Primary treatment of malignant retinal detachment caused by choroidal breast cancer metastasis using only systemic chemotherapy and anti-HER-2 therapy

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.