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Radiasi 6 fraksi tipa minggu dan 5 fraksi tiap minggu pada kanker nasofaring: perbandingan respon tumor pasca terapi = 6 Fractions per week of radiation and 5 fractions per week of radiation in nasopharyngeal cancer: comparation of after treatment tumor response.

Karsinoma Nasofaring (KNF) adalah keganasan yang banyak ditemukan di Indonesia. Saat ini sebagai standar pengobatan untuk KNF stadium I adalah radiasi saja, sedangkan untuk stadium II-IVB adalah radiasi dikombinasi dengan Cisplatin (kemoradiasi). Kombinasi kemoradiasi ini belum memberikan hasil yang memuaskan. Untuk meningkatkan keberhasilan pengobatan maka dilakukan modifikasi fraksinasi radiasi 6 fraksi tiap minggu. Penelitian ini membandingkan respon tumor antara pasien yang dilakukan radiasi 6 fraksi tiap minggu dan radiasi fraksinasi konvensional 5 fraksi tiap minggu. Desain penelitian adalah randomized control trial (RCT), dengan jumlah sampel sebanyak 24 pasien. Respon tumor dinilai berdasarkan kriteria response evaluation criteria in solid tumors (RECIST versi 1.1) dan diuji dengan uji t tak berpasangan. Efek samping dinilai berdasarkan kriteria radiation therapy oncology group (RTOG). Penelitian dilakukan di Departemen Radioterapi RSUPN Dr. Cipto Mangunkusumo pada tanggal 18 Mei 2011 sampai 12 Desember 2011. Hasil penelitian menunjukkan rerata pengecilan tumor (respon tumor) kelompok perlakuan dibanding kelompok kontrol adalah 75,18% ± 12,11% dibanding 69,11% ± 32,18% (p=0.61). Efek samping akut berat (grade 3) yaitu disfagia akut (50% v 33,3%), dermatitis (16.6% v 8.3%), dan lekopenia (8.3% v 0%). Tidak ada efek samping berat grade 4. Overall treatment time (OTT) adalah 44,87 ± 2,74 hari dibanding 49,55 ± 2,50 hari. Pada penelitian ini tidak ada peningkatan respon tumor secara statistik pada radiasi 6 fraksi tiap minggu dibanding radiasi fraksinasi konvensional 5 fraksi tiap minggu. Efek samping akut grade 3 lebih banyak dijumpai pada radiasi 6 fraksi tiap minggu, terutama berupa disfagia akut. OTT radiasi 6 fraksi tiap minggu lebih pendek dari radiasi 5 fraksi tiap minggu. Modifikasi fraksinasi radiasi 6 fraksi tiap minggu tidak membebani pasien namun perlu diantisipasi terjadinya kekurangan asupan makanan.
Kata kunci: Kanker nasofaring (KNF), radiasi 6 fraksi, respon tumor, efek samping akut, overall treatment time (OTT).


Nasopharyngeal carcinoma (NPC) is one of the most common malignancy in Indonesia. Currently, treatment standard for stadium I is radiation only, while for stadium II-IVB the treatment standard comprises of radiation combined with Cisplatin (chemoradiation). However the result of this combination has not been satisfying. To enhance the treatment efficacy, a modification of radiation fractionation by 6 fractions per week had been applied. This study is comparing tumor response between patients receiving 6 fractions per week of radiation and patient receiving conventional 5 fractions per week of radiation. The design of this study is randomized control trial (RCT), with number of sample consist of 24 patients. Tumor response was assessed by using the respon evaluation criteria in solid tumors (RECIST version 1.1) and tested by t-test. The side effect was assessed by using the criteria of radiation therapy oncology group (RTOG). This study was conducted in Departement of Radiotherapy, Dr. Cipto Mangunkusumo National Hospital between 18 May 2011 to 12 December 2011. The study result show average tumor mass decrease (tumor response) in target group when compared to control group is 75,18% ± 12,11% compared to 69,11% ± 32,18% (p=0,61). Severe acute side effect (grade 3) was acute dysphagia (50% v 45,4%), dermatitis (37,5% v 11,1%) and leucopenia (12,5% v 0%). There was no grade 4 side effect. Overall treatment time (OTT) was 44,87 ± 2,74 day compared 49,55 ± 2,5 day. In this study there was no statistically significant increase of tumor response in 6 fractions per week of radiation compared to conventional fractionation radiation 5 fractions per week. The acute side effects (grade 3) was more frecquent in 6 fractions per week, mainly in the form of acute dysphagia. OTT of 6 fractions per week of radiation was shorter than the 5 fraction per week of radiation. Modification of radiation fractionation to 6 fraction per week does not burden the patient. Never the less, side effects such as shortages of food intake should be anticipated.
Keywords: Nasopharyngeal carcinoma (NPC), 6 fractions of radiation, tumor response, acute side effect, overall treatment time (OTT).