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Radiotherapy for eye melanomas

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This page tells you about radiotherapy for melanoma of the eye. There is information about

 

A quick guide to what's on this page

Radiotherapy for eye melanomas

Radiotherapy uses high energy rays to kill cancer cells. It is really only a suitable treatment for small or medium sized eye melanomas. If you have radiotherapy it may be possible to save the eye and keep your sight. This will depend on where the tumour is within the eye, as well as its size. Sometimes you have surgery before radiotherapy.

Brachytherapy (internal radiotherapy)

This type of radiotherapy cures 9 out of 10 people who have small or medium eye melanomas. To have brachytherapy, you need a small operation under general anaesthetic. You have tiny radioactive plates (called plaques) sewn in place above your eye tumour. They stay in place for up to a week. They give off a high dose of radiation directly to the cancer. Because of the radiation, you stay in a single room in the hospital, and visiting time is limited. When the plaques are removed, all the radiation will be gone.

External radiotherapy

This means directing radiotherapy beams at the tumour from outside the eye. Before external radiotherapy, you may need to have a small operation to put in metal clips (tags) at the back of the eye. These help your specialist to plan and give your treatment accurately. You will probably have to stay in hospital for a couple of days after they are put in. Instead you may be offered a treatment called radiosurgery or gamma knife. With this type of treatment, a frame keeps your head very still and then a beam of radiation targets the tumour very precisely. It is still a relatively new treatment and only suitable for certain people.

 

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When radiotherapy is used to treat eye melanoma

Radiotherapy uses high energy rays to kill cancer cells. It is really only a suitable treatment for small or medium sized eye melanomas.

You usually can’t have radiotherapy for a large eye tumour because the amount of radiation you would need is too much for the rest of the eye. Large doses of radiotherapy would mean losing the sight in that eye, so the result would be no better than removing the eye with surgery. Radiotherapy can also cause other problems such as an increase in pressure within the eye (glaucoma).

If you have radiotherapy for a small or medium sized eye melanoma, it may be possible to save the eye and keep your sight. This will depend on where the tumour is within the eye, as well as its size. Sometimes you have surgery for your eye melanoma before you have radiotherapy.

There are different ways of giving radiotherapy to the eye. They are

  • Brachytherapy – small radioactive plates stitched to the eye give the radiotherapy (local radiotherapy)
  • External beam therapy – a machine directs radiotherapy beams at the tumour from outside the eye
 

Local radiotherapy (brachytherapy)

You may have brachytherapy for a melanoma inside the eye that has not spread into the socket. This type of radiotherapy cures 9 out of 10 people who have small or medium eye melanomas. You can’t have brachytherapy if your tumour is too thick. This is because the radiation would not reach the whole tumour. In this case, you would have external beam radiotherapy instead.

To have brachytherapy you need a small operation under general anaesthetic. You have tiny plates (called plaques) sewn in place alongside your eye tumour. The plaques have a lining of radioactive material. They stay in place for up to a week, depending on how thick your tumour is. During this time the plaques give off a high dose of radiation directly to the cancer in your eye. But the radiation does not travel further than 6 to 7mm so it does not damage other parts of your eye near to the tumour. This can vary slightly depending on the type of radioactive material used.

While you have the plaques in place, you will stay in a single room in the hospital. This is because the plaques give off a small amount of radiation. So other people in the room are exposed to it. Your nurses will monitor the amount of time your visitors spend in your room. And as a precaution, they will only be able to stay for a set period of time so that they don’t get too much exposure to the radiation. Pregnant women and children will not be able to visit you at all.

When the treatment time is up, you have another operation to remove the radioactive plaques. After this, all the radiation is gone, along with the plaques. So you will not give off any radiation to yourself or anyone you are with. All your personal belongings that were in the room with you during the treatment are safe to take home. They won’t be radioactive.

There is more information on the safety procedures for internal radiotherapy in the main radiotherapy section.  It can be quite difficult and boring having to stay in one room, even if it is only for a few days. Make sure you take something to keep you occupied. Recordings of favourite music or talking books are a good idea. It is safe to watch TV and needs very little eye movement. The ward will usually provide a radio or TV.  If they can’t provide one, ask if you can take your own in.

 

External radiotherapy

This means directing radiotherapy beams at the tumour from outside the eye. You can have external radiotherapy from several different types of machine. Some are better for treating cancers near the skin surface and others are best for cancers that are deeper in the body. Your radiotherapy specialist (clinical oncologist) will carefully choose the machine they will use for you.

Sometimes doctors name external radiotherapy treatment after the machines they use to give it. For treating eye melanomas the machines used include

Before having external radiotherapy, you may need to have a small operation to put in metal clips (tags) at the back of the eye. These help your radiographer to give your treatment accurately. You will have the clips put in under general anaesthetic. They remain in place after treatment and will not affect your vision.

You will probably have to stay in hospital for at least a couple of days after the clips are put in. This is because the pressure in the eye can rise after an operation like this. If this happens, your doctor will want to treat you as soon as possible to prevent any damage in your eye.

Cyclotron

The Cyclotron machine treats eye cancers using a different type of radiation known as proton radiation. The proton beams are aimed directly at the tumour and focus very precisely. So the surrounding healthy eye tissue gets very little radiation. Doctors call treatment using this type of machine proton therapy.

Radiosurgery

There are several types of radiosurgery machine, including the gamma knife. The radiation from these machines treats the tumour with a very high dose of radiation that is precisely targeted. It is a fairly new treatment that is only suitable for certain patients.

To have radiosurgery you need to have a frame fixed to your head. This keeps your head completely still and helps to target the radiation beam so that only the tumour gets the strong dose of radiotherapy. After the head frame is fixed to your head you have an MRI scan to locate the tumour precisely. You then have the radiosurgery. It usually takes between 30 minutes and an hour to have the treatment. The whole treatment is completed in a day.

Transpupillary Thermotherapy (TTT)

This treatment is used for small eye melanomas or as a treatment after radiotherapy. TTT uses infrared light (a special type of laser beam) to heat the tumour and destroy the cancer cells. You may need several treatments.

LINAC

The LINAC is one of the most common standard radiotherapy machines. Cancer specialists use this type of machine to treat many different types of cancer. But it is not often used to treat eye melanoma in the UK.

Picture of a LINAC radiotherapy machine

 

More information about radiotherapy

Our general radiotherapy section  has detailed information about

Look at our general cancer organisations page for organisations that can give you more information about radiotherapy.

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Updated: 24 September 2013