Efikasi Kemoterapi Neoadjuvan Terhadap Luaran Histerektomi Radikal Penderita Kanker Serviks Stadium IB-IIB

Abstract

Latar Belakang : Pada kanker serviks stadium dini diperlukan tindakan yang bertujuan mengurangi ukuran massa tumor (down-staging) serta faktor resiko patologik sehingga meningkatkan keberhasilan radikalitas operatif, mengurangi kebutuhan radioterapi adjuvan dan meningkatkan prognosis, hal ini dapat dicapai dengan kemoterapi neoadjuvan. Tujuan: Mengetahui efikasi kemoterapi neoadjuvan ifosfamide-cisplatin terhadap luaran histerektomi radikal penderita kanker servik stadium IB-IIA dengan penilaian faktor resiko patologi Bahan dan Metode: Penelitian ini merupakan penelitian deksriptif retrospektif dengan design case series pada 62 kasus kanker serviks IB-IIA di RSUP H. Adam Malik Medan yang menjalani kemoterapi neoadjuvan dan histerektomi radikal dari tahun 2014 sampai 2017. Subjek direkrut berdasarkan kriteria inklusi. Data dikumpulkan dari rekam medis dan dianalisis menggunakan statistik deskriptif, uji wilcoxon sign rank dan uji chi-square dengan angka kebermaknaan p<0.05 Hasil: Subjek penelitian kanker serviks stadium IB-IIA terbanyak pada usia 40-49 tahun, jenis histopatologi squamous carcinoma dan stadium IB2. Terdapat penurunan rerata ukuran massa tumor setelah pemberian kemoterapi neoadjuvan dibandingkan sebelum pemberian kemoterapi (2,24±1,12 cm dan 4,74±1,31 cm). Pada penelitian ini dijumpai keterlibatan parametrium (17,8%), keterlibatan margin vagina (14,5%), LVSI positif (30,6%) dan metastase KGB (25,8%). Toksisitas terbanyak yaitu alopesia (82%), mual-muntah (48%), dan kelainan hematologi (43%). Kesimpulan: Terdapat penurunan ukuran massa tumor serta faktor resiko patologik penderita kanker serviks stadium dini yang mendapat kemoterapi neoadjuvan sebelum histerektomi radikal.

Background: In early-stage cervical cancer, an action that aims to reduce the size of the tumor mass (down-staging) and pathological risk factors that can improve the success of surgical radicality, reduce the need for adjuvant radiotherapy and improve prognosis, it can be achieve by neoadjuvant chemotherapy. Objective: To determine the efficacy of neoadjuvant chemotherapy ifosfamide-cisplatin to outcomes of radical hysterectomy in stage IB-IIA cervical cancer patients with assessment of pathological risk factors. Material and Method: This was retrospective descriptive study with case series design on 62 cases from the year of 2014 until 2017 recruited based on inclusive criterions. Datas were collected from medical record and analyzed by descriptive statistic, wilcoxon sign rank test and chi-square test. p-value less than 0.05 is applied to each statistical test as significant. Results: The most subjects were stage IB-IIA cervical cancer at the age of 40-49 years, histopathology type squamous carcinoma and stage IB2. There was a decrease in mean tumor mass size after administration of neoadjuvant chemotherapy compared to before administration of chemotherapy (2.24 ± 1.12 cm and 4.74 ± 1.31 cm). In this study there was parametrium involvement (17,8%), vaginal surgical margin involvement (14,5%), positive LVSI (30,6%) and lymph node metastase (25,8%). The most toxicity causes alopecia (82%), nausea-vomiting (48%), and hematological abnormalities (43%). Conclusion: There was decrease in tumor mass size and pathologic risk factors in patients with early cervical cancer who received neoadjuvant chemotherapy before radical hysterectomy.