Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Survival Outcomes

Objective: Orbital metastases represent rare neoplasms often leading to severe functional impairments. Surgical resection may play a diagnostic and therapeutic role. To systematically review clinical features and management strategies of orbital metastases and their impact on clinical outcomes.

Methods: We searched PubMed, Scopus, Web of Science, and Cochrane according to PRISMA guidelines. Studies reporting clinical outcomes data of patients with orbital metastases were included. Clinical characteristics, management strategies, and survival data were reviewed.

Results: We included 262 studies comprising 873 patients. Median age at diagnosis was 59 years (range: 18–90). Breast cancer (36.3%) was the most frequent primary tumor, followed by melanoma (10.1%) and prostate cancer (8.5%). Median time interval between primary tumor and orbital involvement was 12 months (range: 0–420), while symptomatic orbital metastases preceded primary tumor diagnosis in 30.1% patients. The most common symptoms were proptosis (52.3%), relative afferent pupillary defect (38.7%), and diplopia (35.5%). No laterality prevalence was noted (left 46.2%; right 46.1%), and 7.7% of patients had bilateral lesions. Metastases mostly showed a diffuse location within the orbit (19%), and frequently infiltrated orbital soft tissues (40.2%) and intraconal muscles (26.8%). In 47 cases (5.4%), tumors invaded the dura extending into the anterior or middle fossa. Incisional biopsy (63.7%) was preferred over fine needle aspiration (10.2%), with partial surgical resection (16.6%) preferred over complete resection (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received adjuvant chemotherapy, 506 (58%) received orbital radiotherapy, and 128 (14.7%) received hormonal therapies. At posttreatment follow-up, symptomatic improvement was significantly superior in patients undergoing tumor resection (p = 0.005) and orbital radiotherapy (p = 0.032), with radiological tumor shrinkage prevalent in 68% cases. Mean follow-up was 14.3 months, and median overall survival was 6 months. Only 15 cases (1.7%) of orbital metastases recurrence were reported, and median progression-free survival was 6 months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing tumor resection rather than biopsy only (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153).

Conclusion: Orbital metastases can severely impair clinical status and quality of life. Surgical resection can safely improve symptoms and survival when combined with adjuvant chemo/radiotherapy.

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022