EBM

CRITICAL APPRAISAL
Clinical treatment of vulvar Paget's disease: a case
report

Disusun oleh :
Wira Sari (1102010290)
Nadia Paramaosa (1102010199)

Dosen Pembimbing :
dr. Dian Mardiyah

FAKULTAS KEDOKTERAN UNIVERSITAS YARSI

APRIL 2013

EBM
Wira Sari (1102010290)
Nadia Paramaosa (1102010199)
TUGAS EVIDENCE BASED MEDICINE
Skenario
Seorang perempuan berumur 80 tahun datang ke dokter dengan keluhan nyeri di daerah kemaluan
disertai gatal-gatal dan kemerahan serta terdapat benjolan di daerah vulva. Kemudian dokter
menyarankan untuk melakukan pemeriksaan lanjutan dan dari hasil pemeriksaan tersebut, pasien
diagnosis mengalami carsinoma vulva.
Pertanyaan (foreground question)
Bagaimanakah prognosis pada pasien diterapi dengan radioterapi pada usia >70 tahun dibandingkan
usia <70 tahun?

PICO

Population

: Pasien Carsinoma Vulva

Intervention
usia <70

: Menilai perbaikan carsinoma vulva pada terapi menggunakan radioterapi

Comparison
usia >70

: Menilai perbaikan carsinoma vulva pada terapi menggunakan radioterapi

Outcomes
usia <70

: perbaiakn pengobatan dengan radioterapi pada usia >70 sama dengan pada

Pencarian bukti ilmiah

Alamat website : http://www.ncbi.nlm.nih.gov/pubmed/16080570
Kata kunci

: vulva carsinoma AND radiotheraphy AND prognosis

Limitasi

Hasil Pencarian : 7

Dipilih artikel berjudul :

Carcinoma of the Vulva: Clinical Results of Exclusive and Adjuvant Radiotherapy

REVIEW JURNAL
Pendahuluan
Vulvar cancer accounts for approximately 4% of gynaecological malignancies. The aetiology of
vulvar cancer is unclear, however many risk factors such as obesity, hypertension, diabetes mellitus,
antecedent infections and human papilloma virus have been indicated.
Metoda
The age of patients ranged from 64 to 89 years (average 74 years and median 75). Cases, biopsy
proven, treated with radiotherapy alone, were evaluated on clinical and radiological research, while
pathological specimen from patients submitted to surgery were evaluated, according to TNM and
FIGO criteria. All patients had chest radiographs, complete blood count and chemistry analysis and
colposcopic examination. Cystoscopy was performed on 56 patients; abdominal pelvic CT and
echotomography were used on all patients; from 1994, also abdomino-pelvic MR was performed in 12
cases. The histological type corresponded in all cases to epidermoidal carcinoma, welldifferentiated in
65%, moderately in 29% and anaplastic in 6%
Hasil
Univariate analysis of our series evidenced statistical difference in terms of stage, number of positive
lymph nodes and age for OS, while age was not significant for DFS. This difference between OS and
DFS regarding age may be explained by the relatively high rate of intercurrent deaths, without
recurrence of disease, in patients with a median age >70 years, which therefore influenced OS
analysis (in contrast, for DFS, patients who died due to causes other than disease were considered
alive at the last follow-up).
Kesimpulan
This difference between OS and DFS regarding age may be explained by the relatively high rate of
intercurrent deaths, without recurrence of disease, in patients with a median age >70 years, which
therefore influenced OS analysis (in contrast, for DFS, patients who died due to causes other than
disease were considered alive at the last follow-up).

APAKAH HASIL PENELITIAN TERSEBUT VALID?

A.

Petunjuk Primer

1. Apakah terdapat sampel yang representatif, terdefinisi jelas, dan berada pada kondisi yang sama
dalam perjalanan penyakitnya?
The age of patients ranged from 64
to 89 years (average 74 years and median 75). Cases, biopsy proven,
treated with radiotherapy alone, were evaluated on clinical and
radiological research, while pathological specimen from patients
submitted to surgery were evaluated, according to TNM and FIGO
criteria. All patients had chest radiographs, complete blood count
and chemistry analysis and colposcopic examination.

2. Apakah follow-up cukup lama dan lengkap?

The median follow-up was 86 months (range 58-116 months).

B. Petunjuk sekunder
1. Apakah kriteria outcome yang digunakan obyektif dan tanpa bias?

2. Bila ditemukan subgrup dengan prognosis yang beda, apakah dilakukan adjustment untuk faktorfaktor prognostik yang penting?

3. Apakah dilakukan validasi pada suatu kelompok independen (test-set)?

TIDAK

APA HASILNYA?
1.

Bagaimana gambaran outcome menurut waktu?

2. Seberapa tepat perkiraan prognosis?

APAKAH HASIL PENELITIAN INI DAPAT DIAPLIKASIKAN?

1.

Apakah pasien dalam penelitian tersebut serupa dengan pasien saya?

IYA

2. Apakah hasil tersebut membantu memilih atau menghindari terapi tertentu?

IYA
Dalam jurnal penelitian ini disebutkan bahwa usia mempengaruhi prognosis dengan
menggunakan radioterapi

3. Apakah hasilnya membantu dalam memberikan konseling kepada pasien saya?

YA
Dalam jurnal penelitian ini disebutkan bahwa hasil prognosis carsinoma vulva dengan
radioterapi tergantung dengan usia pasien