Tesis

Pola Tatalaksana Radiasi Eksterna Paliatif di Instalasi Pelayanan Terpadu Onkologi Radiasi Rumah Sakit Dr. Cipto Mangunkusumo pada Tahun 2019-2023: Analisa Deskriptif pada Pasien Metastasis Tulang dan Pasien Metastasis Otak = Palliative External Beam Radiation Therapy Pattern of Practice in Radiation Oncology Department of Dr. Cipto Mangunkusumo Hospital in 2019-2023: Descriptive Analysis on Bone Metastasis Patient and Brain Metastasis Patient.

Tujuan: Melakukan analisa deskriptif pada pola tatalaksana radioterapi paliatif di Instalasi Pelayanan Terpadu Rumah Sakit Dr. Cipto Mangunkusomo Jakarta (IPTOR RSCM). Metode: Desain penelitian deskriptif retrospektif dengan tabulasi silang. Data dari rekam medis pasien metastasis tulang dan pasien metastasis otak yang telah dilakukan perencanaan radiasi pada 2019-2023 di IPTOR RSCM, survei preferensi dokter onkologi radiasi, dan wawancara keluarga pasien. Dilakukan analisa bivariat untuk mengetahui karakteristik pasien, kesesuaian pola tatalaksana radioterapi paliatif di IPTOR RSCM dengan panduan klinis, dan skema radioterapi paliatif ideal. Hasil: Karakteristik kasus metastasis tulang dan metastasis otak adalah perempuan, usia 50-59 tahun, primer payudara, asal Jakarta, target radiasi multipel lesi, dan dosis multifraksinasi. Terdapat hubungan yang bermakna antara preskripsi ≤ 5 hari radiasi dengan kasus metastasis tulang KPS ≤ 50; preskripsi 6-10 hari radiasi dengan kasus metastasis tulang KPS > 50; whole brain radiotherapy skema pendek (WBRT 5x4 Gy atau 10x3 Gy) dengan kasus RPA III dan extensive brain metastasis; kasus RPA II dan limited brain metastasis dengan preskripsi WBRT-SIB yang menargetkan lokal gross tumor volume (GTV); dan skema fraksinasi radioterapi paliatif pendek dengan overall treatment time (OTT) dengan delay 0-7 hari. Kesimpulan: Pola tatalaksana radioterapi paliatif tulang dan otak di IPTOR RSCM telah mempertimbangkan aspek prognosis pasien dengan pemilihan skema fraksinasi pendek dan telah sesuai dengan panduan klinis acuan. Skema radioterapi paliatif pendek direkomendasikan untuk mencapai OTT yang ideal. Dibutuhkan penelitian lanjutan untuk menilai pola tatalaksana dan rekomendasi klinis terkait skema dosis paliatif yang lebih spesifik.
Kata kunci: pola tatalaksana, radioterapi paliatif, metastasis tulang, metastasis otak, delay overall treatment time, Indonesia


Objective: To conduct a descriptive analysis on the palliative radiotherapy pattern of practice at the Radiation Oncology Department of Dr. Cipto Mangunkusomo Hospital Jakarta (IPTOR RSCM). Method: Retrospective descriptive study design with crosssectional data. Data from medical records of bone metastasis patients and brain metastasis patients who have undergone radiotherapy planning in 2019-2023 at IPTOR RSCM, radiation oncology doctor preference surveys, and interviews with patient families. Bivariate analysis was conducted to determine patient characteristics, the conformity of clinical guidelines in palliative radiotherapy pattern of practice at IPTOR RSCM, and the ideal palliative radiotherapy scheme. Results: The characteristics of bone metastasis and brain metastasis cases were female, aged 50-59 years, primary breast, origin of Jakarta, multiple lesion radiation targets, and multifractionation doses. There was a significant relationship between the prescription of ≤ 5 radiation days with bone metastasis cases KPS ≤ 50; prescription of 6-10 radiation days with bone metastasis cases KPS > 50; short whole brain radiotherapy scheme (WBRT 5x4 Gy or 10x3 Gy) with RPA III and extensive brain metastasis cases; RPA II and limited brain metastasis cases with WBRTSIB targeting local gross tumor volume (GTV); and short palliative radiotherapy fractionation scheme with overall treatment time (OTT) with a delay of 0-7 days. Conclusion: The palliative radiotherapy pattern of practice for bone and brain metastasis at IPTOR RSCM had considered the patient's prognosis aspect by selecting a short fractionation scheme and was accordance with the reference clinical guidelines. A short palliative radiotherapy scheme is recommended to achieve the ideal OTT. Further research is needed to assess the palliative radiotherapy pattern of practice and clinical recommendations for more specific palliative dose schemes.
Keywords: pattern of practice, palliative radiotherapy, bone metastasis, brain metastasis, delayed overall treatment time, Indonesia