title: Iodine-125 orbital brachytherapy with a prosthetic implant in situ.
abstract: OBJECTIVE
  Brachytherapy is one method of irradiating the orbit after enucleation of an eye with a malignant tumor that has a potential to recur. It consists of 6 trains of I-125 seeds placed around the periphery of the orbit, a shorter central train, and a metal disc, loaded with seeds, placed beneath the eyelids. The presence of a prosthetic orbital implant requires omission of the central train and adjustment of the activity of the seeds in the anterior orbit around the prosthesis.
  
  
  METHODS
  This is a retrospective review of the technical modifications and outcome of 12 patients treated in this manner: 6 with retinoblastoma, 5 with malignant melanoma, and 1 with an intraocular rhabdomyosarcoma. The median dose was 35.5 Gy in 73 hours for retinoblastoma and 56 Gy in 141 hours for malignant melanoma. Patients with retinoblastoma and rhabdomyosarcoma also received chemotherapy.
  
  
  RESULTS
  The tubes can be placed satisfactorily around the prosthesis. The increased activity in the anterior half of the tubes produced comparable dose distributions. There have been no orbital recurrences, no extrusion of the prosthesis, and cosmesis is good.
  
  
  CONCLUSIONS
  Insertion of a prosthetic implant at the time of enucleation greatly enhances the subsequent cosmetic appearance. This should be encouraged unless there is frank tumor in the orbit. Orbital brachytherapy without the central train continues to give excellent local control. The short treatment time and good cosmesis are added advantages. The patient is spared the expense and inconvenience of removing and replacing the prosthetic implant.
authors.affiliation: Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. Clare.Stannard@uct.ac.za
authors.forename: Clare
authors.initials: C
authors.lastname: Stannard
authors.forename: Gert
authors.initials: G
authors.lastname: Maree
authors.forename: Roger
authors.initials: R
authors.lastname: Munro
authors.forename: Karin
authors.initials: K
authors.lastname: Lecuona
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sauerwein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002648:Child; D005123:Eye / Q000000981:diagnostic imaging; D005134:Eye Neoplasms / Q000532:radiotherapy*; D005137:Eye, Artificial; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000532:radiotherapy; D011859:Radiography; D012175:Retinoblastoma / Q000532:radiotherapy*; D012189:Retrospective Studies; D018232:Rhabdomyosarcoma, Alveolar / Q000532:radiotherapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes