When is brachytherapy recommended for retinoblastoma?

A small radioactive plaque is positioned on the outside of the eye over the tumour. It stays in place for a planned period and is then removed. The aim is to deliver radiation to the tumour while limiting exposure to nearby healthy tissue. Eye specialists consider the tumour’s size, position and number, whether it is close to the optic nerve or other sensitive structures, and the response to treatments such as chemotherapy or laser therapy. Brachytherapy is not appropriate when disease has spread beyond the eye or when another treatment offers safer control.

Arrange assessment at a specialist paediatric eye cancer service. The team may examine the eye under anaesthesia and use imaging to map the tumour and surrounding structures. Ask how the plaque will be placed, whether a short hospital stay is expected, how the child’s eye will be protected and how vision will be checked afterwards. Share previous treatment details and tell the team about any new eye changes. Treatment planning should include the child’s overall health and the needs of both eyes.

Seek urgent medical advice for a painful red eye, sudden change in vision, marked swelling, fever or discharge after treatment. Emergency help is needed for severe pain, heavy bleeding, collapse or a sudden major loss of vision. A new white reflection in the pupil, a misaligned eye or persistent swelling in a child also needs prompt specialist assessment, even when the child seems otherwise well.

Is the tumour in a position that a plaque can treat? What are the aims for tumour control and vision in each eye? Could laser treatment, chemotherapy or another local treatment be used? How will the child be monitored for recurrence and late effects?