Abstract
Ocular tumours present a therapeutic challenge because of the sensitive tissues involved and the necessity to destroy the tumour while minimising visual loss. Radiotherapy (RT) is one of several modalites used apart from surgery, laser, cryotherapy, and chemotherapy. Both external beam RT (EBRT) and brachytherapy are used. Tumours of the bulbar conjunctiva, squamous carcinoma and malignant melanoma, can be treated with a radioactive plaque: strontium-90, ruthenium-106 (Ru-106), or iodine-125 (I-125), after excision. If the tumour involves the fornix or tarsal conjunctiva, proton therapy can treat the conjunctiva and spare most of the eye. Alternatively, an I-125 interstitial implant can be used with shielding of the cornea and lens. Conjunctival mucosal-associated lymphoid tissue lymphoma can be treated with an anterior electron field with lens shielding and 25–30 Gray (Gy) in 2 Gy fractions. Discrete retinoblastoma (RB), too large for cryotherapy or thermolaser, or recurrent after these modalities, can be treated with plaque therapy, I-125, or Ru-106. For large RB, multiple tumours, or vitreous seeds the whole eye can be treated with an I-125 applicator, sparing the bony orbit, or with EBRT, under anaesthetic, using X-rays or proton therapy with vacuum contact lenses to fix the eyes in the required position. Post-enucleated orbits at risk for recurrent RB can be treated with an I-125 implant with shielding to reduce the dose to the bony orbit. Uveal malignant melanomas can be treated with plaque or proton therapy with excellent local control. Preservation of vision will depend on the initial size and location of the tumour.
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Hall E . Radiobiology for the Radiologist 5th edn. Lippincott, Williams & Wilkins: Philadelphia, 2000.
Moore RF . Choroidal sarcoma treated by the intraocular insertion of radon seeds. Br J Ophthalmol 1930; 14: 145–156.
Moore RF, Stallard HB, Milner JG . Retinal gliomata treated by radon seeds. Br J Ophthalmol 1931; 15: 673–696.
Stallard HB . Radiotherapy of intraocular neoplasms. Br J Ophthalmol 1948; 32: 619–639.
Stallard HB . Radiotherapy for malignant melanoma of the choroid. Br J Ophthalmol 1966; 50: 147–155.
Lommatsch PK, Volmer R . Ein neuer Weg zur konservativen Therapie intraokularerTumoren mit Betestrahlen (106Ru/106Rh) unter Erhaltung der Sehfahigkeit. Klin Monatsbl Augenheilkd 1966; 148: 682–699.
Sealy R, le Roux PLM, Rapley F, Hering E, Shackleton D, Sevel D . Treatment of ophthalmic tumours with low-energy sources. Br J Radiol 1976; 49: 551–554.
Lecuona K, Stannard C, Hart G, Myer L, Wetter J The treatment of squamous carcinoma of the conjunctiva with beta irradiation. Presented at the International Society of Ocular Oncology (ISOO) meeting. Cambridge: England. 8–12 September 2009.
Damato B, Coupland SE . An audit of conjunctival melanoma treatment in Liverpool. Eye 2009; 23: 801–809.
Brualla L, Zaragoza FJ, Sempau J, Wittig A, Sauerwein W . Electron irradiation of conjunctival lymphoma. Monte Carlo simulation of the minute dose distribution and technique optimization. Int J Radiat Oncol Biol Phys 2012; 83: 1330–1337.
Goda JS, Le LW, Lapperriere NJ, Millar BA, Payne D, Gospodarowicz MK et al. Localised orbital mucosa-associated lymphoma managed with primary radiation therapy: efficacy and toxicity. Int J Radiat Oncol Biol Phys 2011; 81: e659–e666.
Hata M, Omura M, Koike I, Tomita N, Iijima Y, Tayama Y et al. Treatment effects and sequelae of radiation therapy for orbital mucosa-associated lymphoid tissue lymphoma. Int J Radiat Oncol Biol Phys 2011; 81: 1387–1393.
Chauvel P, Caujolle JP, Sauerwein W, Friedrichs W, Brassart N, Herault J . Proton therapy as a possible salvage treatment for conjunctival melanomas. In: Frezzotti R, Balestrazzi E, Falco L, (eds) Intraocular and Epibulbar Tumors. Monduzzi Editore: Bologna, 1994 pp 177–181.
Sauerwein W, Stannard CE . Auge und Orbita. In: Bamberg M, Molls M, Sack H, (eds) Radioonkologie Band 2: Klinik, W. Zuckschwerdt Verlag München Wien: New York, 2009 pp 294–316.
Wuestemeyer H, Sauerwein W, Meller D, Chauvel P, Schueler A, Steuhl KP et al. Proton radiotherapy as an alternative to exenteration in the management of extended conjunctival melanoma. Graefes Arch Clin Exp Ophthalmol 2006; 244: 438–446.
Stannard CE, Sealy GRH, Hering ER, Pereira SB, Knowles R, Hill JC . Malignant melanoma of the eyelid and palpebral conjunctiva treated with I-125 brachytherapy. Ophthalmology 2000; 107: 951–958.
Shields CL, Shields JA, Cater J, Othmane I, Singh AD, Micaily B . Plaque therapy for retinoblastoma. Long term tumour control and treatment complications in 208 tumors. Ophthalmology 2001; 198: 2116–2121.
Stannard C, Sealy R, Shackleton D, Hill J, Korrubel J . The use of I-125 plaques in the treatment of retinoblastoma. Ophthalmic Paediatr Genet 1987; 8: 89–93.
Schueler AO, Fluhs D, Anastassiou G, Jurklies C, Neuhauser M, Schilling H et al. β-ray brachytherapy with Ru-106 plaques for retinoblastoma. Int J Radiat Oncol Biol Phys 2006; 65: 1212–1221.
Schipper J . An accurate and simple method for megavoltage radiation therapy of retinoblastoma. Radiother Oncol 1983; 1: 31–41.
Toma NMG, Hungerford JL, Plowman PN, Kingston JE, Doughty D . External beam radiotherapy for retinoblastoma: II. Lens sparing technique. Brit J Ophthalmol 1995; 79: 112q–117q.
Messmer E, Sauerwein W, Heinrich T, Hopping W, Klueter-Reckmann D, Bornfeld N et al. New and recurrent tumor foci following local treatment as well as external beam radiation in eyes of patients with hereditary retinoblastoma. Graefe’s Arch Clin Exp Ophthalmol 1990; 228: 426–431.
Krengli M, Hug EB, Adams JA, Smith AR, Tarbell NJ, Munzenrider JE . Proton radiation therapy for retinoblastoma: comparison of various intraocular tumour locations and beam arrangements. Int J Radiat Oncol Biol Phys 2005; 61: 583–593.
Stannard C, Sealy R, Hering E, Korrubel J, Hill J, Barron A et al. Localised whole eye radiotherapy for retinoblastoma using an I-125 applicator, ‘Claws’. Int J Radiat Oncol Biol Phys 2001; 51: 399–409.
Stannard C, Hering E, Lecuona K, Maree G, Munro R, Davidson A Localised whole eye therapy for retinoblastoma using an iodine-125 applicator, ‘claws’. Presented at the International Congress of Ocular Oncology (ICOO). Siena, Italy. 25–30 June 2007.
Stannard C, Sealy R, Hering E, Hough J, Knowles R, Lecuona K et al. Postenucleation orbits in retinoblastoma: treatment with I-125 brachytherapy. Int J Radiat Oncol Biol Phys 2002; 54: 1446–1454.
Stannard C, Maree G, Munro R, Lecuona K, Sauerwein W . Iodine-125 orbital brachytherapy with a prosthetic implant in situ. Strahlenther Onkol 2011; 187: 322–327.
Shields CL, Naseripour M, Shields JA, Freire J, Cater J . Custom-designed plaque radiotherapy for non-resectable iris melanoma in 38 patients: tumour control and ocular complications. Am J Ophthalmol 2003; 85: 648–656.
The Collaborative Ocular Melanoma Study Group. Design and methods of a clinical trial for a rare condition: The Collaborative Ocular Melanoma Study. COMS report no. 3 Control Clin Trials 1993; 14: 362–373.
Finger PT, Berson A, Ng T, Szechter A . Palladium-103 plaque radiotherapy for choroidal melanoma: an 11 year study. Int J Radiat Oncol Biol Phys 2002; 54: 1438–1445.
Char DH, Castro JR, Quivey JM, Phillips TL, Irvine AR, Stone RD et al. I-125 brachytherapy versus helium ion irradiation. Ophthalmology 1989; 96: 1708–1715.
Packer S, Stoller S, Lesser ML, Mandel FS, Finger PT . Long term results of iodine-125 irradiation of uveal melanoma. Ophthalmology 1992; 99: 767–774.
Fontanesi J, Meyer D, Xu S, Tai D . Treatment of choroidal melanoma with I-125 plaque. Int J Radiat Oncol Biol Phys 1993; 26: 619–623.
Wilson M, Hungerford J . Comparison of episcleral plaque therapy and proton beam radiation therapy for the treatment of choroidal melanoma. J Ophthalmol 1999; 106: 1579.
Shields C, Naseripour M, Cater J, Shields JA, Demirci H, Youseff A et al. Plaque radiotherapy for large posterior uveal melanomas (⩾8 mm thick) in 354 consecutive patients. Ophthalmology 2002; 109: 1838–1849.
Kivela T, Puusaari I, Damato B . Transscleral resection versus iodine brachytherapy for choroidal malignant melanoma 6 millimeters or more in thickness: a matched case-control study. Ophthalmology 2003; 110: 2235–2244.
Damato B . Adjunctive plaque radiotherapy after local resection of uveal melanoma. Front Radiat Ther Oncol 1997; 30: 123–132.
Egger E, Zografos L, Schalenbourg A, Beati D, Boehringer T, Chamot L . Eye retention after proton beam radiotherapy for uveal melanoma. Int J Radiat Oncol Biol Phys 2003; 55: 867–880.
Dendale R, Lumbroso-Le Rouic I, Noel G, Feuvret L, Levy C, Delacroix S et al. Proton beam radiotherapy for uveal melanoma; results of Curie Institute-Orsay Proton Therapy Centre (ICPO). Int J Radiat Oncol Biol Phys 2006; 65: 780–787.
Gragoudas E, Wenjun U, Goitein M, Lane AM, Munzenrider JE, Egan KE . Evidence-based estimates of outcome in patients irradiated for intraocular melanoma. Arch Ophthalmol 2002; 120: 1665–1671.
Dunavoelgyi R, Dieckmann K, Gleiss A, Sacu S, Kircher K, Georgopoulos M et al. Local tumour control, visual acuity and survival after hypofractionated stereotactic photon radiotherapy of choroidal melanoma in 212 patients treated between 1997 and 2007. Int J Radiat Oncol Biol Phys 2011; 81: 100–205.
Aizman A, Finger PT, Shabto U, Szechter A, Berson A . Palladium-103 (103Pd) plaque radiation therapy for circumscribed choroidal hemangioma with retinal detachment. Arch Ophthalmol 2004; 122: 1652–1656.
Zografos L, Egger E, Bercher L, Chamot L, Munkel G . Proton beam irradiation of choroidal hemangioma. Am J Ophthalmol 1998; 126: 261–268.
Levy-Gabriel C, Rouic LL, Plancher C, Dendale R, Delacroix S, Assetain B et al. Long-term results of low dose proton beam therapy for circumscribed choroidal hemangioma. Retina 2009; 29: 170–175.
Ritland JS, Eide N, Tausjo J . External beam irradiation therapy for choroidal haemangioma. Visual and anatomic results after a dose of 20-25 Gy. Acta Ophthalmol Scand 2001; 79: 184–186.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
This paper was presented at the Cambridge Ophthalmology Symposium. 13–14 September 2012.
Rights and permissions
About this article
Cite this article
Stannard, C., Sauerwein, W., Maree, G. et al. Radiotherapy for ocular tumours. Eye 27, 119–127 (2013). https://doi.org/10.1038/eye.2012.241
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2012.241
Keywords
This article is cited by
-
Surgical resection and orbital iodine-125 brachytherapy for orbital malignancy: a novel treatment for orbital lymphoma
International Ophthalmology (2023)
-
Klinik und Versorgung von radiogenen Behandlungsnebenwirkungen am Auge
Die Ophthalmologie (2022)
-
Iodine-125 interstitial brachytherapy for malignant lacrimal sac tumours: an innovative technique
Eye (2021)
-
Management of conjunctival melanoma with local excision and adjuvant brachytherapy
Eye (2021)
-
Ocular surface squamous neoplasia: management and outcomes
Eye (2021)
