Metastatic orbital tumors in southern China during an 18-year period

Objective To determine the primary sites, clinical features, treatment, and outcome of 46 patients with cancer metastatic to the orbits in southern China. Methods Retrospective review of medical records at a tertiary center in southern China between Jan 1, 1991 and Dec 31, 2008. Results The study included 35 males and 11 females, with an age range of 3–78 years (average 47 years). All of the patients came from southern China. The left orbit was affected more frequently than the right orbit (3:2), and no cases were bilaterally involved. The most common primary cancer that metastasizes to the orbit is nasopharyngeal carcinoma (30.34%), followed by lung cancer (8.70%), liver cancer (6.52%), breast carcinoma (4.35%), renal cell cancer (4.35%), medullary thyroid carcinoma (2.17%), lacrimal gland carcinoma (2.17%), stomach carcinoma (2.17%), mediastinum carcinoma (2.17%), other forms (6.52%), and unknown carcinomas (30.34%). Orbital metastasis was the first sign of systemic cancer in 24 patients (52.17%). The five most common clinical findings at the initial examination were abnormal eye position (65.22%), proptosis (63.04%), increased orbital pressure (54.35%), diplopia (54.35%), and limited ocular motility (52.17%), followed by swollen eyelid (50%), visible mass or swelling (46%), blurred vision (41%), conjunctival hyperemia, and edema (35%), pain (28%), blepharoptosis (20%), papilledema (17%), and vasodilatation of the retina (7%). Primary treatment included surgical excision, radiotherapy, systemic chemotherapy, and observation. Among the patients (78% of 46) with sufficient follow-up time (mean 20.7 months), 30.56% of them died of disseminated metastasis. Twenty-five percent of them were in remission with no active metastases and 27.78% of them were living with active metastases. Overall, the mean survival time was 18 months (range, 5–38 months) after diagnosis of orbital metastasis. Conclusions The most common primary cancer that metastasizes to the orbit is nasopharyngeal carcinoma (30.34%), followed by lung cancer (8.70%) and liver cancer (6.52%) in southern China. Orbital metastasis can display a variety of clinical features and should be considered in patients with known systemic cancer. The systemic prognosis is generally poor.