Mayangsari, Ika Dewi
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Peran radioterapi lokoregional pada kasus karsinoma nasofaring dengan metastasis jauh: laporan serial kasus berbasis bukti Mayangsari, Ika Dewi; Rahman, Muhammad Ade; Adham, Marlinda; Prajogi, Gregorius Ben; Cahyanur, Rahmat; Safitri, Eka Dian
Oto Rhino Laryngologica Indonesiana Vol. 53 No. 2 (2023): VOLUME 53, NO. 2 JULY - DECEMBER 2023
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v53i2.638

Abstract

Background: Nasopharyngeal carcinoma (NPC) is a highly metastatic head and neck cancer primarilytreated with platinum-based chemotherapy. The oligometastasis hypothesis proposed by Hellman andWeichselbaum suggested that controlling the primary tumor through locoregional radiotherapy couldsignificantly improve prolonged disease-free survival. Purpose: To evaluate the effectiveness of combining locoregional radiotherapy with chemotherapy for metastatic NPC. Case series report: The first case involved a 57-year-old male with NPC at T4N3M1 (lungs) with partial response to chemotherapy, who then underwent concurrent chemoradiotherapy. However, his condition deteriorated after completing chemoradiation. The second case featured a 56-year-old male with NPC at T4N3M1 (liver), exhibiting partial response to chemotherapy and remaining at a stable condition after concurrent chemoradiotherapy. Method: Using specific keywords based on clinical questions in the PubMed, Cochrane, EBSCOhost, and Proquest databases. Inclusion criteria, exclusion criteria, and critical appraisal were carried out to find relevant studies. Result: Eleven articles were appraised critically based on the Oxford Centre for Evidence-based Medicine (CEBM) worksheet and include the validity, importance, and applicability in clinical scenarios. Conclusion: Metastatic NPC patients had better overall survival outcomes when treated with locoregional radiotherapy and systemic chemotherapy. Predictive factors influencing survival included oligometastasis, locoregional radiotherapy, chemotherapy response, lactate dehydrogenase, C-reactive protein, EBV DNA, total chemotherapy administration, Karnofsky performance score, number of metastatic lesions, and liver metastases. Platinum-based chemotherapy combined with locoregional radiotherapy could be considered as a management approach for cases of oligometastatic NPC.Keywords: nasopharyngeal carcinoma, chemotherapy, metastasis, overall survival, radiotherapy
Disfagia pasca kemoradiasi pada karsinoma nasofaring Mayangsari, Ika Dewi; Rachmawati, Elvie Zulka Kautzia; Az Zahra, Amira
Oto Rhino Laryngologica Indonesiana Vol. 54 No. 1 (2024): VOLUME 54, NO. 1 JANUARY - JUNE 2024
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v54i1.679

Abstract

Background: Dysphagia is one of the early and long-term consequences of nasopharyngeal carcinomamanagement. Chemotherapy with radiation may improve the local control and survival rate but also canlead to serious dysphagia caused by radiation damage, and chronic alteration of tissues leading to fibrosisthat can happen during or soon after the radiation therapy. Dysphagia can result in dehydration andmalnutrition, place people at risk of aspiration, and reduce the quality of life by increasing anxiety anddepression. Purpose: Identifying causes, relevant factors, clinical presentation, and management of postchemoradiation dysphagia in nasopharyngeal cancer patients. Literature review: Structures demonstratingpost-therapy changes were deemed as dysphagia aspiration-related structures (DARS). Management ofnasopharyngeal carcinoma is radiotherapy with fibrosis found in 38.2% of the nasopharyngeal carcinomapatients on at least one side of the neck post-treatment. The presence of fibrosis in the pharyngeal andlaryngeal muscles impacted hyoid bone anterior movement and upper esophageal sphincter relaxationcontributed to dysphagia. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is utilised to detectdysphagia in these patients. The treatment algorithm for dysphagia after chemoradiation consists of historytaking, clinical evaluation, instrumental examination, and management. The management options may bebehavioral, medical, surgical, or combination. Conclusion: Identifying the cause, the components of thedeficit, and the relevant patient factors has prime importance in managing dysphagia besides consideringthe options and weighing the risks versus benefits.   Keywords: Dysphagia, chemoradiation, nasopharyngeal carcinoma, dysphagia aspiration-related structures, fiberoptic endoscopic evaluation of swallowing