Radiation Plaque for Retinoblastoma

Retinoblastoma is a rare and aggressive eye cancer that affects young children, most often before the age of 5. Treating the disease requires urgency, technical precision and close coordination across specialties. For clinicians and families alike, the goal is to preserve vision and to avoid both metastasis and eye removal.

At Children’s Wisconsin, we serve as a referral center for retinoblastoma, providing comprehensive, multidisciplinary care for children across the region. Our team brings together Ophthalmology, Oncology, Radiation Oncology, Anesthesia and specialized nursing to manage a disease that demands seamless collaboration. As treatment options have evolved, so has our program.

In September 2025, we performed the first plaque brachytherapy procedure for retinoblastoma in the state of Wisconsin. This milestone marked a significant expansion of our ability to offer eye-sparing therapy for carefully selected patients. The procedure was completed for a child referred from out-of-state and required coordination across institutions, teams and clinical environments.

Plaque brachytherapy delivers targeted radiation directly to the tumor while minimizing exposure to surrounding tissue. Each radiation plaque is custom-designed for the individual child, sized and shaped to match the eye and precisely target the tumor. The plaque contains lead pellets that emit a controlled dose of radiation over three to four days. After careful localization in the operating room, surgeons suture the plaque directly to the surface of the eye. Once the planned treatment duration is complete, the team removes the plaque, limiting radiation exposure to surrounding structures.

The precision of plaque brachytherapy distinguishes it from other radiation approaches. The radiation dose drops off rapidly with distance, concentrating treatment at the tumor while sparing critical structures such as the optic nerve and macula. This distinction carries particular importance for children with retinoblastoma. These patients face an elevated lifetime risk of second cancers, a risk that broader radiation exposure can increase. Because plaque brachytherapy delivers radiation focally, it does not raise the risk of secondary malignancies. Reported tumor control rates range from 80–90%, and successful treatment often preserves the eye, avoiding enucleation.

Bringing plaque brachytherapy to Children’s Wisconsin required coordination beyond our standard operating environment. Radiation privileges necessitated a shared-care model across institutions. Our ophthalmology and anesthesia teams worked with our colleagues in radiation oncology from the Medical College of Wisconsin. Together, we performed the procedure in the Froedtert Hospital Interventional Radiology Suite, aligning safety protocols, staffing and workflow across systems. This level of coordination reflects both the complexity of the therapy and the commitment shared by all involved.

The addition of plaque brachytherapy strengthens an already robust Retinoblastoma Program. Our multidisciplinary model allows us to tailor treatment plans to each child, balancing tumor control with long-term visual outcomes. For families, access to this therapy within a coordinated pediatric care system reduces the need for distant referrals and fragmented care.

This first case represents a foundation rather than a finish line. We plan to continue growing the Retinoblastoma Program and establish Children’s Wisconsin as a regional center of excellence in the Midwest. Our team is actively engaged in research aimed at improving outcomes, including the exploration of chemotherapy-based plaque therapy as an alternative to radiation. In parallel, we are collaborating with radiation oncology partners to evaluate additional targeted approaches that may further reduce treatment burden.

For children with retinoblastoma, the difference between eye salvage and enucleation can shape quality of life for decades. By adding plaque brachytherapy to our treatment options, we have expanded our ability to individualize care and preserve vision without compromising oncologic control. This milestone reflects not only technical capability, but also the multidisciplinary culture that defines how we care for children with complex, high-risk disease at Children’s Wisconsin.