Letter to the Editor
Orbital metastasis from oesophageal cancer. When the ophtalmologist meets gastrointestinal specialists
Metástasis orbital de cáncer de esófago. Cuando el oftalmólogo se reúne con los especialistas gastrointestinales
a Departamento de Oncología Médica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
b Departamento de Oftalmología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
c Departamento de Radiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
d Departamento de Radioterapia, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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When the ophtalmologist meets gastrointestinal specialists" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "594" "paginaFinal" => "595" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Ruiz-Casado, M. Hijos, R. Ruiz, J. Romero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Ruiz-Casado" "email" => array:1 [ 0 => "arcasado@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Hijos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Departamento de Oncología Médica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Radiología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Radioterapia, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis orbital de cáncer de esófago. Cuando el oftalmólogo se reúne con los especialistas gastrointestinales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 703 "Ancho" => 755 "Tamanyo" => 60230 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right intraconal metastasis from oesophageal origin.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the manuscript on orbital metastases reported by Montejano-Milner et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This series do not include any case of gastrointestinal origin. We agree with the authors that being a rare location of metastases, and having the ophthalmologist an essential role in the diagnosis, the basis for the collaboration with the usual multidisciplinary team should be established.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We have recently diagnosed a case of intraconal metastasis from oesophageal cancer. A 73 year-old patient with a history of oesophageal adenocarcinoma in Barrett’s oesophagus diagnosed in January 2018, presented in November 2020 with diplopia and proptosis. This patient had received neoadjuvant radiotherapy. Pathological staging after total oesophagectomy was ypT1b pN1 M0. No evidence of disease had been suspected in the follow-up. CT scan and MR showed a right metastasis with proptosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This metastasis was located in the intraconal fat contacting with optic nerve, globe and muscle.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A PET-CT showed disseminated disease with liver, adrenal, bone, muscular and peritoneal metastases. After discussion in the multidisciplinary team meeting, the responsible physicians contacted both the ophthalmologist and the radiologist who actually had diagnosed the patient and were not summoned to the meeting because they are not usually involved with the management of patients with gastrointestinal cancer.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was initially treated with palliative radiotherapy followed by chemotherapy (FOLFIRI). He survived 11 months after the diagnosis of orbital metastases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Orbital metastases from gastrointestinal origin are very rare representing only 4% of the total.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Metastases from esophageal cancer are extremely rare, but at least two other cases have been reported.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> A very interesting article revealed that eye was the second most frequent location of uncommon metastatic sites of oesophageal cancer.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> From this case, we can learn that it is meaningful treating these patients because relevant survivals can be obtained with active therapies, as Montejano-Milner et al. propose.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This is a paradigmatic situation that occurs out of the setting of multidisciplinary team meetings. The cancer committee should have procedures to incorporate the specialists involved in the diagnosis of this rare metastasis into the discussion.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz-Casado A, Hijos M, Ruiz R, Romero J. Metástasis orbital de cáncer de esófago. Cuando el oftalmólogo se reúne con los especialistas gastrointestinales. Arch Soc Esp Oftalmol. 2022;97:595–596.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 703 "Ancho" => 755 "Tamanyo" => 60230 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right intraconal metastasis from oesophageal origin.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Orbital metastasis: clinical presentation and survival in a series of 11 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. 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