Treatment

Radiation Treatment

All the radiation treatments work by ‘sterilising’ the tumour cells so that they are unable to reproduce, growth ceases and eventually the tumour dies.

Proton beam therapy

Protons are high energy, charged particles that are produced by a machine called a cyclotron which is only available at Clatterbridge, a unit in the Wirral. Protons penetrate tissue to a specific, clearly defined depth and area, and for this reason are very practical for treating small areas of the eye. Small markers are surgically inserted on the outside of the eye to mark the tumour, usually under general anaesthetic, to plan the treatment.

Ruthenium plaque therapy

This is a treatment whereby a plaque is surgically placed over the tumour in your eye usually under a general anaesthetic. The plaque contains a radioactive isotope called ruthenium which delivers a dose of radiotherapy to the underlying tissues. These plaques are available in different sizes. This means the correct size can be used for each individual patient, minimising damage to the retina.

Stereotactic radiosurgery

Stereotactic radiosurgery is a type of radiation treatment that uses gamma rays and is only available in Sheffield. Gamma rays are different from the x-rays used in a standard x-ray in that they have a much shorter wavelength. These gamma rays are directed at the tumour in your eye. The advantages of stereotactic radiosurgery are that it is performed under a local anaesthetic and treatment is completed in one day.

Treatments for Uveal Melanoma. Tumours inside the eye

Surgical Treatment

Removal of the eye (enucleation)

People have eyes removed for several different reasons, some of which are given below. Usually, we only consider removal of the eye if:

Your tumour is in a difficult place to treat using conventional treatments e.g. using laser or radiation.
Your tumour is relatively large and because of this there is an increased risk of causing a painful blind eye following conventional treatment.

You decide that removing your eye is a better choice than other treatment options.

For more information please download our leaflet here

Local resection

Occasionally small tumours located near the front of the eye may be removed surgically under a general anaesthetic.

Laser Treatment

Photodynamic therapy (PDT)

PDT is a form of laser therapy that is occasionally used in the treatment of small melanomas and other tumours, including choroidal haemangiomas and choroidal metastasis.

Prior to any making any decisions about the treatment options to treat your cancer, your case will be discussed at a multi-disciplinary team (MDT) meeting. All the clinical team members will attend, taking into account your thoughts and preferences. Your specialist nurse will discuss the recommendations of the MDT with you and arrange your admission for treatment.

Treatments for Uveal Melanoma. Tumours inside the eye

The aims of treatment of uveal melanomas are as follows:

Destroy the tumour
Retain as much vision as possible
Prevent metastasis and recurrence

Whether all these aims can be achieved will depend on the size and location of the tumour and how the various treatments achieve these aims will be discussed in the clinic.

At the Sheffield Ocular Oncology Service, we offer the following treatments:

Laser Treatment:
- Photodynamic therapy (PDT)
Radiation Treatment:
- Ruthenium plaque therapy
- Stereotactic radiosurgery
- Proton beam therapy
Surgery:
- Removal of eye (Enucleation)
- Local resection

The mainstay of treatment of conjunctival tumours is surgical removal (excision) with additional freezing (cryotherapy) of the surrounding tissue.

A number of patients will also require additional treatment with cytotoxic chemotherapy eyedrops such as mitomycin or 5FU which have been shown to reduce the risk of recurrence. Such eye drops may also be used for patients with atypical cells either squamous or PAM as they have been shown to reduce the degree of atypia and hopefully therefore reduce the chance of progression to an invasive tumour.

Occasionally, patients require treatment with plaque radiotherapy or proton beam therapy particularly if the disease is extensive or resistant to conventional treatment.