A Visionary Treatment

Eye cancer patient

Eye cancer patients get new hope from an innovative radiation therapy.

Moles on the skin are familiar to most people. Less familiar is the fact that mole-like growths called nevi can form inside the eye as well. And just like moles on the skin, nevi in the eye can develop into melanoma, a form of cancer that often spreads to other parts of the body.

“Melanoma of the eye is a relatively rare type of cancer for radiation oncologists to be involved with,” says Dolly Razdan, MD, Medical Director of Radiation Oncology at Clara Maass Medical Center (CMMC) and a member of Barnabas Health Medical Group. “As a result, very few specialists are
qualified to treat it.” Treatment is available at CMMC through a partnership with ophthalmologistSteven Madreperla, MD, PhD, President and CEO at NJRetina in Union. “I do all my surgeries at Clara Maass, which is one of a limited number of sites across the country that do ocular oncology,” says Dr. Madreperla.

A silent threat

As with skin moles, nevi are often benign. The tiny lesions develop in a thin layer of blood vessels called the choroid that lies between the retina and the back of the eye. Even when cancerous, choroidal tumors often don’t trigger any symptoms until they become large enough to interfere with vision. “In many cases, they’re picked up on a routine exam,” Dr. Madreperla says. Growths that are found to be melanoma require prompt treatment. “Melanoma can be lethal,” Dr. Madreperla says.

“The primary goal is to eradicate the tumor in the eye before it has a chance to spread.” Choroidal melanoma that escapes the eye becomes much more difficult to treat. “As eye doctors, our primary goal is preserving the patient’s vision,” says Dr. Madreperla. “In ocular oncology, we need to consider a great priority: survival.”

Preserving the eye

Traditional surgery for eye melanoma involves removing the eye. “That can be psychologically devastating for patients,” says Dr. Razdan. “Even if they lose vision in that eye, people would rather keep their original eye than have a prosthesis.” In addition, traditional external beam radiation therapy is not considered a good option because of the amount of local tissue in the area that would be unnecessarily treated. Instead, oncologists use an innovative radiation procedure called brachytherapy, sometimes known as internal radiation.“‘Brachy’ means the radiation source is placed very close to the tumor,” says Dr. Madreperla.

Seeds of hope

With brachytherapy, radioactive seeds are loaded into a small disk called a plaque that is implanted near the melanoma. “It looks like a small gold coin sewn into the back of the eye directly underneath the tumor,” says Dr. Madreperla. “The expertise of the radiation oncologist makes this approach possible at Clara Maass.” Disks are customized for each patient based on variables such as the size and position of the tumor. “Dr. Madreperla provides measurements from his exam that help us plan factors such as the number and strength of the seeds to be used,” says John Sakellakis, Chief Medical Physicist at CMMC.

Brachytherapy allows high doses of radiation to bathe the tumor over the course of several days while generally sparing other parts of the eye. “ The opposite end of the eyeball gets very little radiation,” Sakellakis says. Surgery to place the plaque and its radioactive seeds typically takes about 45 minutes. “The procedure is similar to many other eye surgeries,” says Dr. Madreperla. Patients are discharged after surgery and the plaque remains in the eye for five days, after which patients return for a brief procedure to remove it.

“In 85 to 90 percent of cases, brachytherapy controls the tumor in the eye and prevents it from spreading,” says Dr. Madreperla. Depending on the size and position of the tumor, patients may substantially preserve their eyesight after surgery or lose vision in the affected eye due to the radiation. “It’s a matter of how much radiation is delivered and how close it is to vital structures of the eye,” says Dr. Madreperla.

Recovery is typical of other eye surgeries, with stiffness, swelling or discomfort generally abating after a week or two and remaining vision returning within two to four weeks. “That’s generally the entire treatment,” says Dr. Madreperla.

Vigilance is key

It’s important for patients to continue being monitored after surgery. “A medical oncologist also becomes involved,” says Dr. Razdan. “Because melanoma has a propensity to spread, patients need consistent follow-up to make sure the cancer hasn’t metastasized to other parts of the body.”

The silent nature of eye melanoma highlights the importance of getting regular eye exams either to update a prescription for corrective lenses or to have eyes evaluated by an ophthalmologist. “It’s during the early stages that eye melanoma is symptom-free,” says Dr. Madreperla. “In too many cases, by the time we see people, things are already far along.”

Learn more about eye cancer treatment at Clara Maass Medical Center..

RWJBarnabas Health and Clara Maass Medical Center, in partnership with Rutgers Cancer Institute of New Jersey—the state’s only NCI-Designated Comprehensive Cancer Center—provide close-to-home access to the latest treatment and clinical trials. To schedule an appointment with one of our cancer specialists, click here or call (844)-CANCERNJ or (844) 226-2376.