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Retrobulbar metastases from transitional cell carcinoma of the urinary bladder are very rare. This is a case report of palliative radiotherapy successfully reducing acute clinical symptoms such as proptosis, dysfunction of the eye muscles and diplopia in a 50-year-old male patient with a retrobulbar metastasis from transitional cell carcinoma. Radiotherapy quickly ameliorated the proptosis and dysfunction of the eye muscles without side effects. The patient's quality of life was clearly improved.

Purpose: The aim of this study is to illustrate our personal experience concerning the diagnostic and therapeutic management of primary and secondary orbital melanomas., Patients and Methods: Nine patients (five men and four women) with a histological diagnosis of orbital malignant melanoma were surgically treated in our department during the last 10 years (1995 - 2005)., Results: All the patients had a unilateral orbital malignant melanoma. A primary tumour was diagnosed in one case. There was metastatic orbital localisation of a cutaneous malignant melanoma in two cases. In six cases, a secondary melanoma originated from the uveal tract (three cases), conjunctiva (two cases), or paranasal sinuses (one case). All the patients underwent surgical treatment of the tumour (exenteration in 5 cases; subtotal exenteration in one case; subtotal excision in two cases; and craniofacial resection in one case) combined with immunotherapy in one case. The median age at surgery was 66 years, with a mean postoperative follow-up of 17 +/- 14 months. Four patients died of widespread dissemination of the melanoma after a mean time of 13 +/- 7 months. Two more patients died of causes other than melanoma. Three patients were still living at 9, 33 and 45 months after surgery. None of the patients presented with a local relapse of the melanoma during follow-up., Conclusion: Although different approaches have been proposed, the prognosis of orbital melanoma remains poor. In our experience too, the patients with longest survival were those whose tumours were exenterated.

Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage. We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life.

Fifteen patients at the University of Mainz were diagnosed as having T3 or T4 carcinomas of the paranasal sinuses that invaded the orbit. Treatment involved surgical resections of tumor with adjacent periorbita but without enucleation in an attempt to preserve vision and/or cosmesis. Survival rates and especially the rate, time and locations of recurrences were investigated. Analysis of the data revealed that preservation of the eye in these cases with advanced sinus carcinomas with orbital tumor involvement did not seem to worsen prognosis. The individual gain in terms of quality of life through the preservation of vision and cosmesis seems to justify the surgical approach used.

Orbital NHLs are rare and manifest themselves primarily in localized stages. The value of radiotherapy is discussed, reviewing retrospectively the treatment results obtained in 41 patients irradiated for orbital NHL between 1958 and 1966. All were histologically verified. There were 15 lymphomas of low and nine of high malignancy according to the Kiel classification. Among the 17 remaining patients, 15 cases had been classified as reticulum cell sarcoma and two as lymphosarcoma. Fourteen cases were in stage IE, 19 in stage IIE, and eight in stage IIIE/IVE. After surgical biopsy (n = 25) or resection (n = 5), megavoltage irradiation was delivered in conventional fractionation from 20 Gy up to a total dose of 50 Gy. During the last decade treatment has been based on CT scans and corresponding computer assisted treatment planning. Clinically, complete remission was achieved in 13 out of 14 patients (93%) with stage IE, in 17 out of 19 patients (90%) with stage IIE, and in five out of eight patients (63%) with stage IIIE/IVE. The nonrecurrence rate is 65% (10 out of 14) for stage IE and 75% (13 out of 17) for stage IIE after a mean follow-up time of 36 months. As regards lymphomas of low and high malignancy, the nonrecurrence rate is 89% and 43% respectively. Recurrence (n = 8) and dissemination (n = 6) occurred only twice more than two years after radiotherapy had been discontinued. The incidence of side effects was low. Two patients developed a "dry eye." In two eyes the lens had to be removed because of progressive cataract. Radiotherapy with individual treatment planning based on CT scans is the curative treatment of choice fo localized orbital NHL.