Choroidal mets - treatment question

[iradi8u]

I have just received a patient with widespread mucinous adeno of unclear etiology. CT C/A/P negative, PET next week.
Bizarre story - compression fx first week of June in a lady with osteoporosis, DJD, and 2 other compression fractures. Bx before vertebroplasty AND bone scan of the spine were negative. Fast forward 6 weeks and she has diffuse bone pain & rapidly deteriorating vision. She has widespread bony disease on bone scan, biopsy of a hip met shows mucinous adeno, and she has bilateral choroid mets L>R with early retinal detachments. Mammogram negative, but she does have a 1 cm left axillary node that's firm.


Gammaknife was recommended to her family, but I suspect the doctor who recommended this didn't know the extent of her disease.

My plan is to scan her brain today - if brain mets, whole brain EBRT to 30 to include the posterior 1/2 of both eyes. If no brain mets, 40 Gy in 20 fx to the posterior 1/2 of the eyes.

There are limited data, but I can't find anything to suggest this is a bad plan.

Any thoughts would be greatly appreciated! Thanks.

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[Palex80]

Sounds reasonable.
Although I'd hate to have an old lady come in for 4 weeks of treatment if her prognosis is so bad. You can stick to 30/3 for her choroidal mets, even if she diesn't have any brain mets.

ER/PR-status in the biopsy?

 

[iradi8u]

Sounds reasonable.
Although I'd hate to have an old lady come in for 4 weeks of treatment if her prognosis is so bad. You can stick to 30/3 for her choroidal mets, even if she diesn't have any brain mets.

ER/PR-status in the biopsy?

Thanks! I really appreciate your input.
No ER/PR in the path report.
The MDACC ophthalmologist wanted her to have gamma knife to her posterior eyes, but I disagree - this lady has rapidly progressive widespread disease, so I'm getting the dose in.
I'm going to 33/11 since there are data that say that >35.5 Gy with standard fractionation has better outcome with respect to vision, so from a BED perspective, 33/11 will work and will limit the time she has to spend with me. I'll simultaneously treat her most painful areas in the pelvis.
Poor lady.