Brachytherapy Boost For Orbital Tumors

After seed implantation, an x-ray is used to document radioactive seed locations and allow for in vivo dosimetry.
After seed implantation, an x-ray is used to document radioactive seed locations and allow for in vivo dosimetry.

By Paul T. Finger, MD

Dr. Finger has been using the Brachytherapy Boost Technique (BBT) for over 25 years. It is a multidisciplinary approach that can spare patients from exenteration surgery (removal of the eye and all the orbital contents).

During the BBT procedure, instead of removing the eye lids and orbital tissues, the bulk of the orbital tumor is removed and radioactive seeds or HDR catheters are temporarily placed in the tumor-bed. With this method, the area of tumor infiltration is irradiated more than the rest of the remaining ocular and/or orbital structures. An overlay of a reduced amount of external beam radiation therapy is typically given to the entire orbit or targeted zone.

Dr. Finger considers the brachytherapy boost technique in the following clinical situations

1. When the standard external beam radiotherapy would require using a dose so high that it would result in a blind and painful eye (e.g. orbital melanoma, squamous and basal cell carcinoma, adenoid cystic carcinoma).

Catheters (upper right) for radioactive seed implantation are placed at the time of surgery.
Catheters (upper right) for radioactive seed implantation are placed at the time of surgery.

2. When exenteration of the orbit is the only option, but offers historically poor local control rates (e.g. adenoid cystic carcinoma).

3. When a patient refuses exenteration surgery.

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