Brachytherapy for benign fundus lesions

Abstract

Brachytherapy is the surgical placement of a radioactive source near a target lesion to allow local therapeutic delivery of radiation, in an effort to limit collateral damage to adjacent tissues by virtue of the restricted penetrative ability of the radioactive source. The eye is suited to brachytherapy since surgical access to the globe is relatively easy. For nearly 90 years, brachytherapy has been used to treat eye cancers such as retinoblastoma and uveal melanoma. Radiation risks may limit its appeal for treating benign fundus disorders, yet many of these lesions are sight threatening, and the risks of radiation can sometimes be mitigated. This article reviews the literature on the current use brachytherapy to manage benign fundus disorders. Broadly, this encompasses the treatment of benign but sight-threatening tumours, such as retinal capillary haemangiomas, vasoproliferative tumours and choroidal haemangiomas, and to attenuate angiogenesis, inflammatory and fibroblastic activity in neovascular age-related macular degeneration.

Keywords::

• age-related macular degeneration
• benign fundus lesion
• brachytherapy
• choroidal hemangioma
• circumscribed choroidal hemangioma
• diffuse choroidal hemangioma
• plaque radiotherapy
• retinal capillary hemangioma
• vasoproliferative tumor

Financial & competing interests disclosure

T Jackson's employers received research funding from Oraya, NeoVista and Novartis. He served on one paid advisory board for Oraya. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Brachytherapy provides a relatively safe and effective method of delivering radiation to the eye.

• Benign vascular lesions that are not amenable to laser photocoagulation or cryotherapy can be controlled with brachytherapy.

• In benign fundus disorders, the indication for brachytherapy is to preserve or improve vision or increase the chance of retaining the eye, rather than to treat the lesion per se.

• Radiation has the potential to reduce the fibrotic, inflammatory and neovascular processes that cause neovascular age-related macular degeneration.

• Radiation complications can occur, though in benign disorders, the dose is adjusted to be as nontoxic as possible.