Tesis

Hubungan Nilai Apparent Diffusion Coefficient (ADC) pada Diffusion Weighted - MRI (DW-MRI) Pra Pengobatan dengan Respon Kemoterapi Pada Karsinoma Sel Skuamosa Rongga Mulut Stadium Lokal Lanjut = Association of pre-treatment Apparent Diffusion Coefficient (ADC) on Diffusion Weighted-MRI (DW-MRI) with chemotherapy response of advanced staged oral cancer.

Latar Belakang: Insiden kanker sel skuamosa rongga mulut (KSSRM) tercatat meningkat pada dekade terakhir, sebagian besar kasus datang dengan stadium lokal lanjut. Kemoterapi induksi merupakan rekomendasi pada sebagian besar kasus stadium lokal lanjut, dengan harapan tumor mengecil sehingga dapat dioperasi lebih baik dan dapat dilakukan preservasi organ. Namun tercatat, 40 % pasien tidak berespon baik terhadap kemoterapi induksi, sehingga berpeluang menambah morbiditas bahkan mengubah status tumor menjadi unresectable. Nilai Apparent Diffusion Coefficient (ADC) pada Diffusion Weighted - MRI (DW-MRI) merupakan parameter fungsional MRI yang berhubungan dengan densitas sel jaringan kondisi matriks ekstraseluler. Sehingga pemeriksaan ini dapat digunakan untuk memprediksi respon kemoterapi pasien. Tujuan: mengetahui hubungan nilai ADC pra pengobatan dengan respon kemoterapi pada pasien KSSRM stadium lokal lanjut. Metode: Desain studi ini adalah kohort retrospektif. Subjek berasal dari pasien KSSRM lokal lanjut yang menjalani kemoterapi induksi di Divisi Bedah Onkologi RSCM periode 2020- 2023). Dilakukan penilaian ADC pada MRI pra pengobatan, selanjutnya dilakukan penilaian respon kemoterapi pada pasien. Hasil: Terdapat 43 subjek dengan nilai median ADC pra pengobatan 1172.49 mm2/s, dan 17 (40%) subjek berespon baik terhadap kemoterapi berbanding 26(60%) subjek tidak respon. Dilakukan analisis hubungan nilai ADC pra pengobatan dengan respon kemoterapi, dengan median nilai ADC pada kelompok responder dibanding non-responder, 1244.04 berbanding 1163.30, nilai p 0.172. Kesimpulan: nilai ADC pra pengobatan tidak berhubungan dengan respon kemoterapi pada kasus KSSRM stadium lokal lanjut
Kata kunci: Kanker Rongga Mulut, Apparent Diffusion Coefficient, ADC, MRI, respon kemoterapi


Background: The incidence of oral squamous cell carcinoma (OSCC) has been noted to increase in the last decade, most cases come with locally advanced stages. Induction chemotherapy is a recommendation treatment in most cases of this stage, with purpose that the tumor will shrink so that surgery can be performed better with favourable organ preservation. However, it was noted that 40% of patients did not respond well to induction chemotherapy, most patient would face additional morbidity, tumor progression and worse case became unresectable. The value of the Apparent Diffusion Coefficient (ADC) in Diffusion Weighted MRI (DW-MRI) is a functional parameter of MRI related to the density of tumor cells and extracellular matrix. So that this examination can be used to predict the patient's chemotherapy response. Aim: to find association between pretreatment ADC with chemotherapy response of advance stage OSCC patient. Methods: this is a retrosective cohort study. The subjects are advace stage OSCC patient that undergoing induction chemothrapy at Surgical Oncology Division of Ciptomangukusumo Hospital from 2020 to 2023. Subject’s ADC value was determined at pretreatment MRI and then chemoterapy response was assesed for each subject. Results: there were 43 subjects, with median pre treatment ADC value was 1172.49 mm2/s, 17 (40%) subjects respond well to chemotherapy and 26(60%) subject were not respond. Further analysis to find association between variables found the median ADC value was 1244.04 for responder subjects vs 1163.30 for non-responder (p 0.172). Conclusion: pre-treatment ADC value is not associated with chemotherapy response of advance stage OSCC patient.
Keyword: Oral cancer, oral squamous cell carcinoma, Apparent Diffusion Coefficient, ADC, MRI, chemotherapy response