International Journal of Nasopharyngeal Carcinoma (IJNPC) Vol. 02, No. 04, December 2020 | 121-123 International Journal of NASOPHARYNGEAL CARCINOMA Journal homepage: https://talenta.usu.ac.id/IJNPC Copyright © International Journal of Nasopharyngeal Carcinoma Published by Talenta Publisher, ISSN: 2656-9027 e-ISSN: 2656-9035 DOI: 10.32734/ijnpc.v2i04.4818 121 Hemoglobin Levels before and after Chemotherapy (Cisplatin-Paclitaxel) of Nasopharyngeal Cancer Patients at Prof. Dr. Margono Soekarjo Hospital Delima Rochmah Nur Syahbani 1 , Sekti Joko Suntono Islamanto 2* , Vitasari Indriani 3 1 Faculty of Medicine, Jenderal Soedirman University, Jawa Tengah, Indonesia 2 Departement of Otorhinolaryngology, Faculty of Medicine, Jenderal Soedirman University/Margono Soekarjo Hospital, Indonesia 3 Departement of Clinical Pathology, Faculty of Medicine, Jenderal Soedirman University/Margono Soekarjo Hospital, Indonesia Abstract Article Info Introduction: The National Comprehensive Cancer Network recommends induction chemotherapy and concurrent chemoradiotherapy as one of the standard therapy for stage II-IVA nasopharyngeal cancer. The use of induction chemotherapy given before radiotherapy is an effective treatment strategy because it has a better level of adherence and facilitates early eradication of micro metastasis. Chemotherapy has a direct side effect of disruption of erythrocyte formation in the bone marrow and reduces the erythropoietin hormone in the kidney. Decreased hemoglobin levels exacerbate oxygen deficiency in tumours thereby increasing hypoxic cells and contributing to the development of radiotherapy resistance. Objective: This research was conducted to find out the hemoglobin levels before and after chemotherapy (cisplatin-paclita). An analytical observational study with cross sectional method. The subjects were 36 nasopharyngeal cancer patients that gone through 6 cycles of chemotherapy and meets the research criteria.xel in nasopharyngeal cancer patients. Methods: An analytical observational studies with cross sectional method. The subjects were 36 nasopharyngeal cancer patients that gone through 6 cycles of chemotherapy and meets the research criteria. Results: The results of the bivariate analysis showed differences in the average of hemoglobin levels before and after chemotherapy, the average hemoglobin levels before chemotherapy which were 13.39 g/dL and after chemotherapy which were 11.35 g /dL in nasopharyngeal cancer patients at Prof. Dr. Margono Soekarjo Hospital (P=0,001). Conclusion: There is a significant difference between hemoglobin levels before and after chemotherapy (cisplatin-paclitaxel) in nasopharyngeal cancer patients in Prof. Dr. Margono Soekarjo Hospital. Article history: Received: 7 November 2020 Received in revised form 28 November 2020 Accepted 7 December 2020 Keywords: Hemoglobin, chemotherapy, nasopharyngeal cancer *Corresponding author: Sekti Joko Suntono Islamanto Address: Jl. Dr. Soeparno, Kampus Karangwangkal Gedung E, Karang Bawang, Grendeng, Kec. Purwokerto Utara, Kabupaten Banyumas, Jawa Tengah 53122 e-mail: sektijokosuntono@gmail.com 1. INTRODUCTION The definition of nasopharyngeal cancer is squamous cell carcinoma arising from nasopharyngeal epithelium, futhermore the disease is bounded by geographical and racial distribution [1]. Globally, there are 80.000 new cases reported annually related to nasopharyngeal cancer [2]. Data in 2012 shows five countries that had the most deaths due to nasopharyngeal cancer were China (21,300 deaths), Indonesia (7,391 deaths), Vietnam (2,885 deaths), India (2,836 deaths), and Thailand (1,141 cases) [3]. The Global Cancer Observatory (GLOBOCAN) recorded in 2018 there were 17,992 new cases of nasopharyngeal cancer and the death rate reached 1,204 cases in Indonesia. Nasopharyngeal cancer occupies at the top 5 most frequently found new cancer cases in men, as many as 13,966 cases (8.7 %) in 2018 [4]. New nasopharyngeal cancer cases reported at RSUP Dr. Kariadi Semarang as many as 127 cases in the span years of 2000 to 2002 [5], had increased to 141 cases in 2014-2016 [6]. In Prof. Dr. Margono Soekarjo Hospital, nasopharyngeal cancer is the second most common type of malignancy found after cervical cancer [7]. Nasopharyngeal cancer cases in Prof. Dr. Margono Soekarjo Hospital reported as many as 497 cases in the span years of 2007 to 2016 [8]. Nasopharyngeal cancer therapy based on the National Comprehensive Cancer Network (NCCN) recommends induction chemotherapy and concurrent chemoradiotherapy as one of the standard treatments for stage II-IVA nasopharyngeal cancer. The use of induction chemotherapy given before radiotherapy is an effective treatment strategy because it has a better level of adherence and facilitates early eradication of micrometastasis [9]. Chemotherapy drugs are more effective when used in combination. Combination regimens that can be given with the platinum group include 5- fluorouracil, paclitaxel, and docetaxel. Combination cisplatin-paclitaxel chemotherapy produces higher clinical response rates than other drug combinations in particular [10]. Chemotherapy is a cytotoxic drug that has known to have myelosuppression side effects [11]. Chemotherapy cytotoxic agents can induce anemia through direct disorders of hematopoiesis, including the synthesis of erythrocyte precursors in the bone marrow and reducing erythropoietin production the kidney [12]. Decreased hemoglobin (Hb) levels might exacerbate oxygen deficiency in tumors thereby increasing hypoxic cells and contributing to the development of radiotherapy resistance. Low Hb levels have been reported as adverse factors in the management of radiotherapy from various tumors (ex., head and neck squamous cell cancer, cervical cancer, lung cancer, and bladder cancer) [13]. The lack of radiation optimization results in the repair of cancer cells that cause the therapeutic process becomes ineffective both technically, clinically, and economically. Anemia is dangerous state in patients as it has a higher risk of death rather than non anemic patients [14]. Thereafter, hemoglobin levels after chemotherapy induction can influence the choice and the outcome of further therapy. The authors expect the results of this study can serve as initial research on one of the side effects of chemotherapy combination, especially in bone marrow suppression by looking at hemoglobin levels in nasopharyngeal cancer patients. 2. MATERIALS AND METHODS This observational analytic study was using cross sectional method with simple random sampling technique. The study was conducted using secondary data obtained from the ENT Installation of Prof. Dr. Margono Soekarjo Hospital from 2014 to 2019. Samples included in this study were stage II-IVA nasopharyngeal cancer patients who received combination chemotherapy cisplatin-paclitaxel within a period of 6 cycles. Criteria for exclusion of the study includes patients who were treated for radiation within 4 months before the initiation of chemotherapy, as well as incomplete medical record data of patients.