Ocular Oncology Treatment
The Ocular Oncology Center at Sheba Medical Center is the largest center in Israel for the diagnosis and treatment of a variety of ocular tumors and other related conditions. Ocular tumors are rare and can be life-threatening. The treatment for these diseases can be complex, requiring advanced therapies and cutting-edge surgical techniques. We implement a multidisciplinary approach to treat ocular cancer, based on the collaboration of oncologists, hemato-oncologists, radiologists, pathologists, and other Sheba specialists.
Our mission is to save the sight and lives of adult and pediatric patients with ocular tumors, while preserving each patient’s overall health and well-being. The Ocular Oncology Center at Sheba Medical Center is a service of the Goldschleger Eye Institute, located within the hospital’s Division of Surgery, and we operate as a leading national and international referral center.
Diseases We Treat
- Ocular/Uveal Melanoma: This is the most common primary cancer of the eye in adults. Called uveal melanoma because it develops in the uveal tract of the eye, it is a malignant and aggressive tumor that can grow and spread to other parts of the body. Just like melanoma of the skin, uveal melanoma can remain silent until it has progressed to a stage where it is difficult to treat effectively.
- Retinoblastoma: This cancer begins in the retina, the light-sensitive tissue at the back of the eye. It occurs when retinoblasts grow out of control. If left untreated, the tumors can fill most of the eyeball or break away to form additional tumors on other parts of the eye or spread to lymph nodes and other organs. Retinoblastoma is the most common type of pediatric eye cancer, but it has a high cure rate due primarily to advanced treatments.
- Astrocytomas: This cancer is the most common type of glioma. It is a brain tumor that originates in the astrocytes, which are star-shaped glial cells that nourish neurons in the brain and protect them from infection. Childhood astrocytomas often form in the visual pathway of the central nervous system. The majority of astrocytomas are highly treatable and highly curable.
Brachytherapy/Radioactive Iodine 125
Also known as plaque therapy, this innovative treatment is only available at a few clinics worldwide, and Sheba is pleased to offer it as an effective therapy for ocular tumors. In Israel, Sheba is the exclusive provider of brachytherapy.
Conventional radiotherapy can damage many healthy cells in the eye, leading to vision loss. Brachytherapy involves placing radioactive iodine 125 plaques directly on the surface of the eye and above the base of the tumor. Advanced computer software enables our doctors to adjust and customize the size of each plaque to optimize it for irradiating the individual’s eye tumor precisely. The plaques are left in place for several days to administer radiation.
Brachytherapy allows controlled, point-to-point irradiation to be delivered to the tumor, thereby minimizing the radiation exposure to healthy retinal areas. This revolutionary therapy helps to preserve the future vision of the treated eye.
In general, brachytherapy and other types of radiotherapy provide exceptional control over ocular tumors. However, studies have shown that uveal melanoma often leads to secondary tumors – even years later. Therefore, all patients treated for uveal melanoma at Sheba’s Ocular Oncology Center are referred for close follow-up surveillance at our Ella Lemelbaum Institute for Immuno-Oncology.
TIL (tumor-infiltrating lymphocytes) immunotherapy is a cutting-edge treatment that involves genetically modifying some of the body’s own cells so they target and attack cancer cells. Patients with ocular melanoma may develop secondary tumors in the future, and if the melanoma metastasizes, TIL immunotherapy can be an effective treatment option.
Some types of ocular cancer cannot be treated with brachytherapy due to their size or location near the optic nerve. In this case, focused external radiation may be delivered via the new, highly progressive LINAC – Linear Accelerator (Novalis-TX), by specialists in the Neurosurgery Unit.
Surgical operations to treat ocular cancer include procedures to remove part of the eye or the entire eye, depending on the location and size of the tumor.
Chemotherapy is generally recommended only when the ocular cancer has become widespread, chemotherapy drugs may be delivered topically, intravenously, intra-arterially, or intravitreally.
Sometimes, a laser can be used to kill melanoma cells. Thermotherapy, which involves an infrared laser, may be combined with radiation therapy.
Roberto Spiegelmann, MD
Senior Staff Neurosurgeon, Department of Neurosurgery
Head, Stereotactic Radiosurgery Unit and Functional Neurosurgery Service
Dr. Spiegelmann was born in Montevideo, Uruguay, and he received his MD from Universidad de la Republica, Uruguay. In 1980, he immigrated to Israel and completed a residency in neurosurgery at Sheba Medical Center. He then served as a clinical fellow in functional neurosurgery and radiosurgery at the University of Florida, Gainesville, Florida, working with William A. Friedman and Frank Bova, who started their pioneering work in LINAC radiosurgery at the time.
Upon his return to Israel, Dr. Spiegelmann founded the first radiosurgery facility in the Middle East at Sheba in December 1992. This linear accelerator Radiosurgery Unit has since treated over 5,000 patients.
Dr. Spiegelmann is very active in the field of radiosurgery, both nationally and internationally. In Israel, he pioneered the combined approach of microsurgery and radiosurgery improve the management of complex clinical situations in patients with metastatic brain disease, acoustic neurinomas, and meningiomas. As the first functional neurosurgeon in the country, Dr. Spiegelmann introduced many advanced therapies to Israel.
Dr. Uzi Nissim
Senior Physician, Department of Neurosurgery
Dr. Nissim, a specialist in radiosurgery, received his medical degree from the Sackler Faculty of Medicine, Tel Aviv University.
Sheba’s Holistic Approach to Healing
We believe that successful treatment for people with oncological eye disease results from the compassionate commitment of the attending physicians, the willingness of the patient to undergo the recommended treatment, and the expertise of a multidisciplinary team. At Sheba, we take pride in combining all of these elements to design the most helpful treatment program possible for each patient. We consider all parts of healing – not just the cancer – including the person’s unique psychological, social, and physical needs. Our knowledgeable staff is always available to answer questions and ease the journey for you or your child during the fight against cancer. Additionally, to ensure an efficient, smooth experience, we assign a personal medical coordinator from the International Medical Tourism Division to assist every family.