Sight-Saving Radiation for a Rare Eye Cancer
After experiencing flashes in his vision, Frederick Wehden of Chestertown, MD, went to see his eye doctor. A scan of his eye revealed a tumor, and he was immediately scheduled to see William Deegan, MD, a retina specialist with a subspecialty in ocular oncology. Dr. Deegan performed an ultrasound which revealed a melanoma on the lining of the inside of Frederick’s eye, underneath the retina.
“Melanoma of the eye is a rare cancer, occurring in only about seven people per million each year,” says Dr. Deegan, who is the only ocular oncologist in the Washington, DC metro area and one of only about 12 in the United States.
The symptoms are similar to retinal detachment and include flashes, floaters and distortions in vision. Melanoma of the eye is more common in people with light skin and light-colored irises. Frederick also had a chest X-ray and CT scan of his liver to determine if the cancer had spread. It had not.
Dr. Deegan explained to Frederick that melanoma of the eye can be treated in one of two ways. The eye can be removed surgically or it can be treated with radiation in an eye- and vision-sparing procedure called plaque brachytherapy. Both options have the same survival rate and the same reduced risk of the cancer metastasizing, or spreading, to the liver, lungs and other organs.
In plaque brachytherapy, rice-sized radioactive seeds are attached to a gold or steel disc called a plaque. The surgeon, Dr. Deegan, places the plaque on the eyeball precisely over the tumor; it is held in place with temporary stitches. The seeds slowly emit radiation into the tumor for four to five days. Then the plaque is removed and the tumor disintegrates over time. In 98% of cases, it is effective in killing the tumor; 40% of patients don’t lose any of their vision. Because of the size and location of Frederick’s tumor, Dr. Deegan recommended plaque brachytherapy.
“I was shocked at my diagnosis, but Dr. Deegan was very confident in the effectiveness of radiation therapy treatment,” Frederick says.
Virginia Hospital Center is the only hospital in the Mid-Atlantic region where plaque brachytherapy is performed — the next closest treatment facility is in Philadelphia.
“I’ve been operating at Virginia Hospital Center since 1998,” Dr. Deegan says. “They take really good care of my patients. The radiation oncology department here has an excellent reputation.” Robert Hong, MD, Chief of Radiation Oncology, Virginia Hospital Center, carefully explained the entire procedure to Frederick.
First, the radiation oncology team took scans of his eye to provide measurements for creating the custom-designed plaque and lead patch to cover his eye during treatment. Then, the optimal dosage and layout of the radioactive sources are planned.
“When the plaque is in place, the radiation is directed to the inside of the eye, directly at the tumor. There is no radiation exposure to other parts of the eye or brain,” says Dr. Hong. “This treatment allows us to destroy the tumor and leave the patient with a functioning eye — preserving better quality of life.”
After surgery, Frederick wore the lead eye shield while the plaque was in place to protect anyone he came in contact with from radiation exposure. He spent four days in the hospital. Then he returned to surgery to have Dr. Deegan remove the plaque.
The procedure and treatment went exactly the way Drs. Deegan and Hong described it. “I felt really good afterwards,” Frederick recalls. “I was told I could have pain and headaches, but I had no problems at all. The hospital was great. Everyone — the nurses, the social worker, the doctors — were all very supportive.”
In the months since he had his treatment, Frederick says he still has some flashes in his eye, but his latest visit to Dr. Deegan revealed that the tumor is shrinking. A biopsy of the tissue showed a low risk of metastasis, and Frederick is very optimistic about his chances for a full recovery.
Sophisticated treatment planning: This image represents a simulation of the radiation dose delivered by the plaque to treat the eye melanoma tumor.