Plaque brachytherapy for choroidal melanoma: strategies and techniques to reduce risk and maximize outcomes

Abstract

ABSTRACT Introduction Plaque brachytherapy has become the most common eye and vision sparing treatment for uveal melanoma. This review explores methods to maximize vision retention, local tumor destruction and metastasis-free survival. Revealed are how medical physics and radiation therapy techniques have been used to improve outcomes and minimize risk. Attention was given to plaque selection based on intraocular radiation distribution, tumor size and intraocular location. Pre-treatment dosimetry-based plaque selection (e.g. palladium-103, ruthenium-106, iodine-125, strontium-90) offers an effective way to maximize vision and improve local control. Areas covered Historical comparisons show how plaque size and isotope selection affect intraocular radiation distribution. Contrasts are made with respect to radiation plaque-source selection. Ocular anatomy-driven management strategies are reviewed for iris, ciliary body, choroid and peripapillary uveal tumors. Methods are described to optimize surgical plaque implantation. Finger’s slotted plaque design is shown to overcome epibulbar obstructions; thereby normalizing episcleral plaque position. Expert opinion Expert opinions include how knowledge of normal tissue tolerances, customized plaque construction and standardized outcome measures can be used to improve local control and vision outcomes. SORRT, an ongoing multicenter, international radiation side-effects registry will be mined to compare and contrast radiation sources, improve our knowledge about plaque selection and patient outcomes.