gms | German Medical Science

Objective: True orbital metastases are rare. This study presents an overview of the clinical course of 11 patients with orbital metastases treated in our centre over a period of 8 years. The surgical approach, systemic and ophthalmologic outcome and histopathology have been examined.

Methods: The surgical approach depended on the location and type of the lesion. Lateral orbitotomy was performed in 4 laterally located lesions, a transconjunctival approach in 2 medial basal intraconal lesions. Pterional intradural (1) and extradural (1) approaches were used in case of intracranial involvement or location in the apex and optic canal. Two superiorly located lesions were operated via a supraorbital approach. One extraconal metastasis with frontobasal extension was approached subfrontally.

Results: The commonest primary cancers metastasizing to the orbit were lung cancer (5) and breast cancer (3). Six patients had no history of malignancy and one primary cancer site remained obscure despite careful systemic evaluation. Three patients showed recurrent tumour growth despite chemo- and / or radiotherapy. The mean survival time was 15 months after diagnosis of orbital metastasis. Ophthalmologic results were improvement in 4, no change in 6 and worsening of ophthalmologic signs in 1 patient.

Conclusions: The systemic prognosis of patients with orbital metastasis is generally poor. A multidisciplinary treatment is required. Therapeutic options include surgical biopsy, debulking or excision, hormonal therapy, chemotherapy and radiation therapy.