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Photodynamic Therapy for an iris metastasis from pulmonary adenocarcinoma
Accepted Manuscript Title: Photodynamic Therapy For An Iris Metastasis From Pulmonary Adenocarcinoma Authors: Yanyan Chen, Yuedong Hu PII: DOI: Reference:
S1572-1000(17)30382-4 https://doi.org/10.1016/j.pdpdt.2017.10.011 PDPDT 1039
To appear in:
Photodiagnosis and Photodynamic Therapy
Received date: Revised date: Accepted date:
2-8-2017 12-10-2017 16-10-2017
Please cite this article as: Chen Yanyan, Hu Yuedong.Photodynamic Therapy For An Iris Metastasis From Pulmonary Adenocarcinoma.Photodiagnosis and Photodynamic Therapy https://doi.org/10.1016/j.pdpdt.2017.10.011 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Photodynamic Therapy For An Iris Metastasis From Pulmonary Adenocarcinoma Yanyan Chen PhD1, 2, Yuedong Hu PhD3, 4
1.
Department of Geriatrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang City, Liaoning Province, PR China, 110001
2.
The Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang City, Shenyang, PR China, 110001
3.
Department of Ophthalmology, the First Affiliated Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang City, Liaoning Province, PR China, 110001
4.
Diabetic Eye Center of Liaoning province. No. 155 Nanjing Bei Street, Heping District, Shenyang City, Liaoning Province, PR China, 110001
Corresponding author: Yuedong Hu Phone: (+86) 24-83283765 Fax: (+86) 24-83283294 E-mail: [email protected]
Highlights： 1. Iris metastasis comes from pulmonary adenocarcinoma. 2. Modified photodynamic therapy. 3. Short time result.
Abstract Uveal metastasis is the most common intraocular malignancy. Lung cancer is one of the most common malignancies that metastasize to uvea. Iris involvement is rarely reported. Here we report a case of iris metastasis from pulmonary adenocarcinoma that was treated with photodynamic therapy (PDT). A 65-year-old Chinese man was referred to our hospital for iris white neoplasm and blurred vision for 2 weeks in his right eye. His accepted pulmonary lobectomy, radiotherapy and chemotherapy for pulmonary adenocarcinoma 1 year ago and liver metastases were found 2 months earlier. At presentation, anterior segment examination of the right eye showed a hypopigmented, vascularized papillary 3.8 *3.19 mm neoplasm located on the temporal iris expanding to 9-clock anterior chamber angle. The patient refused to accept MRI, biopsy and treatment. One week later the tumor grew up to 5.5*7.4 mm with diffuse mixed conjunctiva congestion and elevated IOP. A modified PDT was applied. Intravenous verteporfin (3 mg/m2) was infused with a 1-minute bolus. PDT with 3 partly overlapped 5 mm laser spots, 689 nm (50 J/cm2) and 166 s were performed 4 minuets later without contact lens. The neo-genesis vessels were occluded with small patch bleeding on the edema tumor that was separated from the anterior chamber angle in the 3 days follow-up. PDT may be a safe, noninvasive and psychologically well-accepted treatment for iris metastasis.
Keywords: iris metastasis; photodynamic therapy; pulmonary adenocarcinoma
Introduction Lung cancer is the most common cancer all over the word.[1] There are 2 major categories of lung cancer including small cell and non-small cell types. Adenocarcinoma belongs to non-small cell type group and accounts for 40% of lung neoplasms.[2] The most common sites of lung cancer metastasis include liver, brain, bone, adrenal glands, contralateral lung, pleural cavity, and skin; however, uncommon sites such as ocular can also be involved.[2] Uveal metastasis is the most common intraocular malignancy, which is rich of vascular. Lung cancer is one of the most common malignancies that metastasize to uvea. Iris involvement has been rarely reported. We report a case of iris metastasis from pulmonary adenocarcinoma that was treated with a half-dosage bolus injection of photodynamic therapy (PDT).
Case report A 65-year-old Chinese man was referred to our hospital in July 2012 with iris whit neoplasm and blurred vision for 2 weeks in his right eye. His medical history was positive for pulmonary lobectomy, radiotherapy and chemotherapy for pulmonary adenocarcinoma 1 year ago and liver metastases were found 2 months earlier. He refused to accept any surgery or chemotherapy. At presentation, the best-corrected visual acuity (BCVA) was 0.5 in the right eye and 0.8 in the left eye. The intraocular pressure was normal in both eyes. Anterior segment examination of the right eye [Figure1A] showed a hypopigmented, vascularized papillary lesion with local mixed conjunctiva congestion. It was located on the temporal iris expanding to 9-clock anterior chamber angle with the following parameters: 3.8(horizontal)*3.19mm (vertical). One week later he returned to our hospital for ophthalmodynia and headache. Anterior segment examination revealed that the tumor grew up to 5.5 *7.4 mm with diffuse mixed conjunctiva congestion [Figure1B]. The BCVA was 0.2. The intraocular pressure was 35 mmHg. 2% Carteolol (Santen Pharmaceutical Co., Ltd.,
JP) and 0.1% Fluorometholone (Santen Pharmaceutical Co., Ltd., JP) were prescribed. After we carefully communicated with the patient, a modified PDT[3] was applied. For the high intrinsic vascularization and hypopigmentation, iris metastasis was treated with a modified PDT protocol. Intravenous verteporfin (3 mg/m 2) was infused over a 1-minute bolus. PDT (Opal photoactivator; Lumenis; Beijing; China) was performed 4 minuets later without contact lens (3 partly overlapped laser spots, 5 mm, 689 nm (50 J/cm2) and 166 s). The neo-genesis vessels were occluded with small patch bleeding on the edema tumor that was separated from the anterior chamber angle in the 3 days follow-up [Figure1C]. The conjunctiva was edema with aggregated mixed congestion. The best-corrected visual acuity was light perception for the pupil was shaded by the free tumor. The intraocular pressure was 38 mmHg. Then methazolamide 0.5 g bid po. and mydrin-p bid eyedrop were prescribed to decrease the intraocular pressure and prevent pupil block. He returned to local hospital for continual therapy and lost connection with us.
Discussion Sanket U. Shah et al. retrospectively studied 374 uveal metastatic tumors originating from primary lung cancer in 229 eyes of 194 patients.[4] For lung cancer, the median survival was 18 months after being diagnosed and 12 months after uveal metastasis was diagnosed. Among them 10% involved iris. Iris metastases usually present as white or light-yellow nodules with anterior uveitis, pseudo-hypopyon, secondary glaucoma and hypehema.[5, 6] For the patients with disseminated cancer are too weak, the treatment should be brief and with less pain as possible. The standard treatment is radiation therapy, including external-beam radiation therapy and episcleral plaque brachytherapy.[7] Enucleation was performed for painful blind eye large with tumors and failure or complications of other therapies.
In 2004, Harbour[8] reported a choroid metastasis from pulmonary carcinoid tumor partially regressed after PDT in a 72-year-old woman. Since then, there have been a few case reports on the use of PDT for choroidal metastasis[9-11]. PDT may be a safe treatment option for patients with choroidal metastasis, especially for the cases that are close to critical structures such as the optic nerve and macula. Multiple treatments are also well tolerated. In 2008, Edoardo Midena et al. reported the first case of a solitary iris metastasis successfully treated with PDT.[12] The iris metastasis originated from mediastinal carcinoid tumor. The iris tumor completely regressed with long-term of 24-month follow-up. The prognosis for patients with iris metastasis generally is poor. The median survival was 13 months after diagnosis of the iris metastasis[13]. PDT may be a safe, noninvasive and psychologically well-accepted treatment for iris metastasis.
Disclosure Statement: The author have nothing to disclose.
Acknowledgments The authors gratefully acknowledge the financial support of the education department projects of Liaoning province (L2015565) and science and technology bureau of Shenyang (F15-199-1-50).
References [1] S. McGuire, World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015, Adv Nutr 7(2) (2016) 418-9. [2] P.C. Hoffman, A.M. Mauer, E.E. Vokes, Lung cancer, The Lancet 355(9202) (2000) 479-485. [3] Y. Hu, Y. Chen, L. Chen, Half-dosage and bolus injection photodynamic therapy for symptomatic circumscribed choroidal hemangioma: a case report, Photodiagnosis Photodyn Ther 12(3) (2015) 526-9. [4] S.U. Shah, A. Mashayekhi, C.L. Shields, H.S. Walia, G.B. Hubbard, 3rd, J. Zhang,
J.A. Shields, Uveal metastasis from lung cancer: clinical features, treatment, and outcome in 194 patients, Ophthalmology 121(1) (2014) 352-7. [5] M. Sakellakis, S. Peroukides, G. Iconomou, H. Kalofonos, Iris Metastasis in a Patient With Small Cell Lung Cancer: A Case Report, Iran Red Crescent Med J 18(4) (2016) e21522. [6] L. Konstantinidis, B. Damato, Intraocular Metastases—A Review, Asia-Pac J Ophthalmol 6(2) (2017) 208-214. [7] V. Martin, X. Cuenca, S. Lopez, A.F. Albertini, P. Lang, J.M. Simon, C.G. Hemery, L. Feuvret, J.J. Mazeron, Iris metastasis from prostate carcinoma: a case report and review of the literature, Cancer Radiother 19(5) (2015) 331-3. [8] J.W. Harbour, Photodynamic therapy for choroidal metastasis from carcinoid tumor, Am J Ophthalmol 137(6) (2004) 1143-5. [9] D.H. Ghodasra, H. Demirci, Photodynamic Therapy for Choroidal Metastasis, Am J Ophthalmol 161 (2016) 104-9 e1-2. [10] S. Kaliki, C.L. Shields, S.A. Al-Dahmash, A. Mashayekhi, J.A. Shields, Photodynamic therapy for choroidal metastasis in 8 cases, Ophthalmology 119(6) (2012) 1218-22. [11] V. Isola, A. Pece, L. Pierro, Photodynamic therapy with verteporfin of choroidal malignancy from breast cancer, Am J Ophthalmol 142(5) (2006) 885-7. [12] E. Midena, S. Vujosevic, E. Pilotto, Photodynamic Therapy For Iris Metastasis From A Mediastinal Carcinoid Tumor, Retin Cases Brief Rep 2(2) (2008) 175-177. [13] J.A. Shields, C.L. Shields, H. Kiratli, P. de Potter, Metastatic tumors to the iris in 40 patients, Am J Ophthalmol 119(4) (1995) 422-30.
Figure 1. A. Anterior segment examination of the right eye showed a 3.8*3.19 mm,
hypopigmented, vascularized papillary lesion (↑) located on the temporal iris expanded to 9-clock anterior chamber angle with local mixed conjunctival congestion. B. One week later, the tumor grew up to 5.5 *7.4 mm with pseudo-hypopyon (▲) and
diffuse mixed conjunctiva congestion. C. The edema tumor that was separated from the anterior chamber angle () in the 3 days follow-up, and the neo-genesis vessels were occluded with small patch bleedings on it ().
S1572-1000(17)30382-4 https://doi.org/10.1016/j.pdpdt.2017.10.011 PDPDT 1039
To appear in:
Photodiagnosis and Photodynamic Therapy
Received date: Revised date: Accepted date:
2-8-2017 12-10-2017 16-10-2017
Please cite this article as: Chen Yanyan, Hu Yuedong.Photodynamic Therapy For An Iris Metastasis From Pulmonary Adenocarcinoma.Photodiagnosis and Photodynamic Therapy https://doi.org/10.1016/j.pdpdt.2017.10.011 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Photodynamic Therapy For An Iris Metastasis From Pulmonary Adenocarcinoma Yanyan Chen PhD1, 2, Yuedong Hu PhD3, 4
1.
Department of Geriatrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang City, Liaoning Province, PR China, 110001
2.
The Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang City, Shenyang, PR China, 110001
3.
Department of Ophthalmology, the First Affiliated Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang City, Liaoning Province, PR China, 110001
4.
Diabetic Eye Center of Liaoning province. No. 155 Nanjing Bei Street, Heping District, Shenyang City, Liaoning Province, PR China, 110001
Corresponding author: Yuedong Hu Phone: (+86) 24-83283765 Fax: (+86) 24-83283294 E-mail: [email protected]
Highlights： 1. Iris metastasis comes from pulmonary adenocarcinoma. 2. Modified photodynamic therapy. 3. Short time result.
Abstract Uveal metastasis is the most common intraocular malignancy. Lung cancer is one of the most common malignancies that metastasize to uvea. Iris involvement is rarely reported. Here we report a case of iris metastasis from pulmonary adenocarcinoma that was treated with photodynamic therapy (PDT). A 65-year-old Chinese man was referred to our hospital for iris white neoplasm and blurred vision for 2 weeks in his right eye. His accepted pulmonary lobectomy, radiotherapy and chemotherapy for pulmonary adenocarcinoma 1 year ago and liver metastases were found 2 months earlier. At presentation, anterior segment examination of the right eye showed a hypopigmented, vascularized papillary 3.8 *3.19 mm neoplasm located on the temporal iris expanding to 9-clock anterior chamber angle. The patient refused to accept MRI, biopsy and treatment. One week later the tumor grew up to 5.5*7.4 mm with diffuse mixed conjunctiva congestion and elevated IOP. A modified PDT was applied. Intravenous verteporfin (3 mg/m2) was infused with a 1-minute bolus. PDT with 3 partly overlapped 5 mm laser spots, 689 nm (50 J/cm2) and 166 s were performed 4 minuets later without contact lens. The neo-genesis vessels were occluded with small patch bleeding on the edema tumor that was separated from the anterior chamber angle in the 3 days follow-up. PDT may be a safe, noninvasive and psychologically well-accepted treatment for iris metastasis.
Keywords: iris metastasis; photodynamic therapy; pulmonary adenocarcinoma
Introduction Lung cancer is the most common cancer all over the word.[1] There are 2 major categories of lung cancer including small cell and non-small cell types. Adenocarcinoma belongs to non-small cell type group and accounts for 40% of lung neoplasms.[2] The most common sites of lung cancer metastasis include liver, brain, bone, adrenal glands, contralateral lung, pleural cavity, and skin; however, uncommon sites such as ocular can also be involved.[2] Uveal metastasis is the most common intraocular malignancy, which is rich of vascular. Lung cancer is one of the most common malignancies that metastasize to uvea. Iris involvement has been rarely reported. We report a case of iris metastasis from pulmonary adenocarcinoma that was treated with a half-dosage bolus injection of photodynamic therapy (PDT).
Case report A 65-year-old Chinese man was referred to our hospital in July 2012 with iris whit neoplasm and blurred vision for 2 weeks in his right eye. His medical history was positive for pulmonary lobectomy, radiotherapy and chemotherapy for pulmonary adenocarcinoma 1 year ago and liver metastases were found 2 months earlier. He refused to accept any surgery or chemotherapy. At presentation, the best-corrected visual acuity (BCVA) was 0.5 in the right eye and 0.8 in the left eye. The intraocular pressure was normal in both eyes. Anterior segment examination of the right eye [Figure1A] showed a hypopigmented, vascularized papillary lesion with local mixed conjunctiva congestion. It was located on the temporal iris expanding to 9-clock anterior chamber angle with the following parameters: 3.8(horizontal)*3.19mm (vertical). One week later he returned to our hospital for ophthalmodynia and headache. Anterior segment examination revealed that the tumor grew up to 5.5 *7.4 mm with diffuse mixed conjunctiva congestion [Figure1B]. The BCVA was 0.2. The intraocular pressure was 35 mmHg. 2% Carteolol (Santen Pharmaceutical Co., Ltd.,
JP) and 0.1% Fluorometholone (Santen Pharmaceutical Co., Ltd., JP) were prescribed. After we carefully communicated with the patient, a modified PDT[3] was applied. For the high intrinsic vascularization and hypopigmentation, iris metastasis was treated with a modified PDT protocol. Intravenous verteporfin (3 mg/m 2) was infused over a 1-minute bolus. PDT (Opal photoactivator; Lumenis; Beijing; China) was performed 4 minuets later without contact lens (3 partly overlapped laser spots, 5 mm, 689 nm (50 J/cm2) and 166 s). The neo-genesis vessels were occluded with small patch bleeding on the edema tumor that was separated from the anterior chamber angle in the 3 days follow-up [Figure1C]. The conjunctiva was edema with aggregated mixed congestion. The best-corrected visual acuity was light perception for the pupil was shaded by the free tumor. The intraocular pressure was 38 mmHg. Then methazolamide 0.5 g bid po. and mydrin-p bid eyedrop were prescribed to decrease the intraocular pressure and prevent pupil block. He returned to local hospital for continual therapy and lost connection with us.
Discussion Sanket U. Shah et al. retrospectively studied 374 uveal metastatic tumors originating from primary lung cancer in 229 eyes of 194 patients.[4] For lung cancer, the median survival was 18 months after being diagnosed and 12 months after uveal metastasis was diagnosed. Among them 10% involved iris. Iris metastases usually present as white or light-yellow nodules with anterior uveitis, pseudo-hypopyon, secondary glaucoma and hypehema.[5, 6] For the patients with disseminated cancer are too weak, the treatment should be brief and with less pain as possible. The standard treatment is radiation therapy, including external-beam radiation therapy and episcleral plaque brachytherapy.[7] Enucleation was performed for painful blind eye large with tumors and failure or complications of other therapies.
In 2004, Harbour[8] reported a choroid metastasis from pulmonary carcinoid tumor partially regressed after PDT in a 72-year-old woman. Since then, there have been a few case reports on the use of PDT for choroidal metastasis[9-11]. PDT may be a safe treatment option for patients with choroidal metastasis, especially for the cases that are close to critical structures such as the optic nerve and macula. Multiple treatments are also well tolerated. In 2008, Edoardo Midena et al. reported the first case of a solitary iris metastasis successfully treated with PDT.[12] The iris metastasis originated from mediastinal carcinoid tumor. The iris tumor completely regressed with long-term of 24-month follow-up. The prognosis for patients with iris metastasis generally is poor. The median survival was 13 months after diagnosis of the iris metastasis[13]. PDT may be a safe, noninvasive and psychologically well-accepted treatment for iris metastasis.
Disclosure Statement: The author have nothing to disclose.
Acknowledgments The authors gratefully acknowledge the financial support of the education department projects of Liaoning province (L2015565) and science and technology bureau of Shenyang (F15-199-1-50).
References [1] S. McGuire, World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015, Adv Nutr 7(2) (2016) 418-9. [2] P.C. Hoffman, A.M. Mauer, E.E. Vokes, Lung cancer, The Lancet 355(9202) (2000) 479-485. [3] Y. Hu, Y. Chen, L. Chen, Half-dosage and bolus injection photodynamic therapy for symptomatic circumscribed choroidal hemangioma: a case report, Photodiagnosis Photodyn Ther 12(3) (2015) 526-9. [4] S.U. Shah, A. Mashayekhi, C.L. Shields, H.S. Walia, G.B. Hubbard, 3rd, J. Zhang,
J.A. Shields, Uveal metastasis from lung cancer: clinical features, treatment, and outcome in 194 patients, Ophthalmology 121(1) (2014) 352-7. [5] M. Sakellakis, S. Peroukides, G. Iconomou, H. Kalofonos, Iris Metastasis in a Patient With Small Cell Lung Cancer: A Case Report, Iran Red Crescent Med J 18(4) (2016) e21522. [6] L. Konstantinidis, B. Damato, Intraocular Metastases—A Review, Asia-Pac J Ophthalmol 6(2) (2017) 208-214. [7] V. Martin, X. Cuenca, S. Lopez, A.F. Albertini, P. Lang, J.M. Simon, C.G. Hemery, L. Feuvret, J.J. Mazeron, Iris metastasis from prostate carcinoma: a case report and review of the literature, Cancer Radiother 19(5) (2015) 331-3. [8] J.W. Harbour, Photodynamic therapy for choroidal metastasis from carcinoid tumor, Am J Ophthalmol 137(6) (2004) 1143-5. [9] D.H. Ghodasra, H. Demirci, Photodynamic Therapy for Choroidal Metastasis, Am J Ophthalmol 161 (2016) 104-9 e1-2. [10] S. Kaliki, C.L. Shields, S.A. Al-Dahmash, A. Mashayekhi, J.A. Shields, Photodynamic therapy for choroidal metastasis in 8 cases, Ophthalmology 119(6) (2012) 1218-22. [11] V. Isola, A. Pece, L. Pierro, Photodynamic therapy with verteporfin of choroidal malignancy from breast cancer, Am J Ophthalmol 142(5) (2006) 885-7. [12] E. Midena, S. Vujosevic, E. Pilotto, Photodynamic Therapy For Iris Metastasis From A Mediastinal Carcinoid Tumor, Retin Cases Brief Rep 2(2) (2008) 175-177. [13] J.A. Shields, C.L. Shields, H. Kiratli, P. de Potter, Metastatic tumors to the iris in 40 patients, Am J Ophthalmol 119(4) (1995) 422-30.
Figure 1. A. Anterior segment examination of the right eye showed a 3.8*3.19 mm,
hypopigmented, vascularized papillary lesion (↑) located on the temporal iris expanded to 9-clock anterior chamber angle with local mixed conjunctival congestion. B. One week later, the tumor grew up to 5.5 *7.4 mm with pseudo-hypopyon (▲) and
diffuse mixed conjunctiva congestion. C. The edema tumor that was separated from the anterior chamber angle () in the 3 days follow-up, and the neo-genesis vessels were occluded with small patch bleedings on it ().