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Choroidal melanoma is the most common eye tumour in the UK, affecting over 2,000 people yearly. A new hope comes in the form of radioactive plaque therapy. This treatment is a type of brachytherapy, or plaque therapy, which is now the top choice for treating eye melanomas.

It’s as good as surgery in removing the eye, but it often saves the patient’s vision. This makes it a game-changer for those facing this serious condition.

Key Takeaways

  • Radioactive plaque treatment is a highly targeted radiation therapy that uses a small implant placed directly on the eye to treat intraocular cancers like choroidal melanoma.
  • This approach can preserve vision and save lives, making it a valuable alternative to removing the entire eye.
  • The radiation sources used come in the form of small “rice-sized” radioactive seeds attached within a gold or steel bowl called a plaque, which is surgically placed over the tumour.
  • Brachytherapy (plaque therapy) has become the most common radiation treatment for most eye melanomas, showing as effective as surgery in removing the eye.
  • Brachytherapy cures about 9 out of 10 small to medium-sized tumours and can preserve vision in some cases, particularly depending on the melanoma’s location in the eye.

What is Radioactive Plaque Treatment?

Radioactive plaque treatment, also known as brachytherapy or episcleral plaque therapy, is a way to treat eye cancers. It uses a small device with radioactive “seeds” placed on the eye. This device focuses radiation on the tumour, keeping it away from healthy parts of the eye.

Description of Radioactive Plaque Treatment

The device is usually made of gold or lead and is attached to the eye for a few days. Then, it is removed. The radiation sources include iodine-125, palladium-103, and ruthenium-106. Each has different properties and how they work.

Types of Radiation Used in Plaque Treatment

  • Iodine-125: A low-energy radiation source that is commonly used in radioactive plaques.
  • Palladium-103: Provides a more favourable intraocular dose distribution compared to iodine-125, delivering slightly more irradiation to the tumour while minimising absorption by surrounding normal structures.
  • Ruthenium-106: Another radioactive material that has been used in these plaques.

The choice of radiation source depends on the tumour’s size and location. It also depends on the desired radiation profile.

Radioactive Plaque Treatment Procedure

Preparation and Admission to the Hospital

The surgery to place a radioactive plaque is done in the operating room. It’s usually under general anaesthesia or with local anaesthetic and sedation. Before the surgery, the patient must sign a consent form.

The doctor might also order blood tests, an electrocardiogram, x-rays, or imaging scans. These tests are part of the preparation.

Once in the hospital, the plaque is attached to the eye’s wall. This covers the base of the intraocular tumour. The whole process takes about an hour under local anaesthesia.

Even though the radiation is painless, some discomfort might come from eye movements or stitches. This is because of the surgery.

Radioactive plaque therapy is a common treatment for choroidal melanoma. The plaques are made to fit the tumour’s size. They are usually between 12 to 22 mm in diameter.

Most patients don’t have problems with the surgery. But, there can be complications like retinal detachments, hemorrhages, or infections.

Statistic Value
Surgical placement of the plaque Typically lasts about an hour under local anaesthesia
Effect of radiation on the tumour Generally first evident three months after treatment, with eye melanomas typically shrinking to about 40% of their pretreatment size
Outpatient brachytherapy cost reduction Reduced costs for USC’s patients in 2018 by an average of £19,000 per patient treated with ocular brachytherapy

Patients going home out of state have their treatment planned by the hospital’s radiation safety officer. This follows state and federal guidelines. They also get education on radiation safety at home.

Activity with the Implant in Place

When you have an iodine-125 or palladium-103 plaque, you can often stay at home. You’ll need to wear a lead patch or lead glasses to protect your eye. This keeps the radiation away from your face.

You can still do most things you normally do, but with some limits. Being at home makes recovery easier and more comfortable. You get to rest in your own space.

It’s crucial to listen to your doctor’s advice on home-based treatment. They’ll tell you how to stay safe. This helps keep you healthy while you’re recovering.

“Brachytherapy treatment duration ranges from three to seven days, and patients are educated on radiation safety measures following treatment.”

The closer you are to the radiation source, the more you’ll get exposed. Doctors keep a safe distance to lower your exposure. This is part of the treatment’s safety plan.

Being able to recover at home is a big plus of this treatment. It makes the whole process easier and more comfortable. You can get the treatment you need without leaving your home.

Side Effects and Complications

Radiation therapy, including radioactive plaque treatment, can affect the eye and surrounding tissues. It has both immediate and long-term side effects. It’s important for patients to know about these complications before starting treatment.

Immediate Side Effects

Patients may feel tired, have eyelid inflammation, dry eye, and vision changes early on. These effects usually happen in the first few weeks. They often get worse around two weeks into treatment, but then get better quickly.

Long-term Complications

Long-term, serious issues can occur, like cataracts, retinal detachment, and glaucoma. Radiation retinopathy and vision loss are also possible. The risk depends on the tumour size, location, radiation dose, and how well the patient tolerates treatment.

Those having radioactive plaque treatment face various side effects. These range from immediate tiredness and skin issues to serious vision problems later on. It’s key to manage these risks closely to get the best results for patients.

“The risk of these complications depends on the size and location of the tumour, the radiation dose, and the individual patient’s tolerance to treatment.”

Post-treatment Care

Skin Care Around the Eye

After the radioactive plaque is removed, patients need to care for the skin around the treated eye. They should gently wash the eyelids with mild soap and lukewarm water. It’s important to avoid extreme temperatures and prevent any friction or rubbing of the area.

Radiation dermatitis, or inflammation of the eyelid, can be treated with topical ointments like silvadine. Soothing agents like A&D ointment can also help.

Patients may feel tired for a few weeks after the post-radiation skin care procedure. They should plan for rest periods during the day. It’s recommended to avoid rubbing, touching, or pressing on the eye for at least four weeks.

Patients should not do heavy lifting, stooping, or bending for a minimum of four weeks post-surgery.

Avoiding makeup such as eyeliner, mascara, and eye shadow for eight weeks is advised. Patients should also refrain from inserting contact lenses into the operated eye for at least eight weeks. The prescribed eye drops Atropine 1% and Maxitrol Ointment are to be instilled for eight weeks post-treatment.

Patients are instructed to tilt their head back, pull down the lower eyelid, and look up when instilling eye drops or ointment. A clear plastic shield is recommended to be worn for two weeks post-treatment when going to bed or in windy conditions. Driving is discouraged until further assessment by an ophthalmologist due to potential double vision and blurred vision in the operated eye post-surgery.

Patients will be reviewed at a follow-up appointment eight weeks after receiving ocular plaque radiation therapy. After eye plaque removal surgery, patients will need to take eye medicines for 2 weeks post-surgery. These include antibiotics, steroids eye drops, and eye muscle relaxant eye drops. Stitches left in the eye after surgery can take 4 to 6 weeks to fall off.

Patients can start showering or bathing 2 days after surgery. However, they should avoid washing their hair, head, or face for 5 days post-surgery. Most patients feel more comfortable after the plaque is removed compared to when it was inserted.

Patients are advised not to engage in tiring physical activities or sports. They should not lift anything heavier than 10 pounds for the first few days after surgery. They can return to their usual routine and activities after 2 weeks.

Driving is permissible post-surgery as long as vision is not blurred, doubled, or affected. It is recommended to wait until the follow-up appointment 2 weeks later. Patients experiencing excessive bleeding, sudden increase in pain, significant eye swelling, vision loss, or other concerning symptoms should seek medical help immediately or contact the Princess Margaret Cancer Centre.

Studies and Research on Radioactive Plaque Treatment

Many studies have looked into how well radioactive plaque treatment works for eye cancers. Dr. Paul T. Finger did a thorough review. He found that treatments like iodine-125, palladium-103, and ruthenium-106 plaques can kill eye tumours. But, how much radiation each treatment gives and the side effects can differ.

Dr. Finger suggests that clinics should compare iodine-125 and palladium-103 before treating patients. This helps find the best treatment for each person. You can read more about this in comparative dosimetry studies.

A study looked at 208 eye tumours treated with plaque radiotherapy. The patients were very young, with a mean age of 19 months. Before this treatment, 71% of the tumours had been treated before.

Interestingly, 35% of the tumours had tried other treatments that failed. The study found that 83% of tumours were controlled at 1 year. At 5 years, this number was 79%.

For tumours treated first with plaque radiotherapy, 12% recurred at 1 year. For those treated after other methods failed, recurrence rates varied from 8% to 34% at 1 year.

Radiation Complications at 5 Years of Follow-up Percentage
Nonproliferative Retinopathy 27%
Proliferative Retinopathy 15%
Maculopathy 25%
Papillopathy 26%
Cataract 31%
Glaucoma 11%
Scleral Necrosis 0%

The research shows promising results for clinical trials and comparative studies on brachytherapy for eye cancers. These findings can help doctors make better treatment choices. They can tailor care to meet each patient’s needs.

Comparison with Other Radiation Therapies

Radioactive plaque treatment is the most common way to treat eye cancers. But, external beam radiation therapy and proton beam radiation therapy are also used. External beam radiation therapy uses x-rays to target tumours. However, it can cause problems outside the eye, like eyelid and corneal issues.

Proton beam radiation therapy uses charged particles. These particles can give a strong dose to the tumour while protecting more of the healthy tissue around it.

External Beam Radiation Therapy

External beam radiation therapy uses x-rays to target tumours. This method can lead to more eye problems outside the tumour area. This is compared to radioactive plaque treatment.

Proton Beam Radiation Therapy

Proton beam radiation therapy uses charged particles to target tumours. It can give a strong dose to the tumour while protecting more of the healthy tissue. This is especially good for bigger tumours or those near the optic nerve. But, it’s not as common as plaque brachytherapy.

Treatment Modality Advantages Disadvantages
Radioactive Plaque Treatment – Widely used and established treatment
– Can precisely target the tumour
– Invasive procedure requiring surgery
External Beam Radiation Therapy – Non-invasive – Higher risk of external eye complications
Proton Beam Radiation Therapy – Highly targeted dose delivery
– Spares more surrounding healthy tissue
– Limited availability
– May not be suitable for all tumour sizes and locations

“Proton beams can spare healthy tissues posterior and lateral to irradiated tumour, as they can be stopped at desired depth.”

Radioactive Plaque Treatment Success Rates

Radioactive plaque treatment, also known as brachytherapy, is very effective for many eye tumours, especially uveal melanoma. It has shown to control tumours well, with up to 90% of small to medium-sized ocular melanomas treated successfully.

This treatment also helps in saving vision for many patients. But, the chance of keeping vision is lower if the tumour is near the optic nerve. It’s also noted that plaque brachytherapy causes fewer eye problems than other radiation treatments.

A study of 1,066 patients with uveal melanoma showed good survival rates after treatment with ruthenium plaque radiotherapy. Another study with 15 years of experience using beta-rays in treating eye tumours showed high survival and good eye function results with ruthenium brachytherapy.

Ruthenium-106 brachytherapy has shown great results in controlling tumours, saving eyes, and improving vision in patients with choroidal melanoma. Studies on posterior uveal melanomas treated with ruthenium-106 plaques have shown high control rates, low metastasis rates, and good survival outcomes.

Long-term studies on treating choroidal melanoma with ruthenium-106 brachytherapy have shown positive results. These findings highlight the success of radioactive plaque treatment in managing eye cancers, especially in saving vision and achieving good brachytherapy outcomes, tumour control, and vision preservation.

Time Period Uveal Melanoma-related Mortality Rate Relative Survival Rate
5 years 18% 74%
10 years 28% 64%
15 years 32% 62%
20 years 35% 62%
25-40 years 36% ≥100%

The table shows the long-term success of radioactive plaque treatment in managing uveal melanoma. The brachytherapy outcomes show impressive tumour control and vision preservation rates. Even decades after treatment, relative survival rates remain high.

Conclusion

Radioactive plaque treatment is a targeted and effective way to fight ocular cancers like choroidal melanoma. It delivers a precise dose of radiation right to the tumour. This method helps save the eye and as much vision as possible.

Studies show it’s very good at keeping the eye intact and improving patient outcomes. This vision-sparing therapy targets cancer cells without harming healthy tissue. It’s a key part of treating ocular cancer.

As research grows, so does hope for those with ocular cancers. Radioactive plaque treatment is a beacon of hope. It’s a game-changer in saving lives and vision.

FAQ

What is Radioactive Plaque Treatment?

Radioactive Plaque Treatment is a new therapy for eye cancers. It uses a small radioactive “plaque” placed on the eye. This method can save vision and lives, offering a better option than removing the eye.

What types of radiation are used in Plaque Treatment?

The treatment uses iodine-125, palladium-103, and ruthenium-106. Each has different properties and radiation levels.

How is the Radioactive Plaque Placement Procedure performed?

The procedure happens in the operating room. It’s done under general anaesthesia or with local anaesthetic and sedation. The plaque is attached to the eye’s wall, covering the tumour base.

What activities can patients do while the Plaque is in place?

Patients can stay at home with the plaque in place. They must wear a lead patch or glasses to protect the eye from radiation.

What are the potential side effects and complications of Radioactive Plaque Treatment?

Side effects include fatigue, eyelid inflammation, and dry eye. Vision changes are also common. Long-term risks include cataracts, retinal detachment, and vision loss.

How should patients care for the treated eye after the Plaque is removed?

After the plaque is removed, patients need to care for the eye. They should gently wash the eyelids and avoid extreme temperatures and friction.

What do studies and research say about the efficacy of Radioactive Plaque Treatment?

Studies show the treatment is very effective. It can treat up to 90% of small to medium-sized eye cancers. It also helps save vision in many cases.

How does Radioactive Plaque Treatment compare to other radiation therapies?

External beam radiation can harm the eye more. Proton beam therapy is better but less common. Plaque brachytherapy is more available and effective.

What are the success rates of Radioactive Plaque Treatment?

The treatment is very successful. It can treat up to 90% of small to medium-sized eye cancers. It also helps save vision in many cases.

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