Ocular Brachytherapy (Interventional Radiotherapy): Preserving the Vision

Uveal melanoma represents the most common intraocular neoplasia among adults. Brachytherapy (interventional radiotherapy; IRT) has a great advantage, when compared with enucleation, both in terms of organ and function sparing. The Collaborative Ocular Melanoma Study introduced into clinical practice a standardised procedure that allowed the equivalence of IRT with enucleation in terms of overall survival to be demonstrated. IRT is carried out by placing a plaque in direct contact with the sclera under the uveal melanoma. Several radioactive sources may be used, including 106-ruthenium, 125-iodine, 103 palladium and 90-strontium. It is a multidisciplinary procedure requiring the collaboration of interventional radiation oncologists and ophthalmologists in the operating theatre and medical physicists for an accurate treatment time calculation. It also relies on ultrasound imaging to identify the lesion and verifiy the correct plaque placement. An emerging tool of paramount importance could be the use of artificial intelligence and predictive models to identify those patients at higher risk of developing late side-effects and therefore who may deserve preventive and supportive therapies. & COPY; 2023 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Automated summary

Uveal melanoma is the most common eye tumor in adults. Brachytherapy, compared to enucleation, offers advantages in preserving organ and function. The Collaborative Ocular Melanoma Study demonstrated the equivalence of interventional radiotherapy (IRT) and enucleation in terms of overall survival. IRT involves placing a plaque with radioactive sources in direct contact with the sclera under the melanoma. Multidisciplinary collaboration is required in this procedure, involving interventional radiation oncologists, ophthalmologists, and medical physicists. The use of artificial intelligence and predictive models could help identify patients at higher risk of late side-effects.