Kurva regresi β - Human Chorionic Gonadotropin Serum pada Penderita Penyakit Trofoblas Ganas Resiko Rendah yang Mendapat Kemoterapi Metotrexat Tunggal di RSUP. H. Adam Malik Medan

Abstract

Introduction: Gestational Trophoblastic Neoplasia is a malignancy that is very sensitive to methotrexate, but the effectiveness is limited by the resistance. Monitoring of serum β-hCG during chemotherapy is important to know the success of chemotherapy and prediction the chemoresistance. Therefore, we need to know the regression curve of serum β-hCG for early identification of methotrexate resistance. Objective: To determine the regression curve of serum β-hCG patients with low-risk gestational trophoblastic neoplasia who were undergoing single methotrexate chemotherapy at RSUP. H. Adam Malik Medan. Methods: This study is a descriptive research with case series design, which was performed on 34 patient’s medical records low risk gestational trophoblastic neoplasia who received a single methotrexate chemotherapy from January 2010 - December 2014. The parameters were assessed were age, parity, anatomical pathology results, low risk FIGO scores, presence or absence of metastasis, and the levels of pre-chemotherapy β- hCG as a prognostic factor. The level of β-hCG serum curve of complete remission group and resistance groups plotted in the curve and analyzed descriptively. Results: 2.5% of patients achieved normal value of β-hCG after receiving 2nd cycle of methotrexate, 50% of patients achieved normal value of β- hCG after 4th cycle and 97.5% of patients achieved normal value of β-hCG after 10th cycle. There are variations of β-hCG regression in the 50th percentile group, where there is an increase in 8th cycle and returned to normal in 9th cycle. Before starting chemotherapy, 2 (28.5%) of the 7 patients of MTX-resistant group are above the 97,5th percentile of complete remission group. Before entering the 2nd cycle, 3 (42.8%) of the 7 patients are above 9.75th percentile. Before entering the 4th cycle, 5 (100%) of 5 patients who were still undergoing chemotherapy until the end of the cycle are above the 97.5th percentile. Conclusion: β-hCG regression curve of complete remission group reach to normal level faster than MTX resistant group’s curve.

Pendahuluan: Penyakit trofoblas ganas adalah keganasan yang sangat sensitive terhadap kemoterapi metotrexat, tetapi efektifitas metotrexat dibatasi oleh resistensi. Pemantauan β-hCG serum selama pemberian kemoterapi penting untuk mengetahui keberhasilan kemoterapi dan prediksi kemoresistensi. Oleh karena itu, perlu diketahui kurva regresi β- hCG serum untuk identifikasi resistensi metotrexat secara dini. Tujuan:Untuk mengetahui kurva regresi β-hCG serum penderita penyakit trofoblas ganas resiko rendah yang menjalani kemoterapi metotrexat tunggal di RSUP. H. Adam Malik Medan. Metode: Penelitian ini merupakan penelitian deskriptif dengan design case series, yang dilakukan pada 34 data rekam medis penderita penyakit trofoblas ganas risiko rendah yang mendapat kemoterapi metotrexat tunggal mulai Januari 2010 - Desember 2014. Parameter yang dinilai adalah usia, paritas, hasil patologi anatomi, skor FIGO resiko rendah, ada tidaknya metastasis, dan kadar β-Hcg pra kemoterapi sebagai faktor prognostik. Kadar kurva β-hCG serum kelompok remisi komplit dan kelompok resistensi metotrexat diplot dalam kurva dan dianalisis secara deskriptif. Hasil: 2,5 % pasien mencapai nilai β-hCG normal setelah mendapat metotrexat siklus ke-2, 50% pasien mencapai nilai β-hCG normal setelah siklus ke 4 dan 97,5 % pasien mencapai nilai β-hCG normal setelah siklus ke 10. Terdapat variasi regresi β-hCG pada kelompok persentil 50, dimana terjadi kenaikan pada siklus ke-8 dan kembali normal di siklus 9. Sebelum memulai kemoterapi, didapat 2 (28,5%) dari 7 pasien kelompok resisten MTX yang berada diatas garis persentil 97.5 kelompok remisi komplit. Sebelum memasuki siklus ke-2, 3 (42,8%) dari 7 pasien berada di atas garis persentil 9,75. Sebelum memasuki siklus ke 4, 5 (100%) dari 5 pasien yang masih menjalani kemoterapi berada diatas garis persentil 97.5 sampai akhir siklus ditegakkan resisten MTX.