Grant: Project Grant

Episcleral plaque brachytherapy (EPBT) is a widely adopted treatment for eye cancers such as uveal melanoma (UM), the second most common form of melanoma after cutaneous melanoma. Due to the close proximity of critical ocular structures-including the optic nerve and retina-external beam radiotherapy is generally unsuitable for UM. EPBT offers a targeted alternative by placing radioactive seeds directly on the surface of the eye, allowing radiation energy (i.e., the dose profile) to be delivered precisely to the tumor site. Despite its status as a standard-of-care for many UM cases, EPBT is still associated with significant toxicity. This is primarily due to lateral radiation emissions from conventional plaque designs, which can damage adjacent healthy tissues. Traditional EPBT plaques are constructed using simple geometric supports based on population-wide anatomical averages (e.g., the "average" curvature of the human eye). Coarse radioactive sources (typically 1 mm × 5 mm) are affixed to these implants, resulting in unintended lateral radiation spread to sensitive structures such as the macula and optic nerve. This project aims to transform EPBT by developing the most precise and personalized treatment approach to date. It will integrate high-resolution imaging techniques with advanced deep-learning algorithms to accurately delineate tumor contours. These contours will inform numerical simulations that "sculpt" the optimal energy distribution around the tumor. The resulting dose profiles will guide the fabrication of custom implants using cutting-edge 3D printing technologies, strategic selection of radioisotopes, and radiobiological insights derived from patient biopsies. Each implant's dose profile will be rigorously validated to ensure precision and safety. Ultimately, this project will establish a new paradigm in EPBT-one that is tailored to individual patient anatomy and tumor biology, significantly improving therapeutic outcomes in eye cancer.