Analisis Teknik Radiotherapy Non-Coplanar (NC) 3 Dimension Conformal Radiation Therapy (3D-CRT) Pada Kasus Acute Lymphoblastic Leukemia (ALL) Di RSUP DR. Hasan Sadikin Bandung

Roucho Yusuf Rondonuwu, Indah Sukmasari, I Wayan Juliasa, Farikhatul Alfiah

Sari


Craniospinal irradiation (CSI) merupakan teknik radioterapi yang digunakan untuk menangani keganasan yang melibatkan otak dan sumsum tulang belakang, seperti acute lymphoblastic leukemia (ALL). Tantangan utama dalam pelaksanaan CSI adalah mencapai distribusi dosis yang homogen pada target kranial dan spinal, serta meminimalkan paparan dosis terhadap organ at risk (OAR). Penelitian ini merupakan studi seri kasus pada empat pasien pediatrik dengan ALL yang menjalani terapi CSI di RSUP Dr. Hasan Sadikin Bandung. Perencanaan terapi dilakukan menggunakan simulasi berbasis CT dengan perangkat imobilisasi yang dirancang khusus untuk pasien pediatrik. Teknik 3D-CRT non-coplanar pada CSI dengan penggunaan lima lapangan penyinaran, penyesuaian sudut gantry, rotasi meja (couch), verifikasi harian menggunakan image-guided radiotherapy (IGRT), serta imobilisasi khusus pediatrik, mampu memberikan cakupan target yang optimal dengan dosis OAR tetap dalam batas aman. Hasil perbandingan menunjukkan bahwa nilai Dmax dan Dmean pada organ kritis seperti lensa, mata, saraf optik, tiroid, paru-paru, jantung, ginjal, dan hati sesuai dengan standar rumah sakit dan data referensi, dengan variasi antar pasien yang minimal. Pendekatan ini efektif dalam meminimalkan paparan terhadap jaringan sehat sekaligus mempertahankan presisi penyinaran, sehingga layak digunakan dalam tatalaksana CSI pada kasus ALL. Kesimpulannya, teknik 3D-CRT non-coplanar mampu menghasilkan distribusi dosis yang merata pada area CSI dengan risiko overlap yang minimal. Perencanaan berbasis CT 3D dan delineasi yang presisi mampu menjaga dosis OAR tetap dalam batas aman. Sistem imobilisasi khusus pediatrik juga meningkatkan stabilitas dan reprodusibilitas, sehingga metode ini aman, efektif, dan layak diterapkan pada pasien pediatrik yang menjalani CSI.


Kata Kunci


Acute Lymphoblastic Leukemia; Craniospinal Irradiation; 3D CRT; non-coplanar; Organ-at-risk; Pediatrik

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Referensi


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DOI: https://doi.org/10.33024/jikk.v13i4.22851

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