Research your groups particular brachytherapy surface applicator.

Using your texts as well

as other sources, prepare a 3 paragraph (one page) summary with photos of your assigned
surface applicator. Post your summary with references, links, and photos to this discussion
forum.
Discuss the COMS radioactive eye plaque.
Ocular melanoma, also known as choroidal melanoma (CM), is the malignancy most
commonly seen for cancers of the eye.1 It is an extremely rare form of cancer, with an incidence
of 4.3 cases out of a population of 1 million, and without proper detection and diagnosis, can lead
to vision loss, metastasis, and death.
Prior to the 1980s, surgery and enucleation were the only options for CM, leaving patients
disfigured and with a poor quality of life.1 The introduction of radiation therapy, cryotherapy,
photocoagulation, and transpupillary thermotherapy offered patients new hope to spare their vision
and prevent the surgical removal of the eye.
In the interest of eye plaque radiotherapy, the Collaborative Ocular Melanoma Study (COMS)
studied the benefits of surgery as it compares to the benefits of radiation therapy to the eye using
Iridium-125 (125Ir) seeds.2 The results showed similar survival rates between the two options, as
well as the added benefits of eye and vision preservation using radiation therapy.
During the process of eye plaque radiation therapy, a plaque composed of gold is placed
directly on the eye, and the 125Ir seeds are placed directly on the plaque to deliver the desired dose
over the course of several fractions.2 The link provided below has a detailed description of ocular
melanoma and summary of brachytherapy treatment of the eye.3
Eye and Vision Sparing Radiation Therapy for Intraocular Tumors
Figures 1 and 2 below are examples of the first models of COMS eye plaque applicators.2,4
Figure 3 illustrates a modified version of the original model of COMS eye plaques, Iris-270, that
is currently in use at the Mayo Clinic.5 It has proven to have better tissue sparing effects for the
eye and surrounding tissues than those of the pioneer COMS eye applicators by adding inner and
outer lips to the applicator.

Figure 1: COMS eye applicator

Figure 2: Inside view of a COMS eye applicator

Figure 3: Iris-270 plaque

Figure 4: Iris-270 plaque positioned on a patient

References:
1. Karlovits B, Trombetta M, Verstraeten T, et al. Local control and visual acuity following
treatment of medium-sized ocular melanoma using a contact eye plaque: A single surgeon
experience. Brachytherapy. 2011; 10(3): 228-231.
http://dx.doi.org/10.1016/j.brachy.2010.09.003
2. Washington CM, Leaver D. Principles and Practice of Radiation Therapy. 4th ed. St.
Louis, MO: Mosby Elsevier; 2010.
3. Finger P. Eye and Vision Sparing Radiation Therapy for Intraocular Tumors. Eye Cancer
Network website. http://www.eyecancer.com/conditions-and-treatments/treatments/6/eyeand-vision-sparing-radiation-therapy-for-intraocular-tumors. Accessed April 19, 2016.
4. Marwaha G, Wilkinson A, Bena J, et al. Dosimetric benefit of a new ophthalmic radiation
plaque.

Int

Radiat

Oncol

Biol

Phys.

2012;

84(5):

1226-1230.

http://dx.doi.org/10.1016/j.ijrobp.2012.01.084
5. Thomson R, Furutani K, Pulido J, et al. Modified COMS plaques for

125

I and

103

melanoma brachytherapy. Int J Radiat Oncol Biol Phys. 2010; 78(4):1261-1269.

http://dx.doi.org/10.1016/j.ijrobp.2009.12.002

Pd iris