Ocular tumors are rare. They can be benign or malignant. They may arise in the eye (primary tumors) or may develop from spread from distant primary tumor sites elsewhere in the body (secondary or metastatic tumors to the eye). Melanoma of the eye although unusual, is the most common primary intraocular malignancy in adults.
Ocular melanoma is diagnosed mostly at older ages that peak near the age of 70. Risk factors associated with the development of this cancer include Caucasian race, light eye color, fair skin color, and the ability to tan. There is no scientific evidence that exposure to UV light is a risk factor for uveal melanoma. Most melanomas are initially asymptomatic. As the tumor grows, it might cause symptoms such as abnormalities of the pupil, blurred vision, decreased vision and retinal detachment. Careful examination by an experienced ophthalmologist is essential to diagnose an intraocular melanoma.
Metastases to the eye
Many tumors of the eye are metastatic from other distant primary cancers, specially breast and lung cancer. Management of these tumors is mostly with radiation therapy if the tumor is isolated or combined with chemotherapy depending on the extent of the disease.
Non-Hodgkin Lymphoma (NHL) is the most common type of ocular lymphoma. Depending on the site of involvement, ocular lymphoma can be either intraocular or orbital. The most common symptomatology of intraocular lymphoma is visual impairment. Diagnosis is made by obtaining an intraocular biopsy specimen. Orbital lymphoma is associated with systemic lymphoma in 30-35% of patients. At ICI, we use targeted external beam radiation therapy (EBRT) in the management of ocular lymphoma. Radiation therapy offers high local control rates with minimal side-effects and is non-invasive.
Ocular Melanoma Treatments
Treatment depends on the type of tumor as well as on the extent of disease. In the past, enucleation (eye removal) was the accepted standard treatment for ocular melanoma. However today, when preservation of vision can be obtained there are alternative treatments, like radiation therapy, particularly Brachytherapy. Other treatment methods include external-beam radiation therapy (EBRT), photocoagulation and cryotherapy. Brachytherapy using iodine 125 epiescleral-plaques for small-sized tumors have demonstrated over 90% of globe preservation from a recent study.
At ION, we offer radiation as an eye and vision-sparing alternative for patients with intraocular cancer. The two main types of radiation we use are eye plaque radiotherapy and external beam radiation therapy. Eye plaque brachytherapy is the most widely used treatment for choroidal melanoma and delivers a highly concentrated radiation dose to the tumor (with relatively less radiation to surrounding healthy tissues). Placement of the plaque is performed in the operating room. During the procedure, the eye surgeon will attach the plaque to the wall of the eye, covering the base of the intraocular tumor. The plaque stays in the patient for 72 hours. The procedure is done in conjunction with the radiation-oncologists and the medical physicist. Dr. Amendola and Dr. Wu have several decades of experience in this field.