Plaque Brachytherapy
Information for Patients
You are planning to have plaque brachytherapy surgery to treat uveal/choroidal melanoma in your eye. The purpose of the brachytherapy is to radiate and destroy the tumor in your eye.
To radiate the tumor it is also necessary to radiate adjacent structures in the eye. Depending on the location of your cancer this may include the cornea, the iris, the optic nerve and the macula. Radiation kills tumor cells but also kills cells in these other areas. With time, this can lead to damage to the eye including problems with your cornea such as severe dry eyes, the development of glaucoma, and loss of vision due to radiation damage to the optic nerve (radiation optic neuropathy) and macula (radiation retinopathy). There are some treatments available if you develop these conditions but you should know that in general radiation damage can cause permanent vision loss. This is why we only radiate eyes when they have certain diagnoses, such as a cancer in the eye.
What to expect before surgery?
At USC we use customized plaques (pieces of gold loaded with radiation) that are made just for you! They provide the best dose to kill the tumor while trying to limit radiation to other parts of the eye as much as possible. To make these plaques we need to have images available so you will have an ultrasound in clinic and also have a CT scan of the area around your eye. You will also have a CT scan of your body to make sure there are no signs of cancer in other parts of the body. Remember, that even if cancer is not seen at this time we will still need to monitor you for several years after your treatment.
You will also meet with a radiation oncologist, Dr. Jennelle, to discuss your therapy
All attempts are made to ensure that you are treated within 1 month of your diagnosis.
What to expect the day of surgery?
The surgical coordinator will give you the time to arrive at USC. On the day of surgery you will see your surgeon who will mark your eye and answer any questions, a nurse will dilate your eye, give you a gown to use and place an IV line for you. You will also meet the radiation physicist, Dr. Astrahan, who will discuss precautions for home with you.
The surgery to place the plaque takes about 1 hour and to remove the plaque takes about 30 minutes. You are able to go home after the procedures.
What to expect after surgery?
Immediately after surgery your eye will have a soft patch to catch blood and discharge from the eye and a black ‘pirate patch’ to shield others from radiation. You can change the soft patch daily and put antibiotic cream in the eye. When you are alone you do not need to wear the black patch however PLEASE REMEMBER TO WEAR THE BLACK PIRATE PATCH WHENEVER YOU ARE AROUND OTHER PEOPLE OR LEAVE YOUR HOUSE INCLUDING RETURNING TO THE HOSPITAL FOR PLAQUE REMOVAL.
You will be given medications also for pain and nausea, which are normal in the first few days after surgery.
You do need to stay at home without going out into the community the week that the plaque is in place – even if you feel well. This is because you are a source of radiation with the plaque in place. If you do light, office work you can go back Monday after the plaque is removed (so 7 work days off total). While at home you can do most things except heavy strenuous work. You do need to avoid children and pregnant people in the home. Pets are ok and a great comfort!
I will see you two weeks after the plaque is removed just to check how you are healing. We will measure the tumor again with ultrasound 3 months after therapy.
What to expect in the months after surgery?
We will measure the tumor with ultrasound and photos 3 months after therapy. You will have appointments at USC every 3-4 months for the first 2-3 years, then every 4-6 months until 5 years after therapy. If you are stable at that time we will move to annual visits.
During this time you may have a change in vision due to radiation changes – if that happens call USC and we will see you.
You will also need to have liver screening with liver imaging (generally ultrasound) and blood tests. We can discuss the best interval for you but in general every 6 months for the first 5 years. Your primary care physician will order these tests.
Are there any alternative treatments available?
There may be other treatments available which include enucleation (removal of the eye), referral to another center for a different type of radiation (proton beam) or in certain cases close monitoring although once a diagnosis of cancer has been made the recommendation is for treatment. If you feel that you need any further information please feel free to ask your provider.
What will happen if I don’t have any treatment?
Your tumor may continue to grow. This might make treatment more difficult to treat and the tumor may cause further damage to the eye. Additionally, there may be an increased risk of tumor spread out of the eye and to other parts of the body.
How will I receive my appointments?
The surgical scheduler will help you with this and you will be given a form to take to your primary care provider to order imaging and preoperative testing.
Further Information
If you have any questions, please contact the USC Roski Eye Institute: 323-442-6335
Your Ocular Oncology Service
Jonathan Kim, MD (director)
Jesse Berry, MD (associate director)
Hebers Castro (oncology technician)