Disertasi

Efikasi terapi oksigen hiperbarik untuk mengurangi proktitis sebagai efek samping radiasi: tinjauan khusus pada angiogenesis. = THE EFFICACY OF HYPERBARIC OXYGEN THERAPY IN REDUCING PROCTITIS, A SIDE EFFECT OF RADIATION WITH SPECIAL CONSIDERATION ON ANGIOGENESIS.

Background Cervical cancer (Ca cervix) is the most common female malignancy in developing countries, especially Indonesia. It usually occurs at the age of 20 years, reaches the peak incidence at the age of 35-55 years and subsequently it declines.4 Radiotherapy is the main method for local advanced stage or stage llb-IV a of cervical cancer and it is also effective for early stage cervical cancer. Acute side effect of pelvic radiation includes diarrhea, abdominal pain, tenesmus, and hematochezia, which usually occur less than 6 months post- radiation period. However, the more severe late side effect may occur after more than 6 months post-radiation period." The American Society for Therapeutic Radiology and Oncology has reported a scoring system for radiation side effect by using LENT SOMA scale. Moreover, Kamofsky scale is utilized to evaluate the quality of life of patient with cancer disease. The oxygen hyperbaric therapy (OHBT) is defined as lOO% oxygen (02) administration with pressure of 2-3 ATA (Absolute atmosphere) in a high- pressure room. OHBT accelerates wound healing by increasing oxygen perfusion near the wound and increasing angiogenesis through NOS (Nitric Oxide Syntethase ). Methods: This study was conducted in Cipto Mangunkusumo Hospital, while OHBT was conducted in Dr. Mintoharjo Navy Hospital, Jakarta. Block randomization was performed and there were 32 patients in OHBT group and 33 patients in control group with normal distribution. The t-test and two different means were used as statistical analysis in this study. Chi-square test was used to obtain prevalence of proctitis radiation between OHBT group and the control group. The correlation of side effect radiation and MVD for OHBT patients was analyzed by using Pearson correlation. Angiogenesis stage developed immediately after pelvic radiation was determined by usmg ROC (Receiving Operating Characteristic) curve. Moreover, the quality of life in this research was determined by using the intention-to-treat analysis. Results: Acute side effects value revealed p < 0.001, late side effect value revealed p = 0.008 and p T 0.001 for quality of life after treatment. After six month treatment, the result revealed p = 0.007. Chi-square test was used to obtain prevalence of proctitis radiation between OHBT group and the control group. The result indicated that OHBT decreased proctitis prevalent by p = 0..03. The correlation between radiation side effects and MVD for OHBT patient after OHBT treatment was strong with the value of 0.477 to p = 0.008. Angiogenesis stage developed immediately after pelvic radiation was determined by using ROC (Receiving Operating Characteristic) curve. The result indicated a cut-off rate of l3.5 as the most efficient value for 50% sensitivity and 66.7% specificity. Moreover, the correlation between MVD after 6 month OHBT treatment and the side-effects was minimal, with the value of p = 0.482, which indicated that there was no correlation. The quality of life research by using intention-to-treat analysis after pelvic radiation involved 75 patients consisting 35 patients in OHBT group and 40 patients in control group. The result indicated there was improved quality oflife post-treatment with p < 0.01, and p = 0.002 after 6 month treatment, which were very significant. Conclusion: This study indicates that OHBT treatment may reduce acute side effects, late side effects, prevalence of proctitis radiation and improve the quality of life for the patient after pelvic radiation. It also shows that there is a correlation between the side effects and micro vascular density. Last but not least, it also shows that the cut-off for angiogenesis with acute radiation side effects can be determined. Keywords: OHBT, early effect, late effect, LENT SOMA, proctitis radiation, Kamofsky scale, micro vascular density.