Pneumonitis Radiasi pada Penderita Karsinoma Payudara yang Mendapat Terapi Kemoradiasi di RSUP Dr. Kariadi

Abstract

Radiation pneumonitis in breast cancer patients who recieved chemoradiation therapy at Dr. Kariadi hospital
Background: The diagnosis of radiation pneumonitis relied on clinical symptoms and chest x-ray. Radiation pneumonitis will arise 6 to 12 week after external radiation therapy was completed, combination with chemotherapy will increase risk factor of radiation pneumonitis. The aim of this research is to find incidence of radiation pneumonitis among the breast cancer patient with chemoradiation therapy.
Method: This study was an analitic descriptive, with subjects were patients with stage II-III breast carcinoma that have finished chemoradiation therapy at Dr. Kariadi hospital from January 1st 2007 to March 31st 2009. They were contacted by telephone or came for control. Radiation was given with dosage of 50 Gy and booster 10 Gy on chest wall. Incidence data of radiation pneumonitis was analyzed.
Result: The mean age was 48.7 years. The incidence of radiation pneumonitis was 13 from 32 subjects (40.6%), with 69% was mild degree. As much as 31.3% used CAF regiment, 55.6% CAF-xeloda regiment, 20.0% CEF regiment, and xeloda + CEF-xeloda was 100%. There was no significant difference of radiation pneumonitis proportion based on age (p=0.09) and stadium (p=0.15). Most of the patients examined by chest x-ray with pulmonary symptoms, while no pulmonary symptom disapproved to be taken the chest x-ray. This caused the selection bias, thus the incidence of radiation pneumonitis tend to be high.
Conclusion: There were high tendency (40.6%) of radiation pneumonitis incidence at stage II-III breast cancer patient who get chemoradiation therapy at Dr. Kariadi General Hospital, but the most degree of radiation pneumonitis is mild.

ABSTRAK
Latar belakang: Diagnosis pneumonitis radiasi didasarkan pada gejala klinis dan pemeriksaan x foto toraks. Pneumonitis radiasi akan timbul 6-12 minggu setelah terapi radiasi lengkap dan pemberian kemoterapi akan meningkatkan faktor risiko pneumonitis radiasi. Penelitian ini bertujuan mencari insidens pneumonitis radiasi pada penderita karsinoma payudara.
Metode: Penelitian ini adalah deskriptif analitik dengan subjek penderita karsinoma payudara stadium II-III yang telah menyelesaikan terapi kemoradiasi di RSUP Dr. Kariadi pada periode 1 Januari 2007 sampai dengan 31 Maret 2009 yang bisa dihubungi lewat telepon atau datang kontrol. Radioterapi diberikan dengan dosis 50 Gy dan booster 10 Gy pada dinding dada. Data insidens pneumonitis dianalisis secara deskriptif analitik.
Hasil: Rerata umur subjek 48,7 tahun. Insidens pneumonitis radiasi sebanyak 40,6%. Sebagian besar (69%) gambaran pnemonitis termasuk dalam kategori ringan. Sebanyak 31,3% menggunakan regimen CAF, 55,6% menggunakan CAF-xeloda, 20,0% menggunakan CEF. Xeloda dan CEF-xeloda masing-masing ditemukan 1 dari 1 subjek (100%). Tidak ada perbedaan bermakna proporsi kejadian pneumonitis radiasi berdasarkan kelompok umur (p=0,09) dan kelompok stadium (p=0,15). Sebagian besar pasien yang bersedia datang untuk dilakukan pemeriksaan x foto toraks PA adalah yang merasa ada kelainan pada paru-parunya, sedangkan yang merasa tidak ada kelainan pada paru-parunya tidak bersedia untuk diperiksa. Hal ini yang menyebabkan adanya selection bias pada subjek penelitian ini sehingga insiden pneumonitis radiasi cenderung tinggi.
Simpulan: Insiden pneumonitis radiasi pada penderita karsinoma payudara stadium II-III yang mendapat terapi kemoradiasi di RSUD Dr. Kariadi cenderung tinggi yakni 40,6%, dengan derajat pneumonitis radiasi mild yang terbanyak.