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CRITICAL APPRAISAL

Postmastectomy irradiation in breast in


breast cancer patients with T1-2 and 1-3
axillary lymph nodes: Is there a role for
radiation therapy?

Disusun oleh :
Inge A Syafrida (1102011126)

Dosen Pembimbing :
Dr. Zwasta P.M, MMED
Skenario

Seorang wanita berusia 58 tahun dating ke dokter dengan keluhan timbul benjolan di payudara kiri. Benjolan tersebut dirasakan
tidak sakit, namun bertumbuh besar dalam setahun terakhir. Hasil anamnesis menyatakan bahwa pasien punya riwayat pertama kali
haid saat kelas 4 SD, lebih awal daripada teman-teman sebayanya. Pasien juga melahirkan anak pertama pada usia 39 tahun dan
ibunda pasien meninggal karena keganasan pada payudara. Pada pemeriksaan fisik didapatkan massa dengan konsistensi keras
dengan ukuran 5x2x3cm di kuadran lateral atas, mobile. Pada payudara terdapat peau de orange, retraksi papilla mammae dan
keluar cairan dari putting. Terdapat pula pembesaran kelenjar getah bening pada aksila yang dapat digerakkan. Setelah dilakukan
rontgen dan biopsy, dokter mendiagnosis pasien terkena tumor ganas payudara dengan rincian T3N1MX. Dokter
mempertimbangkan untuk melakukan masektomi radikal modifikasi ditambah kemoterapi. Pasien menanyakan apakah kemoterapi
harus dilakukan karena pasien khawatir kemoterapi memberi dampak negative terhadap pasien.

Pertanyaan :

Apakah pasien dengan keganasan mammae yang melakukan radioterapi memberi hasil yang lebih baik daripada pasien yang tidak
melakukan radioterapi?
PICO

People : Wanita, 59 tahun, kanker payudara T3N1MX

Intervention : masektomi radikal modifikasi dengan kemoterapi

Comparison : masektomi radikal modifikasi tanpa kemoterapi

Outcome : masektomi radikal modifikasi dengan kemoterapi


memberikan hasil yang lebih baik daripada yang tidak disertai
kemoterapi.

Pencarian Bukti Ilmiah :


Alamat website : http://web.a.ebscohost.com/ehost/pdfviewer/
pdfviewer?vid=7&sid=a4c6b44e-e6d5-4718-afc8-a8f7d3afb5da
%40sessionmgr4003&hid=4101
Keywords : breast cancer AND modified radical mastectomy
AND chemotherapy AND prognostic
Limitasi : 2009-2014
Hasil Pencarian : 15 artikel
Dipilih artikel berjudul :
Postmastectomy irradiation in breast in breast cancer patients with
T1-2 and 1-3 positive axillary lymph nodes: Is there a role for radiation
therapy?
Pendahuluan
Mastektomi radikal modifikasi (MRM) merupakan terapi yang penting untuk sebagian besar pasien ca mammae terutama
dengan penyebaran local dan difus dan secara umum terapi ini diterima karena keamanannya dalam mengontrol terapi
pasien dengan T1-2 dan N1-3 pada axilla. Kemoterapi tambahan dan/atau terapi hormonal memperpanjang harapan hidup
pasien ca mammae. Radioterapi pasca mastektomi memberikan manfaat yang sama pada pasien dengan T1-3 maupun T4
atau lebih nodul di hati. Pemilihan dalam melakukan radioterapi pasca mastektomi berdasarkan jumlah status limfonodus
(+) masih menjadi kontroversi karena adanya perbedaan laporan resiko kekambuhan loco-regional. Para ahli
radioonkologi sering menghadapi pasien dengan N1-3 yang menjalani mastektomi radikal modifikasi dalam praktek
sehari-hari. Faktor-faktor yang harusnya dipertimbangkan sebagai faktor resiko prognostic ketika menentukan apakah
seorang pasien sebaiknya menerima radioterapi pada dinding dada dengan atau tanpa sistem limfatik perifer merupakan
hal yang masih sulit untuk diputuskan. Peneliti bertujuan untuk mengevaluasi hubungan Antara tingkat kekambuhan loco-
regional, tingkat metastasis jauh, tingkat harapan bebas dari penyakit, dan tingkat harapan keseluruhan secara umum pada
pasien ca mammae yang dengan atau tanpa radioterapi setelah mastektomi radikal modifikasi.
I. Apakah Hasil Penelitian Ini Valid?
PETUNJUK PRIMER
1. Apakah penempatan pasien dalam kelompok terapi dirandomisasi?
TIDAK.
Pada jurnal tidak disebutkan apakah peneliti menggunakan metoda RCT (Randomized Control Trial)
2. Apakah semua pasien yang dimasukkan ke dalam penelitian dipertimbangkan dan disertakan dalam pembuatan kesimpulan?
PETUNJUK PRIMER
a. Apakah follow-up lengkap?
YA
Pasien di follow up melalui kunjungan dan pemeriksaan fisik setiap 3 bulan pada 3 tahun pertama, setiap 6 bulan di tahun keempat dan
kelima, setelah lima tahun, follow up dilakukan setahun sekali.
patient and invasive Pagets disease for 1 patient. group (20%) had a ratio equal to or higher than 25% (high-
arkably, 3 of the patients with LRR (50%) were est ratio 37%). Eleven of them (85%) were alive without an
ger than 50 of age and premenopousal in no-RT event but 2 had recurrences; 1 with LRR and DM simulta-
p. Interestingly any patient with LRR had no extra- neously, the other one with only DM both dying subse-
l extension in our series. As for DM, lymphatic inva- quently after treatment. Two patients in no-RT group
had an impact on LRRs existing in 5 out of 6 (83%). (8%) had a ratio equal to 25%. One of them developed
RRs in RT group were T2 tumors (3 cm and 4 cm) LRR first followed by DM, the other one had DM without
nly 1 of 4 LRRs in no-RT group was T2 (4.5 cm). LRR, both dying subsequently after treatment.
There was distant metastatic event in 10 patients in
b. Apakah pasien dianalisis padagroup
no-RT kelompok analisis
(42%). Five of themsemula?
developed bone
Disease-Free Survival metastasis first and liver metastasis subsequently. Two
YA. Dari tabel yang ditampilkan, sampel awal berjumlah 90 pasien dan pada saat analisis hasil tetap berjumlah 90.
Table 2 The distribution of recurrences and survivals in
radiotherapy and no-radiotherapy group
Group Radiotherapy No- P
Radiotherapy
n = 66 Radiotherapy
n = 24
n % n %
Local-regional recurrence
Chest wall alone 1 1.5 2 8
No Radiotherapy
Peripheral lymphatics alone 1 1.5 2 8
a
Total LRR 2 3.0 4 17 0.038
Long rankk p value=0.034
L l 0 034
(42.842-132.158 CI 95%)
Distant metastasis 8 12 10 42 0.004
Total Events 10 15 14 58 0.009
Current Status
Death 6 9.0 10 42 0.002
b
ure 2 Kaplan-Meier curve of disease-free probability. (Five DFS (5 yrs actuarial) 82.4 52.4 0.034
s DFS in RT group 82.4%, no-RT group 52.4%, p = 0.034 (42.842- c
OS (5 yrs actuarial) 90.2 61.9 0.087
158 CI 95%)). a
Local-regional recurrence, bDisease-free survival, cOverall survival.

PETUNJUK SEKUNDER
a. Apakah pasien, klinisi dan staf peneliti dibutakan oleh terapi?
TIDAK
Penelitian ini membandingkan kelompok radioterapi (RT) dan non radioterapi (NRT) dimana baik pasien, klinisi dan
staf peneliti tahu ada/tidaknya perlakuan RT tersebut.
b. Apakah kedua kelompok sama pada awal penelitian?
TIDAK
Seluruh pasien (n=90) pada awal penelitian telah menjalani MRM. Namun beberapa karakterisitik pasien seperti status
menopause, staging, grade histologi jauh berbeda
2011, 6:28 Page 2 of 8
tent/6/1/28

c. Selain perlakuan eksperimen, apakah kedua kelompok pendapat perlakuan yang sama?
UNCLEAR
oco-regional RT or no-RT after nuclear grade, extracapsular extension, lymphatic, vascu-
Bersamaan
ever, this study was dengan
closedMRM,lar sebanyak 89 sampel
and perineural (99%)and
invasion, menerima
ratio ofkemoterapi adjuvan dan sebanyak 66 sampel (73%)
involved nodes/
crual. Another closed
menerima study
terapi dissected
endokrin adjuvan nodes),
selama 5and treatment-related
tahun. factors apakah
Namun tidak diberitahu (PMRT,pasien tersebut berasal dari sampel
nducted by the same group, chemotherapy and hormonal therapy) were analyzed
eksperimen atau sampel kontrol.
ad undergone breast-conserving (Table 1).
ode positive, and node negative,
to receive standard only breast Treatment
RT. Nevertheless, this study All patients underwent MRM. Median tumor size was 3
r to our question because the cm (range, 1-5). The median number of dissected lymph
ndergone breast conserving sur- nodes was 11 (range, 3-37). Following MRM, FAC
ected to receive planned breast (5-fluorouracil, adriamycin, cyclophosphamide) or CMF
stion, which requires a precise (cyclophosphamide, methotrexate, 5-fluorouracil) adju-
oncologists, is the rate of LRR vant chemotherapy were administered to 89 of patients
e positive patients who never (99%) and 66 patients (73%) received adjuvant endocrine
MRM. Additional two questions therapy for 5 years. One patient only received hormonal
ld disease free survival (DFS), therapy. Sixty-six patients (73%) received PMRT (RT
S) could be affected by PMRT. group) and 24 patients (27%) did not (no-RT group). All
wer will wait to be clarified by patients were simulated with conventional simulator.
ming years. Ongoing randomized The postmastectomy chest wall received a dose of
signed to evaluate the results of 50 Gy through two tangential fields with 6 MV foton.
n management of the patients The mid-axilla received a dose of 50 Gy through an
pT1N0M0 or pT2N0-1M0 dis- anterior supraclavicular and posterior axillary fields with
etter information the role of cobalt-60. Intended dose was given in 25 fractions in a
oup [6]. period of 5 week.
often confront patients with 1-3
llowing MRM in their routine Follow-up
Figure 3 Kaplan-Meier c
Figure 1 Kaplan-Meier curve of local failure-free probability (Five years OS in RT group
(Five year local-regional failure-free survival in RT group 0.087 (71.127-199.340 CI 9
92.6%, no-RT group 87.1%, p = 0.038, (78.152-220.361 CI
95%)).
Regarding the ratio of
for 1 patient and invasive Pagets disease for 1 patient. group (20%) had a ratio
Remarkably, 3 of the patients with LRR (50%) were est ratio 37%). Eleven of
event but 2 had recurren

II. Apa Hasilnya?


younger than 50 of age and premenopousal in no-RT
group. Interestingly any patient with LRR had no extra- neously, the other one
nodal extension in our series. As for DM, lymphatic inva- quently after treatmen
sion had an impact on LRRs existing in 5 out of 6 (83%). (8%) had a ratio equal
All LRRs in RT group were T2 tumors (3 cm and 4 cm) LRR first followed by D
but only 1 of 4 LRRs in no-RT group was T2 (4.5 cm). LRR, both dying subsequ
1.Berapa besar efek terapi? There was distant m
no-RT group (42%).
Disease-Free Survival metastasis first and liv

Table 2 The distribution

%)
al Rate (%
SEMBUH* TIDAK SEMBUH TOTAL radiotherapy and no-rad
Group
Radiotherapy

Diisease-Freee Surviva
INTERVENSION 54 (A) 12 (B) 66
Local-regional recurrence
Chest wall alone
No Radiotherapy
Peripheral lymphatics alo
Total LRRa
CONTROL 13 (C) 11 (D) 24 Long rankk p value=0.034
L l 0 034
(42.842-132.158 CI 95%)
Distant metastasis
Total Events
Current Status
Death
TOTAL 67 23 90
b
Figure 2 Kaplan-Meier curve of disease-free probability. (Five DFS (5 yrs actuarial)
years DFS in RT group 82.4%, no-RT group 52.4%, p = 0.034 (42.842- OSc (5 yrs actuarial)
132.158 CI 95%)). a
Local-regional recurrence, bDise
* kriteria sembuh berdasarkan kurva Kaplan Meier atas DFS (Disease Free
Survival) dengan perhitungan setelah 5 tahun follow up.
EER (Experimental Event Rate) : B/total CER (Control Event Rate) : D/total
= 12/66 = 11/24
= 0.181x100% = 0.46x100%
= 18.1% = 46%

ARR (Absolute Risk Reduction) : CER-EER


= 0.46-0.181
= 0.279x100% = 27.9%

RRR (Relative Risk Reduction) : ARR/CER


= 0.279/0.46
= 0.606x100% = 60.6%

NNT (Number Needed to Treat) : 1/ARR


= 1/0.279
= 3.584

Kesimpulan : PMRT pada pasien breast cancer bisa menurunkan angka kegagalan sebesar 60.6% dibandingkan
eksperimen kontrol.
2.Bagaimana presisi estimasi efek terapi?

95% CI ARR = ARR + 1.96 V(p1.q1/n1)+(p2.q2/n2)


= 0.279 + 1.96 V(0.18x0.82/66)+(0.46x0.54/24)
= 0.279 + 1.96 V(0.0022)+(0.01035)
= 0.279 + 1.96x(0.1120)
= 0.279 + 0.21952 = 0.06 ; 0.5
5%. Despite the situation, their LRR, total event, death needed to treat to avoid a loco-regional recurrence and/
tes, and DFS rates were significantly worse than RT or death in both groups. Therefore, in management of
oup in which 13 patients (20%) had this disadvantage. patients with 1-3 axillary lymph nodes positive patients
nother debate about PMRT is about the rational of should be reconsidered thoroughly with the guidance of
eripheral lymphatic portal addition to the chest wall long-term results of studies like DBG 82 and British
radiation. In our series there were 3 peripheral lym- Columbia randomized trial [2,15].
hatic recurrence out of 6 LRR in the entire group, all When making decision for PMRT, radiation oncolo-
III. Apakah Hasil Ini Akan Membantu Saya Merawat Pasien?
tuated in supraclavicular region suggesting that a small gist needs additional parameters for this group of
upraclavicular field (excluding humeral head) addition patients. As Overgaard et al. mentioned in their article,
the chest wall portal would be adequate, which also it is obvious that the number of positive lymph nodes
ould prevent a subsequent arm lymphedema. solely is an extremely crude way of defining a potential
1. Apakah hasil ini dapat diterapkan pada pasien saya?
The question whether with current standards of sur- indication for PMRT. More information may come
Tujuan
ery and systemic adjuvant awal penulis
chemotherapy melakukan
in this parti- from telaah
otherkritis pada jurnalparameters
clinicopathologic adalah untuk mengetahui prognosis pasiennya jika
(e.g., capsule
ular subset of intermediate risk patients (N1-3 positive and lymphovascular invasion, malignancy grading,
nd pT2) with additional menjalani mastektomi
risk factors, radikal
the prevention of termodifikasi
etc.). Moreover,dengan radioterapi.
recent years haveDitinjau
given dari segi kesesuaian sampel, pasien adalah
increasing
cal recurrences through only chest wall irradiation will knowledge about the prognostic value of new molecu-
seseorang dengan kanker payudara berlokasi di kuadran lateral atas, stadium IIA T3N2MX yang berusia 59 tahun.
mprove survival, is investigated in an ongoing study of lar and genetic markers in order to select patients for
RC/EORTC SUPREMO trial [6,16].
Dengan adanya jurnal Postmastectomy adjuvant irradiation
systemic therapy in breast [24-26]. In coming
in breast canceryears, patients with T1-2 and 1-3 positive
Arriagada reported a retrospective analysis of IGR these new markers might also be proven as predictors
axillary
atabase between 1963-1983 lymph
on 1105 nodes:
patients Is there
treated by aforrole for radiation
selecting tumors which therapy? penulis
are more sensitivemempunyai
to RT acuan yang terpercaya untuk
tal mastectomy and axillary dissection who did not than the others.
melakukan PMRT kepada pasien. Sesuai dengan paragraf
ceive adjuvant chemotherapy or hormonotherapy. The
sult showed an advantage in favor of PMRT in N1-3 Conclusion
ositive patients [17]. In a more recent study Cheng et Our results share some similar and consistent findings
reported that in addition to axillary nodal status, with the recent literature as presented above, in which
trogen receptor status, lymphovascular space invasion PMRT resulted to improve local-regional control, DFS
nd age at diagnosis were all found to be significant to and OS. Selection of patients for PMRT in this inter-
edict LRR and the impact of PMRT on survival [18]. mediate risk group is a challenging situation, because
eside these individual studies number of reviews and some of them have one or more predictor and prognos-
etaanalyses demonstrate an absolute survival benefit of tic factors for failure. It appears that the benefit of RT is
pproximately 5% to 10% and approximately 66% to worth of the risk of treatment morbidity with accurate
5% relative reduction in LRR, with PMRT [19-23]. selection.
A typical explanation expressed in the following cita- PMRT for T1-2 and N1-3 positive patients has to be
on from the NIH Consensus Report 2000 [5]: There reconsidered according to the prognostic factors and the
evidence that women with high risk of LRR after decision has to be made individually with the considera-
RM benefit from PMRT. This high-risk group tion of long-term morbidity and with the patient
cludes women with four or more positive nodes or an approval, until further data are available.
dvanced primary tumor. At this time, the role of
MRT for women with 1 to 3 positive lymph nodes Author details
mains uncertain and is being examined in a rando- 1Trakya University 2
Hospital, Department of Radiation Oncology, Edirne,
ized clinical trial. Many surgeons and radiation oncol- TURKEY. 3Medicana Hospital, Department of Radiation Oncology, Istanbul,
TURKEY. Trakya University Hospital, Department of Biostatistics, Edirne,
gist are not recommending PMRT to 1-3 axillary TURKEY. 4Trakya University Hospital, Department of Internal Medicine,
mph node positive patients with a common under- Division of Medical Oncology, Edirne, TURKEY. 5Trakya University Hospital,
Department of Surgery, Edirne, TURKEY.
Locaal Failuree-Free Surr
No Radiotherapy

Long rank p value=0.038


(78.152-220.361 CI 95%) Long-rank P value =0.087
(71.127-199.340 CI 95%)

2. Apakah semua luaran yang penting sudah dipertimbangkan?


Figure 3 Kaplan-Meier curve of overall survival probability
Figure 1 Kaplan-Meier curve of local failure-free probability (Five years OS in RT group 90.2%, no-RT group 61.9%, p =
(Five year local-regional failure-free survival in RT group
YA.
92.6%, no-RT group 87.1%, p = 0.038, (78.152-220.361 CI
0.087 (71.127-199.340 CI 95%)).

95%)).

Dari hasil penelitian, pasien pada kelompok PMRT


Regarding the ratio mempunyai
of involved OS
nodes, 13 patients in RT(Overall Survival), DFS (Disease-Free
for 1 patient and invasive Pagets disease for 1 patient. group (20%) had a ratio equal to or higher than 25% (high-
est ratio 37%). Eleven of them (85%) were alive without an
Survival) dan Local Failure-Free Survival yang lebih tinggi dibandingkan kelompok non-PMRT. Selengkapnya
Remarkably, 3 of the patients with LRR (50%) were
event but 2 had recurrences; 1 with LRR and DM simulta-
younger than 50 of age and premenopousal in no-RT
group. Interestingly any patient with LRR had no extra- neously, the other one with only DM both dying subse-
terlampir pada kurva Kaplan Meier berikut :
nodal extension in our series. As for DM, lymphatic inva- quently after treatment. Two patients in no-RT group
(8%) hadCosar
a ratio
Cosar
et equal to 25%.Oncology
et al. Radiation
al. Radiation Oncology One6:28
2011, of2011,
them6:28developed Page 4 of 8 Page 4 of 8
sion had an impact on LRRs existing in 5 out of 6 (83%). http://www.ro-journal.com/content/6/1/28
All LRRs in RT group were T2 tumors (3 cm and 4 cm) LRR first followed by DM, the other one had DM without
http://www.ro-journal.com/content/6/1/28

but only 1 of 4 LRRs in no-RT group was T2 (4.5 cm). LRR, both dying subsequently after treatment.
There was distant metastatic event in 10 patients in
no-RT group (42%). Five of them developed bone
Disease-Free Survival metastasis first and liverLocal Failure-Free SurvivalSurvival
Local Failure-Free
metastasis subsequently. Two Overall Survival
Overall Survival

Locaal Failuree-Free Surrvival Ratte (%)

Locaal Failuree-Free Surrvival Ratte (%)


Radiotherapy
Table 2 The distribution of recurrences and survivals in
Radiotherapy
Radiotherapy
%)

Radiotherapy
Diisease-Freee Survivaal Rate (%

radiotherapy and no-radiotherapy group


Group Radiotherapy No Radiotherapy
No-
Radiotherapy No PRadiotherapy
n = 66 Radiotherapy
n = 24
n % n % No Radiotherapy
No Radiotherapy
Local-regional recurrence
Chest wall alone 1 1.5 2 8
No Radiotherapy
Peripheral lymphatics alone 1 1.5 2 8
Long rank p value=0.038
Total LRRa 2 rank
(78.152-220.361
Long CI3.0
95%) 4
p value=0.038 17 0.038 Long-rank P value =0.087
Long rank
L k p value=0.034
l 0 034 (71.127-199.340 CI 95%)
(42.842-132.158 CI 95%)
Distant metastasis 8(78.152-220.361
12 CI10
95%) 42 0.004 Long-rank P value =0.087
(71.127-199.340 CI 95%)
Total Events 10 15 14 58 0.009
Current Status
Death 6 9.0 10 42 0.002 Figure 3 Kaplan-Meier curve of overall survival probability
Figure 1 Kaplan-Meier curve of local failure-free probability (Five years OS in RT group 90.2%, no-RT group 61.9%, p =
b
Figure 2 Kaplan-Meier curve of disease-free probability. (Five DFS (5 yrs actuarial) 82.4
(Five year local-regional failure-free survival 52.4
in RT group0.034 Figure 3 Kaplan-Meier curve of overall survival probability
Figure 1 Kaplan-Meier curve of local failure-free 0.087 (71.127-199.340 CI 95%)).
probability
years DFS in RT group 82.4%, no-RT group 52.4%, p = 0.034 (42.842- c 92.6%, no-RT group 87.1%, p
OS (5 yrs actuarial)(Five year local-regional = 0.038, (78.152-220.361
90.2 failure-free61.9 CI (Five years OS in RT group 90.2%, no-RT group 61.9%, p =
95%)). survival in0.087
RT group 0.087 (71.127-199.340 CI 95%)).
132.158 CI 95%)). a
92.6%, Disease-free
Local-regional recurrence, b
no-RT group 87.1%,Overall
survival, c
p = 0.038, (78.152-220.361 CI
survival.
95%)). Regarding the ratio of involved nodes, 13 patients in RT
for 1 patient and invasive Pagets disease for 1 patient. group (20%) had a ratio equal to or higher than 25% (high-
est ratio
Regarding the ratio of involved nodes, 13 patients in RT
37%). Eleven of them (85%) were alive without an
Remarkably, 3 of the patients with LRR (50%) were group (20%) had a1ratio
for than
younger 1 patient
50 ofand
age invasive Pagets disease
and premenopousal event but 2 had recurrences;
for 1 patient.
in no-RT with equal
LRR andto or
DMhigher than 25% (high-
simulta-
group.Remarkably, 3 ofpatient
Interestingly any the patients
with LRRwithhad LRR were the other one with only DM both dying subse- without an
(50%) neously,
no extra-
est ratio 37%). Eleven of them (85%) were alive
eventtreatment.
quently after but 2 hadTworecurrences;
patients 1inwith LRRgroup
no-RT and DM simulta-
nodalyounger
extensionthan
in our50series.
of age As and premenopousal
for DM, lymphatic inva-in no-RT
group.
sion had Interestingly
an impact on LRRsany patient
existing in 5with LRR
out of (8%) had a ratio equal to 25%. One of them developeddying subse-
had no extra-
6 (83%).
neously, the other one with only DM both
quently by after
DM,treatment. Two hadpatients in no-RT group
nodal
All LRRs in extension
RT group in ourT2series.
were tumorsAs(3forcm
DM, 4 cm) LRR
andlymphatic inva-first followed the other one DM without
sion1 had
but only an impact
of 4 LRRs on LRRs
in no-RT group existing in 5cm).
was T2 (4.5 LRR,
out of 6 (83%). both (8%)
dying had a ratio
subsequently equal
after to 25%.
treatment. One of them developed
All LRRs in RT group were T2 tumors (3 cm and 4 cm)
There was LRR first
distant followed by
metastatic DM,
eventthein other one had
10 patients in DM without
no-RT group (42%).
LRR, both Fivesubsequently
dying of them developed bone
after treatment.
but only 1 of 4 LRRs in no-RT group was T2 (4.5 cm).
Disease-Free Survival metastasis first and liver metastasis subsequently.
There was distant metastatic event in Two10 patients in
no-RT group (42%). Five of them developed bone
Disease-Free Survival metastasis
Table 2 The first
distribution of and liver metastasis
recurrences subsequently.
and survivals in Two
%)
te (%

radiotherapy and no-radiotherapy group


3. Apakah manfaat terapi tersebut melebih harm dan biayanya?

(+) (-)

Membantu menghancurkan sel kanker sehingga


Kerontokan rambut
hanya tersisa sedikit sel kanker

Radioterapi paliatif juga mampu memperbesar


angka harapan hidup dan memperbaiki kualitas Palpitasi, mual dan muntah
hidup

Berdasarkan penelitian, angka harapan hidup dan


rekurensi dari kanker payudara pada pasien yang Harganya lebih mahal dibandingkan pasien yang
menjalani PMRT lebih baik daripada pasien yang hanya menerima mastektomi
hanya menjalani mastektomi saja

! Radioterapi tidak menyembuhkan kanker, ! Sangat tidak dianjurkan untuk melakukan


teknologi ini hanya membantu memperkecil sel radioterapi dalam keadaan hamil. Efek samping
kanker pada umumnya bersifat sementara (temporary)

Sumber : http://www.royalmarsden.nhs.uk/cancer-information/treatment/pages/radiotherapy.aspx
ALHAMDULILLAH