Kevin Tsai Week 3 Discussion April 24, 13 Eye Plaque Brachytherapy The two main radiation treatments for

intraocular cancer are plaque radiotherapy and external beam. External beam radiation is more commonly use to treat retinoblastoma, choroidal melanoma, and metastatic tumors. Plaque brachytherapy is more popular today for treatment of primary choroidal melanoma because of the high dose to the tumor and less dose to surrounding normal tissues. In 1985, the Collaborative Ocular Melanoma Study (COMS) established the first consensus approach to eye plaque brachytherapy for treatment of intraocular tumors.1 In 2003, the American Brachytherapy Society (ABS) established clinical guidelines for brachytherapy for choroidal melanoma. It recommended an average dose rate of 0.60-1.05 Gy/hr, a prescription dose of 85 Gy to the tumor apex, an implant duration of 3-7 days, and a margin of 2-3 mm for target coverage for all medium tumors.1 After a consultation with a patient with choroidal melanoma, the radiation oncologist will write a prescription including the total dose, number of seeds, length of the plaque, and depth of the tumor. The medical physicist or dosimetrist will use the information given to calculate how many days and hours the eye plaque needs to stay inside the eye. The time of implantation will also depend on when the surgeons have time to implant and remove the eye plaque. The source used at my department for eye plaques is I-125 6711 Point, which is recommended by COMS. The planner will alter the dose rate, activity of the source, and time, to deliver a total dose of 85 Gy. Once the plan is completed, the medical physicist will order the radioactive seeds. The sources need to be delivered at least 2, preferably 3 days before the implant, to have enough time to prepare the plaque and have it sterilized. The I-125 seeds come in a small rice-sized form and will cost around $232 each. Once the I-125 seeds have arrived, the medical physicist will prepare the plaque by gluing the seeds to the correct size gold or steel bowl called a plaque (figure 1). When preparing the plaque, the person making the plaque must follow the 3 main radiation safety principles

which is time, distance, and shielding. Tweezers and plastic spoilers are used to reduce radiation to the person preparing the plaque (figure 2). Once the plaque is completed, it is sent for sterilization and implantation (figure 3). Figures

Figure 1: Iodine 125 seeds and plaque.

Figure 2: Preparing the plaque and following radiation safety principles.

Figure 3: Location of the eye plaque after implantation.

References 1.) Gagne N, Leonard Kara, Rivard M. Radiobiology for eye plaque brachytherapy and evaluation of implant duration and radionuclide choice using an objective function. Medical Physics. 2012;39(6):3332-3343.