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Spencer Arnould DOS 525 Brachytherapy 4/22/13 Brachytherapy Surface Application Within the world of brachytherapy there are

various methods to treating numerous kinds of cancers in the body. For most applications, brachytherapy can be divided into four different categories. These categories include interstitial, intracavitary, intraluminary, and surface treatment brachytherapy. Of these applications, surface brachytherapy is a very common method used to treat any kind of cancers that come towards the surface of the skin superficially. This is due to the advantages of radioactive brachytherapy sources being able to treat more superficially than x-ray or surface treatments like external beam therapy. Surface applications of treatment have been more commonly applied intraoperative after a total resection of the exposed tumor.1 This method also allows for not only sparing of tissues, but also organ and normal physiological functioning in the body.1 One of the more common methods of treating with surface applicators is the use of eye plaques. This form of treatment is used most often to treat choroidal melanoma of the eyeball. This form of brachytherapy uses small rice-sized radioactive isotope Iodine-125 (125I) or Palladium-103 (103P), in which each seed is placed within a small insert backing made of gold or steel (Figure 1).2 Once the radioactive seeds have been measured, they are placed within the plaque that holds the seeds together (the number of seeds usually depend on the source strength, and dose to be delivered). After the seeds have been placed within the plaque container, the plaques are then sutured on the effected area of the eye (Figure 2 and 3). This procedure normally takes place within a specific operating room and is completed by an eye care specialist. Depending on the tumor size, location, and physician prescription, the eye plaque will stay on the effected tumor for a specific amount of time, usually treating anywhere from 70-100 Gray (Gy) in one treatment.2 The patient can be allowed to return home for the period of time, but should wear a lead eye patch over the effected eyeball to prevent from any leakage radiation outside of the plaque. Although this procedure is not one of the most comfortable for the patient, it is a much better choice than either total eye removal or external beam therapy, which can cause total blindness in the eye.

2 Figure 1

Figure 1. This figure shows the brachytherapy seed placement into the small backing insert within the plaque. Once the seeds are inserted into place, the top will be covered and is ready for placement.

Figure 2

Figure 2. This figure shows how the radioactive plaque is applied onto the eyeball. It also shows how the radiation would treat the effected area.

3 Figure 3

Figure 3. This figure shows a three-dimensional view of the eyeball and how the eye plaque is sutured onto the area of interest. This process uses a diode light trans illumination in order to better view the plaque placement on the eye.

4 References 1. Han P, Hu K, Shankar R et al. Head and Neck Brachytherapy. In: Devlin P. Brachytherapy Applications and Techniques. Philadelphia, PA: Lippincott Williams & Wilkins; 2007: 49. 2. Eye Cancer Network. Patient Information Web Site. http://www.eyecancer.com/www.eyecancer.com/Patient/Treatment.aspx?nID=4&Treatm ent=Eye+and+Vision+Sparing+Radiation+Therapy+for+Intraocular+Tumors. Accessed April 23, 2013. Figures 1. Eye Cancer Network. http://www.eyecancer.com/www.eyecancer.com/Patient/Treatment.aspx?nID=4&Treatm ent=Eye+and+Vision+Sparing+Radiation+Therapy+for+Intraocular+Tumors. Accessed April 22, 2013. 2. Eye Cancer Network. http://www.eyecancer.com/www.eyecancer.com/Patient/Treatment.aspx?nID=4&Treatm ent=Eye+and+Vision+Sparing+Radiation+Therapy+for+Intraocular+Tumors. Accessed April 23, 2014. 3. Eye Cancer Network. http://www.eyecancer.com/research/Research.aspx?nID=38&Research=DiodeLight+Transillumination&nResearchCategoryID=3&sResearchCategory=Innovations. Accessed April 23, 2013.

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