Brachytherapy of uveal melanomas

Abstract

AbstractRadioactive plaque brachytherapy is currently the most common treatment modality for primary uveal melanoma. The American Brachytherapy Society consensus guidelines for brachytherapy of uveal melanoma, revised in 2014, are summarised. Several isotopes are used for brachytherapy of the eye, such as strontium‐90 and ruthenium‐106 (beta rays, embedded within the plaque) and palladium‐103 and iodine‐125 (gamma rays, seeds attached to the plaque). The isotope determines how thick tumours can be irradiated (strontium up to 3 mm, ruthenium up to 6 mm, iodine and palladium over 6 mm) and to which extent scatter radiation will affect neighbouring tissues. The plaque is implanted under local or general anaesthesia, localising the tumor by indirect ophthalmoscopy and scleral depression or transillumination. The size and shape of the plaque are chosen according to the size and shape of the melanoma. Most common complications are radiation cataract, retinopathy and optic neuropathy, depending on the location of the tumour, and iris rubeosis and neovascular glaucoma when managing larger tumours. Brachytherapy results for small melanomas irradiated with ruthenium and large melanomas irradiated with iodine are presented as examples.