Tesis

Perbandingan Efektivitas Krioterapi, Koagulasi Termal dan Terapi Trikloroasetat pada Temuan Inspeksi Visual dengan Asam Asetat (IVA) Positif di Kota Jakarta = Comparison of the Effectiveness of Cryotherapy, Thermal Coagulation, and Trichloroacetic Acid Therapy in Women with Positive Visual Inspection with Acetic Acid (VIA) Findings in Jakarta.

LATAR BELAKANG: Kanker serviks merupakan salah satu penyebab utama kematian akibat kanker pada wanita di seluruh dunia, termasuk di Indonesia. Berbagai upaya dikembangkan untuk eliminasi kanker serviks, di antaranya adalah skrining dan tindak lanjut lesi prakanker. Krioterapi, yang selama ini merupakan terapi ablasi yang banyak digunakan, memiliki kendala di lapangan terkait ketersediaan dan transportasi gas. Alternatif seperti koagulasi termal dan TCA dapat dipertimbangkan dalam kondisi ini, namun laporan mengenai efektivitas dan efek sampingnya masih terbatas. METODE: Penelitian ini merupakan studi kohort prospektif di puskesmas Jakarta dan Klinik Kintani RSCM (Januari–November 2025). Subjek adalah perempuan dengan hasil IVA positif yang menjalani tindak lanjut tiga bulan pasca terapi. Efektivitas dinilai melalui hasil IVA dan tes DNA HPV, serta dicatat efek samping. HASIL: Dari 298 subjek, 91 menjalani krioterapi, 178 koagulasi termal, dan 29 terapi TCA 85%. Angka negativitas IVA tiga bulan pasca terapi pada kelompok krioterapi sebesar 91,2% (83/91) dan koagulasi termal 92,7% (165/178), tanpa perbedaan bermakna (p=0,640; RR 1,016; CI 95%: 0,941–1,096). Pada perbandingan krioterapi dan TCA, angka negativitas IVA masing-masing 91,2% (83/91) dan 82,8% (24/29), namun karena kurangnya subjek, tidak dapat diambil kesimpulan bahwa TCA kurang efektif dibandingkan krioterapi. Sebanyak 17 subjek (5,7%) memiliki hasil DNA HPV positif pada awal penelitian, dengan konversi menjadi negatif pada 15 subjek (88,2%). Efek samping tersering adalah kram perut atau nyeri ringan saat prosedur, tanpa efek samping berat. KESIMPULAN: Koagulasi termal memiliki efektivitas yang sebanding dengan krioterapi dan dapat dipertimbangkan sebagai alternatif krioterapi, terutama di daerah dengan keterbatasan sumber daya.
Kata Kunci: tes IVA, kanker serviks, krioterapi, koagulasi termal, trikloroasetat, tes DNA HPV


BACKGROUND: Cervical cancer remains a leading cause of cancer-related mortality among women worldwide, including in Indonesia. Cervical cancer elimination strategies include screening and treatment of precancerous lesions. Cryotherapy, a commonly used ablative treatment, faces challenges related to gas availability and transportation in field settings. Alternative therapies such as thermal coagulation and trichloroacetic acid (TCA) may be used; however, evidence regarding their effectiveness and safety is still limited. METHODS: This prospective cohort study was conducted at primary health centers in Jakarta and Kintani Clinic, Dr. Cipto Mangunkusumo Hospital, from January to November 2025. Women with positive visual inspection with acetic acid (VIA) results who completed three-month post-treatment follow-up were included. Treatment effectiveness was evaluated using VIA and HPV DNA testing, and adverse effects were documented. RESULT: A total of 298 subjects were included: 91 received cryotherapy, 178 thermal coagulation, and 29 received 85% TCA. The VIA negativity rate at three months was 91.2% in the cryotherapy group and 92.7% in the thermal coagulation group, with no significant difference (p=0.640; RR 1.016; 95% CI: 0.941–1.096). The VIA negativity rate for TCA was 82.8%; however, the limited sample size precluded definitive comparison with cryotherapy. Seventeen subjects (5.7%) had positive baseline HPV DNA results, of whom 88.2% converted to negative at follow-up. Mild abdominal cramps or procedural pain were the most common adverse effects, with no severe complications observed. CONCLUSION: Thermal coagulation shows comparable effectiveness to cryotherapy and may serve as an alternative treatment option, particularly in resource-limited settings.
Keywords: VIA test, cervical cancer; cryotherapy, cold coagulation; trichloroacetic; HPV DNA test