PERBANDINGAN PERUBAHAN KADAR ANTIGEN SQUAMOUS CELL CARCINOMA PADA KEMOTERAPI PROTOKOL MINGGUAN DAN PROTOKOL TIGA MINGGUAN PADA KARSINOMA SERVIKS UTERI STADIUM LANJUT

Milhan, Prof. Dr. dr. Ibnu Pranoto, SpAnd, SpOG(K)

2012 | Tesis | S2 Ilmu Kebidanan dan Penyakit Kandungan

Latar belakang: Untuk pengobatan karsinoma serviks uteri stadium lanjut dilakukan kemoradiasi protokol mingguan atau tiga mingguan. Untuk mengetahui perbandingan respon terapi kedua protokol, perlu pemeriksaan petanda tumor yaitu antigen SCC sebelum dan sesudah kemoterapi. Tujuan: untuk mengetahui perbandingan perubahan antigen SCC sebelum dan sesudah kemoterapi yang ketiga pada protokol mingguan dan protokol tiga mingguan pada karsinoma serviks uteri stadium lanjut. Metode: Penelitian dilakukan di RS Sardjito, subyek penelitian adalah penderita karsinoma serviks stadium lanjut yang mendapat kemoterapi protokol mingguan atau tiga mingguan. Dilakukan pemeriksaan kadar antigen SCC sebelum dan sesudah kemoterapi yang ketiga. Hasil: Terdapat 30 kasus,masing-masing 15 kasus yang mendapat protokol mingguan dan 15 kasus protokol tiga mingguan. Umur terbanyak 46-55 tahun (60,0%) pada protokol mingguan dan 60,0% juga pada protokol tiga mingguan. Paritas 3 atau lebih, 73,3% dan 66,7%. Tingkat pendidikan SD (33,3% dan 73,3%). Kelas perawatan III (73,3% dan 66,7%). Histopatologi Epidermoid karsinoma (40,0%) dan squamous cell carcinoma (40,0%). Stadium IIB (73,3%) dan IIIA (40,0%). Pada protokol mingguan, ratarata (mean) kadar antigen SCC sebelum terapi (Ag SCC Pra) 8,080 ± 13,151 µg/L dan antigen SCC setelah protokol mingguan (Ag SCC Post) 3,067 ± 3,465 µg/L, dengan perubahan (penurunan kadar) sebesar 5,013 ± 12,000 µg/L. Sedangkan pada protokol tiga mingguan rata-rata Ag SCC Pra 17,610 ± 21,575 µg/L dan Ag SCC Post adalah 8,074 ± 14,760 µg/L, dengan perubahan (penurunan kadar) sebesar 9,536 ± 14,873 µg/L. Dengan uji t berpasangan secara sendiri-sendiri pada protokol mingguan dan tiga mingguan didapatkan: Pertama, tidak terdapat perubahan kadar antigen SCC yang bermakna sebelum dan sesudah kemoterapi yang ketiga pada protokol mingguan. Kedua, terdapat perubahan kadar antigen SCC yang bermakna sebelum dan sesudah kemoterapi yang ketiga pada protokol tiga mingguan. Dilakukan uji bersama dengan uji t tidak berpasangan diperoleh kesimpulan: tidak terdapat perubahan kadar antigen SCC yang bermakna sebelum dan sesudah kemoterapi yang ketiga antara kelompok protokol mingguan dan kelompok protokol tiga mingguan. Kesimpulan: Tidak terdapat perubahan kadar antigen SCC yang bermakna sebelum dan sesudah kemoterapi yang ketiga antara kelompok protokol mingguan dan kelompok protokol tiga mingguan pada karsinoma serviks uteri stadium lanjut.

Background: For the treatment of advanced carcinoma of the cervix uteri chemoradiation protocol performed weekly or three weekly. To determine the therapeutic response comparison of both protocols, need to check the tumor marker SCC antigen before and after chemotherapy. Purpose: To determine the ratio of SCC antigen changes before and after the third on the protocol of chemotherapy weekly and three weekly protocol at an advanced carcinoma of the cervix uteri. Methods: The study was performed in RS Sardjito, study subjects were patients with advanced carcinoma of cervix uteri who received chemotherapy protocol weekly or three weekly. Examination of SCC antigen levels before and after the third chemotherapy. Results: There were 30 cases, each of the 15 cases who received weekly protocol and the protocol of three weekly 15 cases. Most 46-55 years old (60.0%) in the weekly protocol and also 60.0% at three weekly protocol. Parity 3 or more, 73.3% and 66.7%. Elementary education level (33.3% and 73.3%). Class III of ward (73.3% and 66.7%). Histopathology of epidermoid carcinoma (40.0%) and squamous cell carcinoma (40.0%). Stage IIB (73.3%) and IIIA (40.0%). At the weekly protocol, the average (mean) SCC antigen levels before treatment (SCC Pre Ag) 8.080 ± 13.151 mg / L and SCC antigen after the weekly protocol (SCC Post Ag) 3.067 ± 3.465 mg / L, with changes (decreased levels) amounting to 5.013 ± 12.000 mg / L. While the protocol three weekly average SCC Pre Ag ± 17.610 21.575 ug / L and Post SCC Ag is 8.074 ± 14.760 mg / L, with changes (decreased levels) for 9.536 ± 14.873 mg / L. With a paired t test individually on a weekly and three weekly protocol obtained: First, there is no change in a significant SCC antigen levels before and after the third on the protocol of chemotherapy weekly. Second, there is a change in a significant SCC antigen levels before and after the third chemotherapy at three weekly protocol. Test done together with the independent t test acquired conclusions: there is no change in a significant SCC antigen levels before and after the third chemotherapy between the weekly protocol and three weekly protocols. Conclusion: there is no change in a significant SCC antigen levels before and after the third chemotherapy between the weekly protocol and three weekly protocols on advanced carcinoma of the cervix uteri.

Kata Kunci : karsinoma serviks uteri, kemoterapi protokol mingguan dan protokol tiga mingguan, antigen squamous cell carcinoma (Ag SCC)