Nick Piotrowski Dos 525 Brachytherapy 4/24/13 COMS Surface Applicator Brachytherapy treatments are a form of radiation therapy

that is delivered on a nonexternal basis. While it can be delivered to virtually any part of the body, they are categorized into four separate categories. While not as common as intracavitary, interstitial, or intraluminal, the surface applicator brachytherapy technique provides the key to treating a variety of cancers. Surface applicators require placing the radioactive material directly on the lesion, sometimes by the use of surgery, and others by an easier means. Although it has been known to help with some retinoblastoma cases, the choroidal ocular melanoma study (COMS) eye plaque is most commonly used for choroidal melanoma.1 Choroidal melanoma is a primary cancer derived from pigmented cells of the choroid of the eye. Unfortunately, because these cancers are not able to be seen by the naked eye, they often grow to a size that is larger than treatable. In cases such as these, most patients opt for enucleation which also has a promising outcome. While the recurrence rate for this disease is low, without treatment it can lead to a loss of vision, or worse yet metastases and mortality.2 During an eye exam performed by an ophthalmologist, the use of x-rays, photographs, and ultrasound, a diagnosis can be made. Figure 1 and Figure 2 respectively show what a choroidal melanoma looks like prior to and following treatment. As seen in Figure 3, the COMS eye plaque is composed of two separate pieces, a silicone insert and a gold covering. The gold capsule helps to protect surrounding structures while also capturing scattered radiation and redirecting towards the tumor. The insert has slits within the silicone that allows for the placement of radioactive seeds in a circular fashion. While the seeds were first composed of Cobalt-60 and Ruthenium-106, studies have shown that the most effective isotopes are Iodine-125 and Palladium-103.1 Both of these isotopes emit their radiation at low energy levels, protecting surrounding portions of the eye. Using local anesthesia, the eye plaques are sutured to the eye after the conjunctiva has been cut away.2 The procedure itself only takes an hour or two, but the patient then remains in the hospital for the rest of treatment. The

treatment itself typically last 3 to 7 days dependent on the seeds radiation output. As the treatments are almost always taken to 85 Gray (Gy), the calculations made by the dosimetrist will help determine the exact amount of time the sources need to be in place. The COMS eye plaque has proven to be an effective treatment for this disease, and is just one more piece of evidence supporting brachytherapys as a treatment.

Figure 1: Choroidal melanoma prior to treatment.

Figure 2: Choroidal melanoma after treatment.

Figure 3: COMS eye plaque.

References
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Finger PT, Iodine-125 and Palladium-103 plaques. Eye Cancer Network. 2013. Available at: http://www.eyecancer.com/Research/Research.aspx?nID=47&Research=About+Iodine125+and+Palladium-103+Plaques. Accessed April 24, 2013. John Hopkins University. About choroidal melanoma. The Collaborative Ocular Melanoma Study. 2005. Available at: http://www.jhu.edu/wctb/coms/booklet/book2.htm. Accessed April 24, 2013.