Robotic assisted CyberKnife radiosurgery for the treatment of choroidal metastasis

Purpose Choroidal metastases occur in many patients with systemic cancer and limit quality of life due to visual deterioration or pain. The limited prognosis of these patients demand treatment approaches that aim at a quick response and easy application. We evaluated a robotic assisted radiosurgery device, the CyberKnife, in the treatment of choroidal metastasis. Methods Following retrobulbar anaesthesia, target volume was defined by an interdisciplinary team using gadolinium-contrast-enhanced MRI, computer tomography (CT) as well as all previously obtained clinical data. Radiation was delivered in a single fraction with a CyberKnife at a radiation dose of 21 Gy with a 70% isodose. We evaluated tumour height, reflectivity, visual acuity and side effects over the course of the follow-up. Results A total of four patients were included in this report. Mean follow-up time was 31 months, and all patients showed decreased tumour volume and signs of fibrosis during follow-up. One patient remained stable in terms of visual acuity, two patients lost visual acuity and one patient improved and had a functional visual acuity at last follow-up. One patient developed radiation retinopathy with subsequent neovascular glaucoma that needed further management. All other patients did not show any signs of radiation induced side effects. Conclusion We report on the outcome of robotic CyberKnife radiosurgery in the treatment of uveal metastasis. We believe that single session, outpatient treatment delivery that can be facilitated with CyberKnife radiosurgery offer some benefits for this particularly sick group of patients.