New Radiation Instructions for Eye Plaque Patients 2018
Based on published guidelines from United States Nuclear Regulatory Commission (NRC), The New York Eye Cancer Center and its affiliate New York Eye and Ear Infirmary of Mt. Sinai have agreed that patients undergoing low energy (iodine-125 or palladium-103) eye plaque radiation therapy for intraocular melanoma are allowed to proceed with their lives as usual.
Before this change, eye plaque patients were required to almost quarantine themselves. They had to remain at home, maintain a distance of 6-feet from others, and no pregnant women or children were allowed to visit.
With the new changes, patients can use public transportation. We ended most of the radiation exposure precautions and restrictions (i.e. you may go to the park, restaurants, grocery stores…etc.). However, it is recommended that patients stay at home as much as possible and that they do not engage in activities that could dislodge the implant and/or seeds. As before, the patient’s body fluids, clothing, and utensils ARE NOT radioactive and can be handled by others safely. We ask that the patient sleep alone and in a separate room away from anyone under the age of eighteen.
Dr. Finger says it’s about time: “With the radiation implants I use, eye cancer patients typically receive only a small fraction of the radiation given to patients undergoing implant radiation for other cancers, where patients are sent home on the day of implant.”
Though a few rules remain, they new radiation instructions are not nearly as strict. Free at last, patients can feel the sunlight, do their own shopping, and enjoy the company of their loved ones.
October 2018–––In a recent publication in Cornea: The Journal of Cornea and External Disease, a noteworthy case report describes a patient with squamous cell carcinoma (SCC) in his only functioning eye who had his vision saved using a remarkable application of palladium-103 plaque radiation therapy.
Of all subtypes of conjunctival and corneal cancer, SCC is the most prevalent. The most common treatment for this type of superficial tumor is chemotherapy eye drops. However, in this particularly unique case, a functionally monocular patient presented with invasion of squamous cell cancer through a corneal wound into his eye. Maintenance of vision was essential for this patient, as he could only see using the affected eye.
Thus, a complex decision had to be made. Dr. Finger noted:
“Though we can treat even giant squamous carcinomas of the conjunctiva with topical chemotherapy eye drops, there is no evidence to support their use for intraocular tumor invasions. It is my opinion that it was unlikely that chemotherapy eye drops would penetrate deep enough into the eye to cure this patient.”
This was the potentially vision-saving observation. Since the SCC had spread internally, topical treatment was unlikely to reach the tumor. Had this treatment been chosen as a conservative intervention, the patient might have lost total vision and/or the entire eye.
In an effort to treat the tumor with minimum damage to the eye, palladium-103 plaque radiation therapy was chosen as an eye and vision-saving solution to the patient’s particular case. Such would simultaneously save the patient’s sight and their life.
According to the article, surgery was performed in June of 2014. Nearly 4 years later, the tumor has regressed without recurrence, and his vision is the same as before the radiation.
Thus, even in the face of the most unique cases, palladium-103 radiation therapy has proved remarkably effective.
For more information read the full case report here: [link]
The New York Eye and Ear Infirmary of Mt. Sinai Ocular Oncology Service [link]
The New York Eye Cancer Center and the Eye Cancer Foundation were quite actively represented at the 2017 American Association of Ophthalmic Oncologists and Pathologists (AAOOP) Annual Meeting. The meeting was held on Friday, November 10, 2017 at the Hampton Inn & Suites Convention Center, located in the vibrant city of New Orleans, Louisiana, and was attended by Dr. Paul Finger as well as notable ECF-ICO Fellowship alumni, Dr. Sonal Chaugule, Dr. Ekatrina Semenova, and Dr. Abhilasha Maheshwari.
Now, what are ITA, RM, and Bevacizumab? Often, patients undergoing eye plaque radiation in order to treat their cancerous tumor can be subject to vision-impairing radiation side-effects, or radiation maculopathy (RM), as a result of treatment. Intravitreal anti-VEGF therapy (which is otherwise commonly used to treat macular degeneration) such as Bevacizumab (Avastin), Lucentis, and Eyelea, are used to prolong the effects of radiation maculopathy. Itravitreal triamcinolone acetate (ITA) is a steroid used in conjunction with this anti-VEGF therapy to treat swelling that occurs in the affected eye, called macular edema.
The paper aims to evaluate the effects of using ITA for the treatment of RM in patients with choroidal melanoma after plaque radiotherapy. Eight choroidal melanoma patients undergoing this treatment were studied, having ITA treatment at 4-16 week intervals in addition to continued injections of Avastin. Results found that after starting ITA, vision was stable or improved for patients, leading to the conclusion that ITA can be used as a supplement to decrease macular edema (swelling) and preserve vision in choroidal melanoma patients with RM.
Dr. Abhilasha Maheshwari had separately presented ECF-supported research — a 12-year study evaluating patients with slotted, low energy photon eye plaque radiation therapy. The purpose? To measure the efficacy of this treatment for eye cancer patients, especially those who have tumors located near, touching, or surrounding the optic disc (a critical area that allows for vision) were treated. Forty six patients of these eye cancer patients were treated with eye plaque radiation therapy, using seeds of the chemical isotope Palladium-103 to radiate the affected eye. Over the next 12 years, these patients were monitored for any changes to tumor thickness, visual acuity, and whether or not the cancer had reoccured or metastasized. Results found that the local control rate (i.e, total tumor destruction) was 95.6%, and lead to the conclusion that Slotted Eye Plaque Radiation Therapy is indeed an efficient method of treatment for eye cancer patients. To read the paper, published in the American Journal of Ophthalmology, click here.
But the AAO updates do not end here! Stay tuned for upcoming information on even more presentations at AAO 2017 by ECF alumni.
Patient Stories
"Very well treated by Dr. Finger. He explained everything I needed to know about my issue with detail and attention, putting me at ease and giving me confidence to handle this problem for the rest of my life.”
– N.N.
