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PENGARUH PEMBERIAN INJEKSI KETOROLAC INTRAPERITONEAL TERHADAP PENYEMBUHAN FRAKTUR KRURIS TIKUS WISTAR DEWASA Ivandy Fam; Yan Wisnu Prajoko; Ani Margawati
Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal) Vol 5, No 4 (2016): JURNAL KEDOKTERAN DIPONEGORO
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Latar belakang: Obat anti inflamasi non-steroidal (NSAID) terbukti efektif dalam menangani nyeri fraktur. Namun, berbagai penelitian telah membuktikan bahwa pemberian NSAID jangka panjang dapat menghambat penyembuhan fraktur. Ketorolac, NSAID non-spesifik, merupakan salah satu obat yang paling banyak digunakan pada kasus fraktur. Durasi penggunaan ketorolac dianjurkan maksimal 5 hari, karena penggunaan lebih lama diasosiasikan dengan efek samping berat. Belum diketahui apakah penggunaan ketorolac dalam 5 hari dapat menghambat penyembuhan fraktur.Tujuan: Mengetahui pengaruh pemberian injeksi ketorolac intraperitoneal terhadap penyembuhan fraktur kruris tikus wistar dewasa.Metode: Penelitian ini adalah penelitian eksperimental dengan rancangan post-test only control group design. Sampel tikus wistar dewasa sejumlah 20 ekor dibagi acak menjadi kelompok kontrol dan perlakuan. Dilakukan frakturisasi tertutup pada kruris kanan tikus, dan difiksasi dengan bidai gips. Kelompok kontrol diberikan pakan dan minum standar selama 21 hari, sedangkan kelompok perlakuan diberikan injeksi ketorolac 5mg/kgBB selama 5 hari pertama, kemudian dilanjutkan dengan pakan dan minum standar sampai hari yang ke 21. Pada hari ke 22 tikus diterminasi dengan overdosis chloroform, dan tulang kruris kanan di diseksi. Kalus fraktur kemudian dibuat preparat histologi menggunakan pengecatan HE, dan dibaca menggunakan mikroskop cahaya. Penilaian maturasi kalus fraktur menggunakan scoring Allen yang telah dimodifikasi.Hasil: Kelompok perlakuan menunjukkan penghambatan penyembuhan fraktur yang signifikan, dengan rerata skor maturasi kalus 3.67±0.27, dibanding dengan kelompok kontrol dengan rerata skor 44.38±0.302. Hasil uji independent t-test menunjukkan perbedaan yang bermakna dengan p=0.001.Simpulan: Pemberian injeksi ketorolac intraperitoneal selama 5 hari dapat menghambat penyembuhan fraktur kruris tikus wistar dewasa.

EFEKTIFITAS ALOE VERA (ALOE BARBADENSIS MILLEER) DALAM PENANGANAN HAND FOOT SYNDROME PADA PASIEN KANKER PAYUDARA YANG MENDAPAT KEMOTERAPI CAPECITABINE PER ORAL Paramita Nindya Hapsari; Yan Wisnu Prajoko; Selamat Budijitno
DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) Vol 7, No 2 (2018): JURNAL KEDOKTERAN DIPONEGORO
Publisher : Faculty of Medicine, Diponegoro University, Semarang, Indonesia

Latar Belakang: Kemoterapi merupakan salah satu terapi yang sudah banyak dipakai untuk pengobatan kanker yang terbukti dapat meningkatkan survival rate pasien. Namun, kemoterapi dapat memberikan efek negatif bagi penggunanya. Salah satunya ialah Hand foot syndrome. Hand foot syndrome adalah efek samping kemoterapi yang sering ditemukan dan perlu penanganan yang tepat. Selain urea cream, aloe vera juga dapat melindungi kulit karena bekerja sebagai pelembab dan anti inflamasi.Tujuan: Membuktikan pengaruh aloe vera dalam penanganan hand foot syndrome pada pasien kanker payudara yang mendapat kemoterapi capecitabine per oral.Metode: Penelitian ini merupakan penelitian eksperimental dengantwo groupspretest-posttest design. Penelitian dilakukan di RSUP Dr. Kariadi, Semarang. Sampel penelitiandibagi menjadi dua kelompok, yaitu kelompok perlakuan dan kelompok kontrol (n=33) yang diberikan pretest, lalu pemberian gel aloe vera, kemudiandiberikanposttest. Skor hand foot syndrome setelah diberikan gel aloe vera dianalisis dengan uji Kendall’s tau b dan Mann Whitney, skor kualitas hidup di analisis dengan Paired T test, dan uji korelasi antara grade hand foot syndrome dengan kualitas hidup pasien kanker payudara menggunakan uji Spearman. Hasil: Baik pada kelompok kontrol maupun kelompok perlakuan, masing-masing mengalami perbaikan skor hand foot syndrome dengan hasil pada kelompok kontrol (p=0,025) dan kelompok perlakuan (p=0,008)Kesimpulan: Terdapat perbaikan skor hand foot syndrome pada pasien kanker payudara yang mendapat kemoterapi capecitabine per oral yang diberikan gel aloe vera.

TIROIDEKTOMI MENINGKATKAN IMT ( INDEKS MASSA TUBUH ) PADA PASIEN HIPERTIROID DI RSUP DR. KARIADI SEMARANG Reyhan Zuhdi Gofita Widyawigata; Yan Wisnu Prajoko; Endang Mahati; Albertus Ari Adrianto
Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal) Vol 8, No 4 (2019): JURNAL KEDOKTERAN DIPONEGORO
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Latar belakang : Hipertiroid merupakan peningkatan kadar hormon tiroid bebas secara berlebihan dalam sirkulasi peredaran darah dan dapat menyebabkan peningkatan laju metabolisme yang pada akhirnya menyebabkan penurunan berat badan. Kondisi ini masih banyak dijumpai di Indonesia. Tiroidektomi merupakan satu bentuk pilihan terapi hipertiroid. Data dalam penelitian sebelumnya menyebutkan bahwa pasien yang diterapi dengan tiroidektomi mengalami peningkatan berat badan dibandingkan dengan pasien yang diterapi dengan pengobatan antitiroid lainnya. Tujuan : Mengetahui perbedaan status IMT pada pasien hipertiroid pada periode pra- dan pascaoperasi tiroidektomi. Metode : Jenis penelitian ini adalah observasional analitik retrospektif dengan pendekatan Crossectional. Data didapatkan dari rekam medik pasien dengan diagnosis hipertiroid secara laboratoris yang dilakukan tiroidektomi di RSUP Dr. Kariadi 1 Januari 2015 - 31 Desember 2017 sejumlah 62 pasien dengan metode consecutive sampling. Data dianalisis dengan menggunakan uji statistik wilcoxon, Mann Whitney dan Kruskal Wallis. Hasil : Rata-rata status IMT praoperasi tiroidektomi adalah 23,01 dan rata-rata status IMT pascaoperasi tiroidektomi adalah 24,46. Terdapat kenaikan bermakna pada IMT pascaoperasi tiroidektomi dan jenis kelamin juga berpengaruh secara signifikan terhadap kenaikan IMT pascaoperasi tiroidektomi. IMT praoperasi dan usia tidak berpengaruh terhadap perubahan IMT pascaoperasi tiroidektomi. Kesimpulan: Tiroidektomi meningkatkan IMT pascaoperasi pasien hipertiroid dan kenaikan ini dipengaruhi oleh jenis kelamin.Kata kunci : Hipertiroid, Tiroidektomi, IMT.

GAMBARAN PASIEN KARSINOMA KOLOREKTAL DI RSUP DR. KARIADI SEMARANG YANG MENGALAMIN OBESITAS, HIPERTENSI, DAN HIPERGLIKEMIA Emmanuel Joseph Bagus Hestu Pradipta; Yan Wisnu Prajoko; Firdaus Wahyudi
DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) Vol 6, No 2 (2017): JURNAL KEDOKTERAN DIPONEGORO
Publisher : Faculty of Medicine, Diponegoro University, Semarang, Indonesia

Latar Belakang Insidensi fraktur collum femoris meningkat seiring dengan usia dan merupakan fraktur paling sering pada usia lanjut. Salah satu penanganan fraktur collum femoris adalah dengan Total Hip Arthroplasty (THA) dimana tindakan ini berhubungan dengan derajat fungsional panggul dan kualitas hidup.Tujuan Menganalisis hubungan antara jenis THA terhadap derajat fungsional panggul dan kualitas hidup pada pasien fraktur collum femoris.Metode Penelitian observasional analitik studi belah lintang menggunakan data rekam medis serta kuesioner SF-36 dan Hip Score pada pasien fraktur collum femoris yang mendapatkan tindakan THA di RSUP Dr. Kariadi.Hasil Terdapat 25 kasus yang ditemukan, terdiri dari 12 kasus cemented dan 13 kasus uncemented. Dari 12 pasien yang dilakukan cemented THA, 11 diantaranya termasuk dalam SF-36 kategori baik sedangkan 1 pasien kategori buruk. Dari 13 pasien yang dilakukan uncemented THA, 12 diantaranya termasuk dalam SF-36 kategori baik sedangkan 1 pasien kategori buruk. Pada pemeriksaan Hip Score, dari 12 pasien yang dilakukan cemented THA, 9 diantaranya tidak ada keluhan, 2 pasien kategori ringan-sedang, dan 1 pasien kategori sedang-berat. Pada 13 pasien yang dilakukan uncemented THA, 11 diantaranya tidak ada keluhan, 1 pasien kategori ringan-sedang, dan 1 pasien kategori sedang-berat. Hubungan jenis THA terhadap derajat fungsional panggul dan kualitas hidup pada pasien fraktur collum femoris adalah tidak bermakna (p > 0,05).Kesimpulan Tidak ada perbedaan derajat fungsional panggul dan tingkat kualitas hidup terhadap jenis THA.

Effectiveness of Spirulina platensis Extract on Wound Area and TNF-a Levels on Blood: Experimental Studies In Wistar Rats Made Artificially by Vulnus Scissum and Infected by Staphylococcus aureus Olvaria Misfa; Renni Yuniarti; Yan Wisnu Prajoko
Indonesian Journal of Environmental Management and Sustainability Vol. 4 No. 2 (2020): June
Publisher : Research Centre of Inorganic Materials and Complexs

This research uses randomizedpost-test only control group design. Thirty-two (32) male Wistar rats with incised skin and infected with S. aureusdivided into 4 groups, namely the group given S.platensisextract at a dose of 500 mg / kgBB / day (X1) and a dose of 750 mg / kgBB / day (X2 ), the negative control group was given saline solution (C1), and the positive control group was given amoxicillin 150 mg / kg orally(C2). Wound area measurements were taken on day 14 and serum TNF-? levels were examined on day 14 using the ELISA method. Data analysis was performed with one way ANOVAtestand continued with Post Hoc Test LSD.The results showed mean size of wound closure on the 14th day in groups X1, X2, C1 and C2 is 8095.74; 6270.98;15502.69; 11475.20micrometer with p <0.001. The mean TNF-? serum levels in the 14th day of X1, X2, C1, and C2 groups were 270.75; 222.83; 1730.33; 385.75pg / ml with p <0.001. Post Hoc Test of wound area showed significant differences between groups. Post Hoc Test TNF-? levels showed significant differences between treatment groups X1 and X2 with group C1.Spirulina platensisextract 500mg / kgBB / day and 750 mg /kgBB/ day have the smallest wound area significantly and reduce TNF-? levels on blood.

PENGARUH ELEUHTERINE PALMIFOLIA (L) MERR TERHADAP PROLIFERASI SEL TUMOR PADA TIKUS SPRAGUE DAWLEY DENGAN KANKER PAYUDARA Ratna Widayati; Yan Wisnu Prajoko; Udadi Sadhana
Unram Medical Journal Vol 10 No 4 (2021): Jurnal Kedokteran Volume 10 nomor 4 (Desember) 2021
Publisher : Faculty of Medicine Universitas Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jku.v10i4.545

Background : Immunotherapy is widely used to increase the response rate of chemotherapy drugs. Eleuhterine palmifolia (L) Merr or dayak onion are known to contain phytochemical compounds that have antiproliferative effects, and have been used as anti-cancer empirical therapies. This study aimed to prove the antiproliferative effect of Eleuhterine palmifolia (L) Merr extract in Sprague-Dawley rats with breast cancer. Methods : This study used 18 Sprague-dawley rats, divided into 3 groups, K, P1 and P2. K was given regular feed, P1 received adriamycin 5 mg/kgBW single dose, P2 received adriamycin 5 mg/kgBW single dose and extract of dayak onion 105 mg/kgBW/day for 3 weeks. Results : Difference in tumor size before and after treatment was 7.2 ± 2.57 mm (K), 3.23 ± 3.03 mm (P1), 3.14 ± 2.65 mm (P2), with p value is 0,157 (p>0,05). Ki-67 index calculations are 11.1 ± 7.27% (K), 9.64 ± 6.99% (P1), 9.58 ± 3.52% (P2), with p value is 0,704 (p>0,05). Conclusion : The addition of Eleuhterine palmifolia (L) Merr (dayak onion) extract did not cause a significant difference in tumor cell proliferation in Sprague-Dawley rats with breast cancer.

Profil Penderita Karsinoma Tiroid di RSUP dr. Kariadi, Semarang (Januari 2006 Juni 2010) YAN WISNU PRAJOKO
Indonesian Journal of Cancer Vol 7, No 4 (2013): Oct - Dec 2013
Publisher : National Cancer Center - Dharmais Cancer Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14414/ijoc.v7i4.307

Penelitian ini bertujuan mengidentifikasi insiden dan pola kejadian kanker tiroid di RS Dr. Kariadi periode Januari 2006 Juni 2010. Penelitian deskriptif ini dilakukan terhadap 318 pasien yang dirawat dengan diagnosis Malignant Neoplasma of Thyroid (ICD-10 C73). Pengamatan dilakukan terhadap usia, jenis kelamin, histopatologi, ukuran tumor (T), metastasis KGB (N), metastasis jauh (M), tempat tinggal, dan komorbid. Sebanyak 29 pasien dieksklusi karena data tidak lengkap. Didapatkan 221 pasien perempuan (76,5%); usia tersering 20-50 tahun (56,1%); T3 sebanyak 31,8%; tidak terdapat metastasis KGB dan metastasis jauh 54,7% dan 86,5%; adenokarsinoma papiler 61,2%. Sebanyak 86,9% tinggal di ketinggian <50 m di atas permukaan laut. Hanya 39 penderita yang mengalami gangguan sesak napas. Kesimpulan, kanker tiroid masih menjadi masalah dalam penanganan kasus keganasan, karena jumlah kasus yang relatif masih tinggi dan pada umumnya penderita datang dalam kondisi penyakit yang lebih lanjut. Penanganan yang cepat dan tepat sejak diagnosis, baik klinis maupun patologis, hingga tahap terapi harus dapat dilakukan oleh ahli bedah dengan baik, sehingga dapat diperoleh hasil yang memuaskan.Kata Kunci: karsinoma tiroid, insidensi, faktor risiko

Whey Protein as an Adjuvant Therapy for Wound Healing and Infection Control: A Systematic Review and Meta-Analysis of Clinical and Preclinical Evidence Aliva Nabila Farinisa; Niken Puruhita; Yan Wisnu Prajoko; Felix Setiawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1483

Background: Impaired wound healing and subsequent infections represent a significant clinical and economic burden. Nutritional status, particularly high-quality protein provision, is a critical, modifiable determinant of healing outcomes. Whey protein (WP), a rich source of essential amino acids and unique bioactive components, has emerged as a promising adjuvant therapy. Methods: We conducted a systematic review and meta-analysis adhering to PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from January 2015 to December 2024 for clinical randomized controlled trials (RCTs) and preclinical controlled studies evaluating WP supplementation on wound healing and infection. Rigorous inclusion criteria led to the selection of seven studies (four clinical RCTs, three preclinical) for quantitative synthesis. Data were pooled using a random-effects model to calculate Standardized Mean Differences (SMD) for continuous outcomes and Odds Ratios (OR) for dichotomous outcomes. Results: The meta-analysis of four clinical RCTs (n=340 patients) demonstrated that WP supplementation significantly accelerated wound healing (SMD = 0.78; 95% CI 0.45, 1.11; p < 0.0001) with moderate heterogeneity (I²=38%). Furthermore, WP significantly reduced the odds of wound infection by 48% (OR = 0.52; 95% CI 0.31, 0.87; p=0.01) with no heterogeneity (I²=0%). Preclinical synthesis (3 studies, n=62 animals) revealed a significant reduction in pro-inflammatory cytokines (TNF-α, IL-6) at the wound site (SMD = -1.15; 95% CI -1.67, -0.63; p < 0.0001). Conclusion: This meta-analysis provides robust quantitative evidence that whey protein functions as an effective adjuvant therapy, significantly enhancing wound repair and providing clinically relevant infection control. These benefits appear to be mediated by a dual mechanism: providing essential anabolic substrates for tissue repair and exerting potent immunomodulatory and antioxidant effects via bioactive components like lactoferrin and cysteine.

Vitamin D in the Breast Cancer Continuum: A Systematic Review and Meta-Analysis of Primary Prevention, Patient Prognosis, and Adjunctive Treatment Response Felix Setiawan; Yan Wisnu Prajoko; Niken Puruhita; Aliva Nabila Farinisa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1486

Background: The role of vitamin D across the breast cancer spectrum remains complex and contested. Compelling preclinical antineoplastic mechanisms contrast with inconsistent clinical findings. Large randomized controlled trials (RCTs) show null effects for primary prevention, while observational studies often link higher vitamin D status at diagnosis with better prognosis. Key conflicts include this prevention-prognosis disconnect, debates over linear versus J-shaped prognostic dose-responses, and a "receptor-status paradox" where estrogen receptor-positive (ER-positive) disease shows prognostic links, but hormone receptor-negative (HR-negative)/triple-negative (TNBC) subtypes derive greater benefit (improved pathological complete response, pCR) from vitamin D intervention during neoadjuvant chemotherapy (NACT). This study systematically synthesizes evidence across these distinct clinical contexts. Methods: Following PRISMA guidelines, we systematically reviewed PubMed, EMBASE, and CENTRAL (January 1st, 2014–September 2nd, 2025) for high-impact RCTs and large prospective cohort studies evaluating vitamin D supplementation or serum 25-hydroxyvitamin D (25(OH)D) levels regarding breast cancer incidence, prognosis (survival/recurrence), or pCR after NACT. Quality was assessed (Cochrane RoB 2; Newcastle-Ottawa Scale). Data were extracted dually. Findings were synthesized stratigraphically (prevention, prognosis, treatment). A random-effects meta-analysis pooled pCR data from NACT RCTs. Results: Six high-quality studies (3 RCTs, 3 cohorts; N=31,026) were included. (1) Prevention: The VITAL RCT (N=25,871; mean baseline 25(OH)D 30.8 ng/mL) found no reduction in incident invasive breast cancer with 2000 IU/day vitamin D3 (HR 1.02, 95% CI 0.79–1.31). (2) Prognosis: Cohort studies (N=4,835) showed higher 25(OH)D linked to better OS (Adj HR T3 vs T1: 0.72). Complexity emerged: one study linked benefit specifically to ER-positive recurrence (Adj HR 0.87), while another reported a J-shaped curve for EFS, with worse outcomes at both low (≤52 nmol/L; Adj HR 1.63) and high (≥99 nmol/L; Adj HR 1.37) levels versus intermediate. (3) Treatment: Meta-analysis of two NACT RCTs (N=310) showed vitamin D supplementation significantly increased pCR rates (38.1% vs 22.6%; Pooled RR 1.69, 95% CI 1.21–2.36; P=0.002; I²=0%). Subgroup data strongly suggested greater benefit in HR-negative/TNBC and baseline-deficient patients. Conclusion: Vitamin D supplementation appears ineffective for primary breast cancer prevention in replete populations. Its prognostic role is complex, suggesting an optimal 25(OH)D range (potentially ~30-40 ng/mL) and possible ER-specific hormonal modulation effects, though causality from observational data remains uncertain. Critically, vitamin D intervention during NACT significantly improves pCR, particularly in HR-negative/TNBC, likely via distinct chemosensitization/immunomodulatory mechanisms. This synthesis provides a framework for understanding these context-dependent roles, supporting vitamin D assessment and potentially adjunctive NACT supplementation, especially in deficient patients with aggressive subtypes, pending necessary validation in larger trials.

Adaptive Radiotherapy (ART) versus Non-Adaptive IMRT for Locoregionally Advanced Nasopharyngeal Carcinoma: A Meta-Analysis of Dosimetric Advantages, Clinical Outcomes, and Organ-at-Risk Sparing Gina Amalia; Yan Wisnu Prajoko; Niken Puruhita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1488

Background: Intensity-modulated radiotherapy (IMRT) is the cornerstone of treatment for nasopharyngeal carcinoma (NPC), offering high dose conformity. However, anatomical variations during the multi-week therapy course can compromise dosimetric accuracy. Adaptive radiotherapy (ART), which adjusts the treatment plan based on intra-treatment imaging, aims to mitigate these effects. This meta-analysis synthesized contemporary comparative evidence (2014–2025) on the efficacy and safety of ART versus non-adaptive IMRT in locoregionally advanced NPC. Methods: Following PRISMA guidelines, PubMed, Embase, Scopus, and Cochrane Library were searched for studies comparing ART with non-adaptive IMRT (cohorts or hybrid/phantom plan comparisons) in locoregionally advanced NPC. Primary outcomes were locoregional recurrence-free survival (LRFS) and overall survival (OS); secondary outcomes included progression-free survival (PFS), distant metastasis-free survival (DMFS), and dosimetric metrics for targets (D98, Conformity Index [CI]) and organs-at-risk (OARs: parotid Dmean, spinal cord Dmax, brainstem Dmax). Hazard Ratios (HR) and Mean Differences (MD) were pooled using random-effects models. Data estimation methods (Tierney, Wan, Cochrane) were employed where necessary. Heterogeneity was assessed using I². Results: Nine studies (2 cohort, 7 dosimetric/anatomical) involving 362 patients (clinical) and 215 datasets (dosimetric) were included. ART significantly improved LRFS compared to non-adaptive IMRT (pooled HR = 0.53, 95% CI 0.32–0.88; I²=0%). No significant differences were found for OS (HR=0.98, 95% CI 0.64–1.50), PFS (HR=0.70, 95% CI 0.45–1.07), or DMFS (HR=0.88, 95% CI 0.48–1.62). Compared to hybrid/phantom plans, ART significantly enhanced target coverage (pooled PTV D98 MD = 2.15 Gy, 95% CI 1.10–3.20 Gy; I²=78%) and conformity (pooled CI MD = 0.05, 95% CI 0.02–0.08; I²=85%). ART significantly reduced OAR doses: parotid Dmean (pooled MD = -3.50 Gy, 95% CI -4.95 to -2.05 Gy; I²=90%), spinal cord Dmax (pooled MD = -3.95 Gy, 95% CI -5.80 to -2.10 Gy; I²=93%), and brainstem Dmax (pooled MD = -2.75 Gy, 95% CI -4.40 to -1.10 Gy; I²=91%). Dosimetric analyses exhibited high heterogeneity. Conclusion: ART significantly improves LRFS in locoregionally advanced NPC compared to non-adaptive IMRT. It provides substantial dosimetric advantages, enhancing target coverage and conformity while critically reducing doses to parotid glands, spinal cord, and brainstem. Despite high dosimetric heterogeneity and no demonstrated OS benefit, the improvements in LRFS and dose delivery support the thoughtful implementation of ART.

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