Radiation Plaque Therapy – Brachytherapy

Radiation plaque therapy is the most widely used “eye-sparing” treatment for choroidal melanoma and is also used for some cases of iris melanoma. This procedure delivers highly targeted radiation directly to the tumor, while preserving as much healthy tissue and vision as possible.

A radioactive plaque is a small, gold-covered, dish-shaped device that holds tiny radiation seeds. The gold backing helps direct radiation into the tumor while shielding surrounding structures. The tumor typically shrinks over time, though it rarely disappears completely.

Plaques are custom-made to match the exact size and shape of the tumor, usually ranging from 12 to 22 mm in diameter. Carefully calculated dosages determine how long the plaque must remain in place to deliver the right amount of radiation.

What to Expect

Surgery: Plaque placement takes about one hour and is usually done under local anesthesia. An incision is made in the conjunctiva, and the plaque is sutured to the sclera (white of the eye) directly over the tumor. The conjunctiva is then closed over the plaque.

Hospital Stay: Patients typically remain in the hospital for 3–5 days while the plaque delivers radiation. The plaque is then removed in a second, brief surgery.

Recovery: Most patients tolerate plaque therapy well. As with any surgery, there are risks such as infection, hemorrhage, or retinal detachment. Radiation side effects may include dryness, irritation, eyelash loss, or, rarely, thinning of the sclera. Some patients notice temporary double vision, blurriness, or gradual changes in vision in the treated eye. The other eye is not affected.

The effects of radiation are typically first seen around 3 months after treatment. Over time, tumors shrink to about 40% of their original size and become inactive. Regular follow-up visits are essential to monitor tumor response and manage any side effects.

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FAQ

What is radiation plaque therapy?

Brachytherapy uses a small radioactive plaque sewn temporarily to the eye’s outer wall to target tumors like choroidal melanoma, delivering precise radiation while sparing healthy tissue.

When is it used for eye conditions?

For small-medium eye cancers where saving the eye is possible, avoiding full removal. It’s effective, with 90% tumor control.

What happens during the procedure?

Under anesthesia, plaque placement takes 1 hour, left 3-7 days, then removed outpatient. Monitoring follows for side effects.

Are there side effects from brachytherapy?

Temporary: dry eye, cataracts; long-term: rare radiation retinopathy. Vision preservation is high (80% stable).

How does it compare to other cancer treatments?

Less invasive than external beam radiation, eye-sparing vs. enucleation. Success tracked via ultrasounds over years.