Choroidal Melanoma (eye cancer)

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Information for patients referred for plaque therapy

You have been diagnosed with a choroidal melanoma in your eye by your ophthalmologist and have been referred for an assessment and treatment. Please take some time to read this information leaflet to answer some of your questions. If you still have urgent queries you may contact Loretta at 021 671 5154 during office hours.

What is a choroidal melanoma?

Choroidal melanoma is a tumour in the blood vessel layer of the eye. It is an uncommon tumour, and may sometimes be very difficult to diagnose. There are also other nontumour conditions that may look like a choroidal melanoma.

What is plaque therapy?

Radiotherapy is one of the ways to stop a tumour from growing. Radiotherapy can either be given at a distance, from equipment very much like X-ray machines, or by applying the radio-active substance very close to the tumour. In the case of a tumour in the eye, this is called plaque therapy. It consists of a custom-made mould that is fitted over the eye corresponds to the size of the tumour. A radio active substance is applied to the inner surface of the mould. The mould is attached to the globe, and remains on for 5 days while the tumour is irradiated.

The finer details of the treatment will be discussed with you during your consultation.

What does the treatment for choroidal melanoma involve?

First consultation

This usually occurs on a Monday. We will set up an appointment time with you. The appointments will take all day – please bring a snack with you. You will meet the doctors in charge of your treatment: Dr Steven Lapere (ophthalmologist) at Melrose Eye Clinic and Dr Julie Wetter and her team (radiation oncologist) at Groote Schuur Hospital.

You will undergo a standard ophthalmic examination, similar to the examination that was performed by your referring ophthalmologist. This takes place at Melrose Eye Clinic, 14 Palmyra Road, Claremont. You will also undergo a repeat ultra-sound examination and photographs will be taken. Other examinations to determine the size of the tumour may also be performed. The treatment options will be discussed with you. If indicated, a date will be decided upon for plaque treatment. Your initial visit is a ‘planning’ visit, and treatment will not take place at this visit.

Treatment usually takes place 2-4 weeks after this visit. You may choose to return home between your initial visit and treatment visit. Once this eye examination is complete, you will drive to Groote Schuur Hospital and open a folder. You can take this folder to the radiotherapy department at LE32 and you will be seen by Dr Wetter and her team.

The planning of a custom-made radioactive eye plaque is a collaborative effort between the ophthalmologist, radiation oncologist, medical physicist, mould-room personnel and administrative personnel. Radioactive seeds are ordered for your treatment and placed within the plaque. There are many processes involved in designing and administering this treatment, hence it cannot all happen in one visit.

The Application of the plaque

The operation will involve the attachment of the plaque under general anaesthetic. This operation is performed at UCT Private Academic Hospital and typically lasts 1.5 hours. A patch and lead shield is placed over your eye at the end of the procedure.

Radiation

The plaque stays attached to your eye for approximately 5 days. During this time you will remain in the hospital in a single ward, in a form of isolation. You may feel a bit bored, as you will not be ill at all, and you are welcome to bring a radio, iPad and some books to pass the time. You may receive visitors. The radiation dose is safe to adults, but children and pregnant women should have limited contact with you for these 5 days. Your eye may feel gritty (like there is sand in it) and you will be given regular pain medication to keep you comfortable.

Removal of the plaque

1. The exact duration of the radiation is different for each patient, but is approximately 5 days. The timing of the removal of the plaque will be known once the plaque has been inserted.

2. The plaque is removed under general anaesthetic. You should not book your flight home the same day, as you will need to recover from the general anaesthetic. It is suitable to return home the next day.

Why must you come to Groote Schuur Hospital?

The Radiotherapy Department at Groote Schuur Hospital has been involved in the development of this treatment since 1974. It is the only unit in Southern Africa that has the expertise to design and monitor this type of plaque therapy.

It is important to remember the following:

1. It is possible that we may recommend that plaque therapy is not indicated. In that case, you may need to change your travel arrangements. Please discuss this with your travel agent.
2. Your initial consultation will take all of Monday; the final discussions only take place at about 16:00. Please do not book your return ticket before 20:00.
3. Surgery may be postponed due to unforeseen circumstances. Please bear this in mind when booking transport.
4. Please bring all your medial reports, scans, your doctor’s referral letter and any lists of medication with you for the first consultation.

Further Information

Useful website addresses are:

Eyecancer.com

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