Daya guna kombinasi radioterapi eksternal dengan Brakhiterapi pada Carcinoma Nasopharynx di RS Dr. Sardjito

PRAWATI, M.A. Budi, Prof.Dr.dr. H. Salugu Maesadjie TJ., SpRad.(K)Onk

2006 | Tesis | PPDS I Radiologi

Latar belakang : Carcinoma nasopharynx merupakan keganasan dengan angka kejadian yang tinggi di Asia Tenggara dan China Selatan. Di Asia Tenggara carcinoma nasopharynx merupakan penyebab utama kematian akibat kanker. Pengobatan carcinoma nasopharynx meliputi radioterapi, khemoterapi, atau tindakan operatif. Radioterapi merupakan terapi utama, meliputi radioterapi eksternal dan kombinasi radioterapi eksternal dengan brakhiterapi. Tujuan penelitian : untuk mengetahui daya guna kombinasi radioterapi eksternal dengan brakhiterapi dibandingkan radioterapi eksternal tanpa brakhiterapi pada carcinoma nasopharynx. Bahan dan Cara : Penelitian menggunakan rancangan non randomized control trial. Subyek penelitian adalah penderita carcinoma nasopharynx yang berkunjung di poliklinik Radioterapi RS Dr Sardjito Yogyakarta pada bulan Januari 2003 sampai dengan Desember 2005 yang telah melalui kriteria inklusi dan eksklusi. Tiga puluh pasien carcinoma nasopharynx stadium III mendapat pengobatan radioterapi eksternal 70 Gy diikuti brakhiterapi endokaviter 9-12 Gy sebagai kelompok perlakuan, dan 30 pasien carcinoma nasopharynx stadium III yang lain mendapat radioterapi eksternal 70 Gy tanpa brakhiterapi sebagai kelompok kontrol. Pada kedua kelompok dibandingkan keadaan tumor sebelum dan sesudah terapi dengan menggunakan CT scan kepala potongan coronal. Selanjutnya dinilai respon terapi yang digolongkan complete response (CR), partial response (PR), no change (NC), dan progressive disease (PD). Diamati juga mengenai adanya komplikasi tindakan brakhiterapi nasopharynx yang berupa nekrosis palatum dan synechia concha nasalis. Analisis data : untuk mengetahui karakteristik subyek penelitian dilakukan penghitungan distribusi, frekuensi, dan proporsi, sedangkan untuk mengetahui hubungan antar variabel digunakan analisis dengan Chi Square Test dan selanjutnya dihitung tingkat kemaknaan. Hasil Penelitian: Subyek penelitian terdiri dari 45 (75%) laki-laki dan 15 (25%) perempuan, dengan rentang umur antara 15 – 67 tahun. Jenis sel yang terbanyak adalah undifferentiated carcinoma (WHO tipe III) sebanyak 50 kasus (83,3%). Rerata kadar hemoglobin dan angka leukosit kedua kelompok normal. Respon terhadap pengobatan pada kelompok radioterapi eksternal dengan brakhiterapi didapatkan hasil complete response 19 kasus (63,3%), partial response 11 kasus (36,7%), no change 0 dan progressive disease 0; sedangkan pada kelompok radioterapi eksternal tanpa brakhiterapi didapatkan hasil complete response 8 kasus (26,7%), partial response 21 kasus (70%), no change 1 kasus (3,3%) dan progressive disease 0. Analisis Chi Square test menunjukkan nilai p = 0,014. Efek samping brakhiterapi yang berupa nekrosis palatum dan synechia concha nasalis tidak didapatkan. Kesimpulan: Kombinasi radioterapi eksternal dengan brakhiterapi secara bermakna (dengan nilai p = 0,014) lebih berdaya guna dibandingkan dengan radioterapi eksternal tanpa brakhiterapi dalam pengobatan carcinoma nasopharynx stadium III.

Back ground : Nasopharyngeal carcinoma (NPC) is a malignancy that occurs in high frequency in South East Asia and Southern China. In South Asia NPC is the major cause of cancer death. NPC management consist of radiotherapy, chemotherapy or operative procedure. Radiotherapy is the primary one, consist of external radiotherapy and external radiotherapy combine with brachytherapy. Purpose of the study : The aim of this study is to define the efficacy of the combination of external radiotherapy with brachytherapy compared by external radiotherapy without brachytherapy on NPC management. Material and method : The study use non randomized control trial design. Subject study is NPC patients who visit to radiotherapy unit, Sardjito Hospital Yogyakarta, on January 2003 until December 2005 that has passed inclusion and exclusion criterias. Thirty patients with stage III NPC were treated with 70 Gy external beam radiation therapy (ERT) followed by 9- 12 Gy endocavitary brachytherapy (BT) as treatment group, and the other 30 patients with stage III NPC were treated with ERT 70 Gy without BT as control group. On the two groups, the tumor is compared before and after therapy using coronal head CT Scan. Then response of therapy divided as complete response, partial response, no change, and progressive disease. Complication of BT such as palatum necrosis and synechia of nasal concha also observed. Data analysis : To understand the character of subject, this study use distributional count, frequency and proportion. And to understand intervariable relationship, chi square test analysis is used and then significancy value is counted. Results: Study subyect consist of 45 (75%) men and 15 (25%) women with age interval between 15 – 67 years old. The most pathologic finding is undifferentiated carcinoma ( type III WHO) which found in 50 cases (83,3%). Mean of haemoglobin level and count of leucocyte in both groups are normal. Response of therapy on ERT with BT group are complete response 19 cases (63,3%), partial response 11 cases (36,7), no change 0, and progressive disease 0, whereas on ERT without BT group are complete response 8 cases (26,7%), partial response 21 cases (70), no change 1 cases (3,3%) and progressive disease 0. Chi square analysis show p value = 0,014. Palatum necrosis and synechia of nasal concha as side effect of brachiteraphy is not found. Conclusion: The combination of external radiotherapy with brachytherapy significantly (p= 0,014) has more efficacy than external radiotherapy without brachytherapy on stage III NPC management.

Kata Kunci : Terapi Radiasi,Carcinoma Nasopharynx,Brakhiterapi, Nasopharyngeal carcinoma – external radiotherapy – brachytherapy – complete response – partial response – no change – progressive disease