Resumen Objetivo: Reportar los resultados iniciales de la cirugía estereotáctica con CyberKnife® (CK®) para etapas avanzadas de melanoma de cuerpo ciliar y coroides (MCC-C) en pacientes mexicanos. Método: Revisión retrospectiva de expedientes clínicos. Se analizaron los resultados de los pacientes a quienes se trató con CK® (Accuray Inc, Sunnyvale, CA, Estados Unidos). Resultados: Cuatro pacientes con MCC-C fueron tratados bajo este protocolo. La media de edad fue de 53.2 ± 5.3 años (rango: 47-60). La mediana de seguimiento fue de 9.5 ± 3.1 meses (rango: 5-12). El diámetro promedio del tumor fue de 13.49 mm, el grosor promedio fue de 11.74 mm y el volumen tumoral promedio fue de 1251.97 mm3. Los tumores tuvieron una configuración de domo (50%) y de seta (50%), de tamaño mediano a grande. Tres pacientes tuvieron un tumor T3b y uno tuvo un tumor T4d en fase inicial según el American Joint Committee on Cancer (AJCC). Se prescribió una dosis promedio de radiación de 2763 ± 181,3 cGy al 90% de la línea de isodosis. Todos los pacientes lograron el control local del tumor después de una sesión de radiocirugía en la última visita de seguimiento. Un paciente presentó datos de toxicidad aguda (desprendimiento seroso de retina) y fue tratado con éxito. Ninguno de los pacientes precisó enucleación secundaria. Conclusiones: El abordaje multidisciplinario con CK® es una terapia efectiva en el manejo del MCC-C de tamaño mediano a grande. Es necesario mayor tiempo de seguimiento para confirmar estos hallazgos y evaluar la morbilidad a largo plazo.

Abstract Objective: To report the early results of CyberKnife® (CK®) stereotactic radiosurgery in advanced stages of ciliochoroidal (CBCh) melanoma in Mexican patients. Method: A retrospective review of charts was performed to analyze the outcomes of patients who underwent CK® (Accuray Inc, Sunnyvale, CA, USA). Results: Four patients with CBCh melanoma were treated under this protocol. The mean age was 53.2 ± 5.3 years (range: 47-60). Median of follow-up was 9.5 ± 3.1 months (range: 5-12). Mean tumor diameter was 13.49 mm, mean thickness, 11.74 mm, and mean gross tumor volume, 1251.97 mm3. Tumors were dome- (50%) and mushroom-spahed (50%), in medium-to-large sizes. Three patients had T3b tumors, and 1 had a T4d tumor at the early tumor staging according to the American Joint Committee on Cancer (AJCC). A mean dose of 2763 ± 181.3 cGy was prescribed to the 90% isodose line. All patients achieved local tumor control after a single radiosurgical session at the latest follow-up. One patient presented with acute toxicity (extensive serous retinal detachment associated with radiation induced tumor vasculopathy) that was promptly managed. None of the patients required secondary enucleation. Conclusions: CK® appears to be an effective therapy for the management of medium-to-large sized CBCh melanoma. A prospective comparative study with longer follow-up is needed to confirm these findings and assess long-term morbidity.

RESUMO Um homem de 45 anos apresentou história de massa na carúncula no olho direito durante 3 meses. Uma biópsia incisional foi realizada 1 mês antes por outro especialista e o laudo histopatológico mostrava carcinoma basocelular. A massa foi completamente excisada, com uma margem de segurança de 2 mm, e a grande lesão conjuntival foi reconstruída com uma folha de aloenxerto de membrana amniótica. Foi estabelecido um diagnóstico histológico de carcinoma pilomatricial. Para evitar a recorrência após a cirurgia, adicionamos colírio de bevacizumabe (25 mg/mL, 1,25 mg/mL por gota) quatro vezes ao dia durante três meses. No seguimento de 1 ano, o paciente não apresentou evidência de recidiva local ou metástase distante após a excisão inicial e continua sob acompanhamento próximo. O carcinoma pilomatricial deve ser considerado no diagnóstico diferencial de uma massa caruncular.

ABSTRACT A 45-year-old man presented with a 3-month history of a mass located in the caruncle of his right eye. An incisional biopsy had been performed one month prior by another specialist, and the histopathology report showed basal cell carcinoma. The mass was completely excised with a 2 mm safety margin, and the large conjunctival defect was reconstructed with one sheet of amniotic membrane allograft. A histological diagnosis of pilomatrix carcinoma was established. To prevent recurrence after surgery, we added bevacizumab (25 mg/mL, 1.25 mg/mL per drop) eye drops four times per day for three months. At the one-year follow-up, the patient showed no evidence of local recurrence or distant metastasis after initial excision and remains under close follow-up. Pilomatrix carcinoma should be considered in the differential diagnosis of a caruncular mass.