Brachytherapy
Your Eye Exams Prior to Treatment
The decision to treat ocular melanoma is made on a case-by-case basis. If the tumor is small enough, plaque radiation therapy (also known as brachytherapy) may be offered for treatment. Once you have consented, appointment dates for insertion and removal of the plaque are organized. Prior to the plaque insertion date, there are a series of appointments that you are required to attend: at the Royal Alexandra Hospital (RAH) in Edmonton or the Rockyview General Hospital (RGH) in Calgary and at the Cross Cancer Institute (CCI) in Edmonton. Treatment is provided at the Cross Cancer Institute.
Approximately 2 weeks prior: You will have a full ocular assessment, including photos and ultrasound of your eye(s). This will be done at the RAH for patients living in northern Alberta, and the RGH for patients living in southern Alberta.
Approximately 3 days prior: You will have a repeat ultrasound of the eye. This will be done at the same location as your 2 week full ocular assessment.
Since the plaques are custom made for your eye and the size of the tumour, these appointments ensure that there is not too much growth, and that the custom plaque will be effective.
Ultrasound uses sound energy to measure the thickness of the tumor. Photographs allow for comparison of changes in the size of the base of the tumor, and optical coherence tomography (OCT) measures the amount of fluid and health of the retina. A Humphrey Visual Field Exam, which allows for detection of any dysfunction of central and peripheral visual fields will also be performed prior to your insertion date.
Your Visit to the Cross Cancer Institute
At the CCI, six appointments are booked prior to the plaque insertion day. Efforts are made to place all of these appointments on the same day; however, this cannot be guaranteed. You will receive a phone call to discuss the details. These six appointments consist of the following:
Please Note: For patients from out of province, efforts are made to schedule the initial consult with Dr. Weis within the 2-week range of the brachytherapy date in order to cut down on travel expenses for the patient.
The brachytherapy office will notify you of your insertion/removal dates. The exact time for you to arrive at the CCI on your insertion date is given to you over the phone by the Surgical Daycare Unit (SDCU), a few days prior to surgery. The time of plaque removal is dependent on when the plaque was inserted and this removal time is given to you at the time of discharge on insertion day (after the plaque is in place).
The Surgeries
You will be instructed not to eat or drink anything after midnight prior to the insertion and removal days. You are allowed to take your regular medications, as instructed, with a sip of water the morning of the surgery. Please ensure that you are clear with your instructions because some medications like ‘blood thinners’ and diabetic medications are not taken the morning of the surgery. If you are unsure, please call the SDCU at 780-432-8951.
Plaque Insertion
On the day of plaque insertion, you are asked to arrive at the time provided to you by the SDCU. Nursing staff will start an intravenous line (IV). You will change into a hospital gown and eye drops will be given to dilate your pupils. You will be taken to the operating room (OR), where Dr. Weis will perform the plaque insertion surgery. Patient families can wait in the SDCU while you are in the OR.
For this surgery, you will be asleep (general anaesthesia). Approximately 1.5 hours is expected for plaque insertion and you will wake up in the recovery room with an eye patch in place. This patch must stay on for the duration of treatment (5-7 days). You will return to the SDCU from the recovery room. You will either be admitted to hospital later the same day, or can leave the hospital for your home or hotel room. Admission to hospital is not often required, and is only required when there is a medical need.
After Your Surgery
You cannot drive home after the surgery. Please arrange for transportation home. We encourage you to have family or friend(s) wait with you. You will be sent home with an envelope containing important information and prescriptions.
Patients will often experience two types of sensations after the surgery. The first is a scratchy sensation like sand or gravel in the eye from the stitches. This typically improves significantly every day, as the self-dissolving stiches get softer. If this scratchy sensation is very bothersome you can close both your eyes and it should go away. The second sensation is more of a deep throbbing discomfort from the swelling of the surgery. The pain medications, rest, and keeping your head elevated will control this sensation well for most patients.
You should go for an easy walk every day after your surgery, but should not exert yourself until 2 weeks after your plaque is removed. During these walks you should minimize hills and stairs – we don’t want you breathing hard or raising your blood pressure.
Following the plaque insertion, a brachytherapist from the CCI will call you mid-treatment to see how you are doing and answer any questions you may have.
Plaque Removal
On the day of plaque removal, you will return and follow the same process as per the insertion with the SDCU nursing staff. You will be taken back to the OR, where the removal of the plaque is done under conscious sedation requiring less than 30 minutes. The conscious sedation will eliminate all the anxieties and put you in a relaxed, semi asleep state. Once you have reached this state, you will receive some local anaesthetic so that you will not experience pain. General anaesthesia is not required for plaque removal, and this benefits you in recovery time.
Following surgery, you will be taken to the recovery area and then back to the SDCU. You can go home within a few hours of the removal; however, someone must drive you home since you had conscious sedation. A second information envelope will be given to you prior to leaving the hospital, which includes information on the application of eye drops/ointment and prescriptions.
At 2 weeks after the plaque removal, you should slowly re-introduce yourself to your normal activities. If you feel increased pain or swelling after an activity, then it is too early for that activity. In this situation, you should avoid this activity for a couple of days, and then retry.
Follow-Up After the Surgeries
The eye clinic staff will contact you. A one-month follow-up appointment will be booked with Dr. Weis at the RAH in Edmonton or the RGH in Calgary. There will be no further follow up at the CCI in Edmonton. If you have any questions post-treatment, you should be directed back to the other hospital(s) in charge of your care.
If you have any questions during treatment, please contact the brachytherapy office at 780-432-8475.
If you have any questions after treatment is complete, please contact Dr. Weis’s office.