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Case Report
Primary treatment of malignant retinal detachment caused by choroidal breast cancer metastasis using only systemic chemotherapy and anti-HER-2 therapy
1 Specialist Registrar in Medical Oncology, Tayside Cancer Centre, Ward 32, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK
2 Associate Specialist, Department of Ophthalmology, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK
3 Honorary Senior Lecturer, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK
Address correspondence to:
Douglas James Alexander Adamson
Honorary Senior Lecturer, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, Scotland,
UK
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Article ID: 100119Z10HS2023
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Shareef HEJ, Sharpe G, Adamson DJA. Primary treatment of malignant retinal detachment caused by choroidal breast cancer metastasis using only systemic chemotherapy and anti-HER-2 therapy. J Case Rep Images Oncology 2023;9(1):12–16.ABSTRACT
Introduction: Choroidal metastasis is a disabling complication of several types of common cancer, including breast cancer. Metastases to the choroid may present insidiously but ultimately cause significant visual disturbance and more rarely may result in retinal detachment, causing sudden and profound visual impairment. The usual treatment of choice for choroidal metastases is palliative radiotherapy. External beam radiotherapy to the posterior orbit is often effective in stabilizing and improving the symptoms but it can usually be given only once and carries the risk of cataract induction as a side effect.
Case Report: Here we report using only systemic therapy [chemotherapy and initial dual anti-human epidermal growth factor receptor-2 (HER-2) therapy] to treat a 69-year-old female presenting with newly diagnosed widespread secondary breast cancer, a major symptom of which was visual disturbance related to exudative retinal detachment caused by choroidal metastases. The systemic therapy treated the choroidal metastases effectively and allowed the retinal detachment to improve quickly, and the positive effect of the systemic anti-cancer therapy could be observed directly by serial ophthalmological examination over the first two months of the cancer treatment, allowing earlier detection of treatment response than would normally be seen on routine radiological scanning.
Conclusion: We propose that in selected cases systemic therapy alone may be sufficient initial treatment for choroidal metastases from cancers that are expected to show a marked and relatively rapid response to systemic therapy, such as HER-2-positive breast cancer, allowing radiotherapy to be kept in reserve for further treatment of malignant lesions in the choroid in the future.
Keywords: Breast, Cancer, Choroid, Metastasis
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Acknowledgments
We thank James Talbot and the team of the Ophthalmic Imaging Department and Medical Photography at Ninewells Hospital for expertise in producing the photographs.
Author ContributionsHala Elnagi Jadelseed Shareef - Acquisition of data, Drafting the article, Final approval of the version to be published
Graeme Sharpe - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Douglas James Alexander Adamson - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the late patient’s next-of-kin for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Hala Elnagi Jadelseed Shareef et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
