Tesis

Karakteristik Tumor Otak Metastasis di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo = Demographic and Clinical Profile of Brain Metastasis in RSUPN dr. Cipto Mangunkusumo.

Latar belakang: Tumor otak metastasis merupakan tumor otak tersering. Karakteristik tumor otak berbeda-beda di setiap negara dan rumah sakit. Metode penelitian: Penelitian ini menggunakan desain potong lintang, data sekunder dari rekam medis pasien tumor otak di RSUPNS Cipto Mangunkusumo, Jakarta, sejak Januari 2016 hingga Desember 2020. Tumor otak didiagnosis berdasarkan riwayat perjalanan penyakit, CT scan/MRI kepala, dan histopatologis dari jaringan otak atau organ primer lain. Hasil: Terdapat 222 subjek tumor otak metastasis. Gambaran karakteristik demografis tumor otak metastasis di RSUPN Cipto Mangunkusumo adalah perempuan 60,8%, dengan usia rerata 50,9+10,4 tahun. Gejala klinis tersering pasien tumor otak metastasis adalah gangguan motorik (68%) dan nyeri kepala (65%) dengan karakteristik nyeri kepala kronik progresif yang berat, dan difus (63,4%) Kejang ditemukan sebanyak 27,5% terutama berupa bangkitan fokal (86,9%). Sebanyak 48% subjek memiliki performa buruk, nyeri kanker (36,9%), dan status hiperkoagulasi (57,7%). Karakteristik tumor otak metastasis paling sering pada area supratentorial (50,6%) dengan jumlah lesi multipel (65,8%). Efek desak ruang ditemukan pada 51,4% subjek yang berupa pergeseran garis tengah (69,6%), hidrosefalus (23,7%), dan penyempitan ventrikel (16,7%). Jenis tumor primer paling banyak adalah paru (36,5%) dan payudara (34,2%). Sebanyak 55,9% subjek sudah ditemukan metastasis ke organ lain saat terdiagnosis metastasis otak, yaitu paru (52,4%) dan tulang (51,6%). Berdasarkan awitan tumor primer menjadi metastasis otak, sebanyak 67,6% gejala metastasis otak diketahui setelah tumor primer diketahui lebih dahulu (metakronus). Jenis tumor primer payudara lebih bermetastasis supratentorial dan infratentorial dengan awitan metastasis metakronus. Adapun jenis tumor primer paru lebih banyak memiliki awitan metastasis sinkronus. Adanya efek desak ruang dan penurunan kesadaran berhubungan dengan performa buruk subjek. Kesimpulan: Tumor paru dan payudara memiliki insidens tertinggi bermetastasis ke otak, yaitu 36,5% dan 34,2%. Gejala defisit neurologis utama ialah gangguan motorik (68%) dan nyeri kepala (65%).
\Kata kunci: Tumor otak metastasis, neuro-onkologi


Background: Metastatic brain tumors are the most common brain tumors, 10 times more often than primary brain tumors. In Indonesia, no study has yet described a detail characteristics of metastatic brain tumors. Methods: This study used a cross-sectional design, using medical records of brain tumor patients at Cipto Mangunkusumo Hospital, Jakarta, from January 2016 to December 2020. Brain tumors were diagnosed based on the history of the disease, CT scan/MRI of the head, and histopathology of brain tissue or other primary organs. Results: There are 222 subjects with metastatic brain tumors. The demographic characteristics of metastatic brain tumors in Cipto Mangunkusumo General Hospital are 60.8% women, the mean age are 50.9+10.4 years old. The most common clinical symptoms in subjects were motor disturbances (68%) and headache (65%) with characteristics of severe chronic progressive headache, and diffuse (63.4%) Seizures were found in 27.5%, mainly in the form of focal seizures ( 86.9%). As many as 48% of the subjects had poor performance, cancer pain (36.9%), and hypercoagulation status (57.7%). Characteristics of brain tumors metastases most often in the supratentorial area (50.6%) and had multiple lesions (65.8%). Space occupancy effects were found in 51.4% of the subjects in the form of midline shift (69.6%), hydrocephalus (23.7%), and ventricular narrowing (16.7%). The most common types of primary tumors were lung (36.5%) and breast (34.2%). A total of 55.9% of subjects had metastases to other organs when diagnosed with brain metastases, which the most common organ are lungs (52.4%) and bone (51.6%). Based on the onset of the primary tumor to brain metastases, 67.6% of the symptoms of brain metastases were identified after the primary tumor was identified (metacronus). Primary breast cancer have both supratentorial and infratentorial metastatic with metachronous onset of metastases. Primary lung cancer have more synchronous onset of metastases. The presence of space-occupying effects and decreased consciousness are associated with poor performance of the subject. Conclusion: Lung and breast cancers had the highest incidence of metastases to the brain, 36.5% and 34.2%, respectively. The main neurological deficit symptoms were motor disturbances (68%) and headache (65%).
Keywords: brain metastatic, neuro-oncology