Perbandingan efek samping penekanan fungsi sumsum tulang setelah kemoradiasi ptotokol mingguan dan bulanan pada karsinoma serviks uteri stadium lanjut

RABRAGERI, Alberthzon Kris Silo, Dr. Burham Warsito, ,SpOG.,KOnk

2004 | Tesis | PPDS I Obstetri dan Ginekologi

Tujuan: Mengetahui efek samping kemoradiasi protokol mingguan dan bulanan terhadap perubahan kadar hemoglobin, angka lekosit, angka eritrosit, dan angka trombosit pada penderita karsinoma serviks uteri stadium lanjut. Rancangan penelitian: Penelitian ini adalah penelitian observasional dengan rancangan historical cohort. Bahan dan cara: Data penelitian diambil dari catatan medis, sebagai populasi penelitian adalah pasien karsinoma serviks uteri stadium lanjut (IIB-IV) yang mendapat kemoradiasi protokol mingguan dan bulanan dari Januari 2000 sampai Desember 2003. Sebanyak 128 pasien yang memenuhi kriteria inklusi dan eksklusi, terdiri dari 64 kasus protokol bulanan dan 64 kasus protokol mingguan. Data kadar hemoglobin, angka lekosit,angka eritrosit dan angka trombosit dan riwayat transfusi dicatat pada awal sebelum kemoradiasi, dan setiap akan dilakukan kemoradiasi berikutnya hingga selesai kemoradiasi. Data yang diperoleh diolah dengan menggunakan komputer. Hasil: Terdapat perbedaan bermakna. pada komparabilitas pemberian transfusi darah sebelum dan setiap kemoradiasi mingguan dan bulanan. Pada minggu ketiga setelah kemoradiasi mingguan didapatkan 28,1% pasien protokol mingguan harus mendapat transfusi darah oleh karena anemia, sedangkan pada pasien bulanan 9,4% (p<0,05). Sebelum kemoradiasi mingguan dan bulanan terdapat perbedaan bermakna pada komparabilitas kadar hemoglobin(p=0,04) dan angka eritrosit (p=0,02). Terdapat perbedaan bermakna (p<0,05) pada perubahan kadar hemoglobin, angka lekosit, angka eritrosit dan angka trombosit sebelum dan 6 minggu sesudah kemoradiasi mingguan, demikian juga pada protokol bulanan terdapat perbedaan yang bermakna (p<0,05). Terdapat perbedaan bermakna pada perubahan, angka lekosit, sesudah 6 minggu kemoradiasi mingguan dan sesudah 6 bulan kemoradiasi bulanan (p=0,03). Selisih angka trombosit sebelum dan sesudah kemoradiasi mingguan dan bulanan terdapat perbedaan bermakna (p=0,02). Pada perbandingan kadar hemoglobin, angka lekosit,angka eritrosit dan angka trombosit setiap tindakan kemoradiasi mingguan dan bulanan, terdapat perbedaan bermakna pada angka lekosit setelah kemoradiasi mingguan ke-6 (p=0,03), angka eritrosit minggu pertama (p=0,02), dan angka trombosit sebelum sitostatika ke-2 (p<0,05). Simpulan: Efek samping kemoradiasi mingguan pada penekanan sumsum tulang berupa lekopenia pada minggu ke-6 lebih berat dibanding pada kelompok bulanan. Pengaruh efek samping kemoradiasi protokol mingguan maupun bulanan menimbulkan kecenderungan terjadi penurunan kadar hemoglobin, angka lekosit, angka eritrosit dan angka trombosit

Objectives: Determining tha side efect of chemoradiation weekly and monthly protocols to the blood level of hemoglobin, leucocyt count, erythrocyite count and platelet count on advanced cervical cancer. Study design: Historical cohort study Materials and methods: Data was taken from medical recod. The study population was advanced cervical cancer (stage IIB-IVB) whore received weekly and monthly protocols chemoradiation from January 2000 until December 20003. There were 128 patients whore fullfiled inclution and exclution criterias.divided in two groups consist of 64 patients with weekly protocols and montly protocols. Data of hemoglobin level, leucocyt count, erythrocyite count and platelet count and also history of blood transfusion, were recorded since the patient hospitalized until received the chemoradiation. These procedur also performad for every chemoradiation until it finished. The data was anlized by computer. Results: There were significant different on comparability of blood transfision administration before and after weekly and monthly chemoradiations. On third week of weekly chemoradiation there are 28,1% patiens using wekly protocols must have blood transfusion due to anemia condition and patient with monthly protocol only 9,4% (p<0.05). Before chemoradiation there are significant difference on comparabilities of hemoglobin level (p=0.04) and erithrocyte count (p=0.02). There are significant different on the changes of hemoglobin level, leucocyt count, erythrocyite count and platelet count before and 6 week after weekly chemoradiation, also on monthly protocol. there were significant difference (p<0.05). There were significant different on the changes of leucocyt count after 6 weeks of weekly chemoradiation and after 6 month of monthly chemoradiation (p=0.03).There are differences of platelet count before and after weekly and monthly chemoradiation (p=0.02).On the comparabilities of hemoglobin level, leucocyt count, eryithrocyte count, and platelet count there were significant differences on leucocyt count after the sixth wekkly chemoradiation (p=0,03), first week erythrocyte count, (p=0,02), and platelet count before the second cytostatics(p<0.05). Conclution: The influence of side efect of weekly and monthly protocol of chemoradiation migh cause the decrease of hemoglobin level, leucocyt count, erythrocyte count, and platelet count. Side efect of weekly chemoradiation is myelosupression and there will be leucopenia on the sixth week.

Kata Kunci : Karsinoma Serviks Uteri,Kemoradiasi Protokol Mingguan dan Bulanan, Protocol of weekly chemoradiation, monthly protocol, hemoglobin level, leucocyt count, erythrocyite count and platelet count