Complete regression of a choroidal metastasis secondary to breast cancer with stereotactic radiation: case report and review of literature

Metastatic choroidal tumors from breast carcinoma are an uncommon entity but the signs must be recognized immediately in order to avoid delays in treatment and irreversible blindness. We present the case of a 49-year-old woman who presented with vision loss and redness of her right eye two years after being treated for a stage I infiltrating ductal carcinoma status-post lumpectomy, chemotherapy, and radiation treatment to the left breast. Computed tomographic (CT) scans and magnetic resonance imaging (MRI) of the head demonstrated an intraocular metastasis to the right eye with development of a serous retinal detachmentcausing vision loss. The posterior pole and peripheral retina of the right globe were treated for the ocular metastasis and received a total dose of 25 Gy in 5 Gy fractions given every other day. MRI obtained one month after completion of radiation therapy demonstrated complete resolution of the right posterior chamber lesion with reduction in retinal thickening and resolution of subretinal fluid. The patient had moderate improvement of her vision and a more comfortable sensation in her eye after treatment. Subsequent PET, CT, and MRI demonstrated progression of pulmonary, abdominal, and CNS metastatic disease, which were unsuccessfully attempted to control with multiple chemotherapeutic and radiotherapy attempts. Despite the continued metastatic progression of her disease 5 years after diagnosis, the patient's vision remained stable and there was no evidence of recurrence of the choroidal metastasis 3 years after treatment with stereotactic radiation. An overview of the diagnosis and management of metastatic choroidal tumors is presented here.