Ocular Brachytherapy (Interventional Radiotherapy): Preserving the Vision.

Area of Science:

• Ophthalmology
• Radiation Oncology
• Medical Imaging

Background:

• Uveal melanoma is the most common adult intraocular neoplasia.
• Brachytherapy (interventional radiotherapy; IRT) offers organ and function sparing compared to enucleation.
• The Collaborative Ocular Melanoma Study established IRT's equivalence to enucleation in overall survival.

Purpose of the Study:

• To summarize the principles and practice of IRT for uveal melanoma.
• To highlight the multidisciplinary nature of IRT.
• To explore the potential role of artificial intelligence in managing IRT side effects.

Main Methods:

• IRT involves placing a radioactive plaque (using sources like 106-ruthenium, 125-iodine, 103-palladium, 90-strontium) on the sclera.
• Ultrasound imaging is crucial for lesion identification and plaque placement verification.
• Accurate treatment time calculation requires medical physicist expertise.

Main Results:

• IRT demonstrates equivalence to enucleation in overall survival.
• The procedure requires close collaboration between interventional radiation oncologists, ophthalmologists, and medical physicists.
• Ultrasound is essential for precise localization and treatment delivery.

Conclusions:

• Interventional radiotherapy is a valuable organ- and function-sparing treatment for uveal melanoma.
• Multidisciplinary collaboration and precise imaging are key to successful IRT.
• Artificial intelligence and predictive modeling show promise for identifying patients at risk of late side effects, enabling targeted supportive therapies.