Authors: Christian El-Hadad, Maryam Alam, Joshua Dereck M. Ursua, Karina Richani, Bita Esmaeli
Author Disclosure Block: C. El-Hadad: None. M. Alam: None. J.D.M. Ursua: None. K. Richani: None. B. Esmaeli: None.

Abstract Body:

Purpose: Study the frequency of various histologies and management of orbital metastasis in patients from a tertiary cancer center.
Study Design: Retrospective Chart Review
Methods: A search of our departmental database for consecutive patients seen by the senior author (from 1998 to 2018) with a diagnosis of orbital metastasis. Data retrospectively collected: Age, gender, ethnicity, cancer type, presenting signs, imaging findings, treatments, and status at last follow-up.
Results: 99 patients (40 men, 59 women) had a median age of 52.5. Median time from cancer diagnosis to orbital metastasis was 31 months (range=0-304). The top 6 cancer types metastatic to orbit were: breast carcinoma (n=35), melanoma (n=15), lung carcinoma (n=11), adenocarcinoma (n=8), renal cell (n=5), neuroendocrine (n=5). 83 patients developed orbital metastasis after the diagnosis of their original cancer, 16 patients presented with orbital metastasis as the initial presentation of their metastatic cancer. . In 14 patients, the orbital lesion was the first metastatic site. . The presenting signs included: a painless mass (n=54), orbital congestion (n=58), proptosis (n=45), enophthalmos (n=8). 21 patients had bilateral orbital metastasis. The orbital metastatic lesion involved the soft tissue only in 65 patients, the bony walls in 20, and both soft tissue and bony walls in 14. 64 patients had involvement of at least one EOM. 32 patients (32 %) had an orbital biopsy to confirm the diagnosis of metastasis. 52 patients were treated with chemotherapy and/or immunotherapy after discovery of orbital metastasis. 62 patients were treated with palliative radiation therapy for a median total dose of 30 Gy (range: 8-99 Gy). 57 patients had a combination of systemic drug therapy and radiation. 18 patients had surgery (other than biopsy): 7 had debulking surgery, 10 had gross total resection,1 had orbital exenteration. Reliable follow-up data were available for 89 patients and ranged from 1 to 103 months (median 8). At last follow up, 7 patients had experienced complete resolution of the orbital lesion, 14 had partial response, 50 had stable disease, and 27 had progressed. 70 patients had died of disease at a median of 10 months after diagnosis of orbital metastasis (range: 0-107 months).
Conclusions: Breast cancer followed by cutaneous melanoma were the most common sources of orbital metastasis; the treatments for both have evolved significantly towards better systemic drug therapy and improved survival. Radical surgery or high dose radiation with its inherent ocular toxicity should be avoided in patients with orbital metastasis who have drug treatment options.