35
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Clinical & experimental ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 17760639
- Full Text :
- https://doi.org/10.1111/j.1442-9071.2007.01550.x