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"Tujuan : Untuk mengetahui pengaruh kadar hemoglobin, kadar hematokrit dan transfusi selama radiasi terhadap respon tumor dan kesintasan pada pasien kanker serviks stadium lanjut lokal (FIGO IIB-IIIB) yang menjalani terapi radiasi. Metode : Dilakukan studi kohort retrospektif terhadap pasien kanker serviks stadium IIB-IIIB yang memenuhi kriteria inklusi-eksklusi, yang berobat di Departemen Radioterapi RSCM periode Januari 2007 - Desember 2011, dianalisa dan dibandingkan respon tumor dan kesintasan antara kadar hemoglobin <11g/dL dengan ≥11g/dL, kadar hematokrit ≤35% dengan >35%, pasien yang ditransfusi dan tidak ditransfusi selama radiasi. Hasil : Respon tumor komplit pada kadar Hb sebelum radiasi <11g/dL dibandingkan dengan ≥11g/dL adalah 77,1% vs 70,2% p=0,34 ; kesintasan 3 tahun 84% vs 75% p=0,42. Respon tumor komplit pada kadar Hb selama radiasi <11g/dL dibandingkan dengan ≥11g/dL adalah 81,3% vs 67,9% p= 0,049 ; kesintasan 3 tahun 82% vs 79% p=0,05. Respon tumor komplit pada kadar Ht sebelum radiasi ≤35% dibandingkan dengan >35% adalah 71,7% vs 75,8% p=0,65 ; kesintasan 3 tahun 86% vs 78% p>0,05. Respon tumor komplit pada kadar Ht selama radiasi ≤35% dibandingkan dengan >35% adalah 72,7% vs 72,7% p=1,00 ; kesintasan 3 tahun 78% vs 87% p=>0,05. Kesintasan 3 tahun pada pasien yang ditransfusi dibandingkan dengan yang tidak ditransfusi 80% vs 84% p=0,95. Kesimpulan : Penelitian ini menunjukkan perbedaan yang bemakna pada pengaruh kadar hemoglobin rerata selama radiasi terhadap respon tumor dan kesintasan, pengaruh kadar hematokrit sebelum dan rerata selama radiasi terhadap respon tumor dan kesintasan.

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Aim : To determine the effect of hemoglobin level, hematocrit level and transfusion during radiation on tumor response and survival rate in patients with locally advanced cervical cancer (FIGO IIB-IIIB) who underwent radiation therapy.

Methods : A retrospective cohort study has done on cervical cancer patients stage IIB-IIIB who met the inclusion-exclusion criteria, which is treated in the Department of Radiotherapy RSCM period January 2007 - December 2011, were analyzed and compared to tumor response and survival rate between hemoglobin level <11g / dL with ≥11g / dL, hematocrit level ≤35% to> 35%, patients with blood transfused or not during radiation.

Results : Complete tumor response in Hb levels before radiation <11g / dL compared with ≥11g / dL was 77.1% vs. 70.2% p = 0.34; 3-year survival rate 84% vs. 75% p = 0.42. Complete tumor response in hemoglobin levels during radiation <11g / dL compared with ≥11g / dL was 81.3% vs. 67.9% p = 0.049; 3-year survival rate 82% vs. 79% p = 0.05. Complete tumor response in hematocrit levels before radiation ≤35% compared to> 35% was 71.7% vs. 75.8% p = 0.65; 3-year survival rate 86% vs. 78% p> 0.05. Complete tumor response in hematocrit levels during radiation ≤35% compared to> 35% was 72.7% vs. 72.7% p = 1.00; 3-year survival rate 78% vs. 87% p => 0.05. 3-year survival rate in patients who were not transfused transfused compared with 80% vs. 84% p = 0.95.

Conclusions : This study shows that differences in the influence of mean hemoglobin levels during radiation on tumor response and survival rate, the influence of mean hematocrit levels before and during radiation on tumor response and survival rate."

"Pendahuluan Toksisitas akut radiasi merupakan suatu proses yang diawali dengan kerusakaPendahuluan: Toksisitas akut radiasi merupakan suatu proses yang diawali dengan kerusakan sel normal. Malondialdehyde (MDA) merupakan produk akhir dari peroksidasi lipid yang merupakan biomarker stres oksidatif. Catalase (CAT) adalah antioksidan enzimatik yang mengkatalisis H2O2 menjadi air dan oksigen. Penelitian ini bertujuan untuk mengetahui apakah kadar MDA dan aktivitas CAT dapat dijadikan prediktor derajat toksisitas akut radiasi pada kanker serviks stadium lanjut lokal.Metode penelitian: Penelitian ini merupakan studi kohort prospektif terhadap 30 pasien kanker serviks stadium lanjut lokal yang memenuhi kriteria inklusi di Departemen Radioterapi RS Cipto Mangunkusumo dari Juli sampai September 2013. Pemeriksaan kadar MDA dan aktivitas CAT dilakukan sebelum radiasi dan fraksi ke-15 dengan menggunakan spektrofotometer. Derajat toksisitas akut radiasi dinilai tiap minggunya selama radiasi eksterna dan diklasifikasikan berdasarkan kriteria RTOG.Hasil: Didapatkan rerata kadar MDA serum sebesar 7,6 +/- 1,2 nmol/mL, dan median aktivitas CAT sebesar 0,95 (0,80 ? 1,36) U/mL. Pasca 15 kali RE didapatkan peningkatan kadar MDA serum menjadi 9,5 +/- 1,9 nmol/mL (p<0,001) dan penurunan aktivitas CAT menjadi 0,82 (0,71 ? 0,96) (p<0,001). Tidak ditemukan hubungan yang bermakna antara kadar MDA dan aktivitas CAT awal serta perubahannya terhadap kejadian toksisitas akut radiasi (p>0,05).Kesimpulan: Hasil penelitian ini memperlihatkan bahwa radiasi maupun kemoradiasi terbukti menyebabkan peningkatan kadar MDA dan penurunan aktivitas CAT pada kanker serviks stadium lanjut lokal, akan tetapi kadar MDA dan aktivitas CAT tidak dapat menjadi prediktor terhadap toksisitas akut radiasi.n sel normal Malondialdehyde MDA merupakan produk akhir dari peroksidasi lipid yang merupakan biomarker stres oksidatif Catalase CAT adalah antioksidan enzimatik yang mengkatalisis H2O2 menjadi air dan oksigen Penelitian ini bertujuan untuk mengetahui apakah kadar MDA dan aktivitas CAT dapat dijadikan prediktor derajat toksisitas akut radiasi pada kanker serviks stadium lanjut lokal Metode penelitian Penelitian ini merupakan studi kohort prospektif terhadap 30 pasien kanker serviks stadium lanjut lokal yang memenuhi kriteria inklusi di Departemen Radioterapi RS Cipto Mangunkusumo dari Juli sampai September 2013 Pemeriksaan kadar MDA dan aktivitas CAT dilakukan sebelum radiasi dan fraksi ke 15 dengan menggunakan spektrofotometer Derajat toksisitas akut radiasi dinilai tiap minggunya selama radiasi eksterna dan diklasifikasikan berdasarkan kriteria RTOG Hasil Didapatkan rerata kadar MDA serum sebesar 7 6 1 2 nmol mL dan median aktivitas CAT sebesar 0 95 0 80 1 36 U mL Pasca 15 kali RE didapatkan peningkatan kadar MDA serum menjadi 9 5 1 9 nmol mL p.

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Introduction: Acute radiation toxicity was a process which caused by irradiation and initiated by normal cell damage. Malondialdehyde (MDA) is the end product of lipid peroxidation, and is usually used as a biomarker to assess oxidative stress. Catalase (CAT) is an enzymatic antioxidant that catalyzes H2O2 into water and oxygen. The purpose of this study was to determine whether the levels of MDA and CAT activity can be used as a predictor of acute radiation toxicity in locally advanced cervical cancer.

Methods: This is a prospective cohort study to 30 locally advanced cervical cancer patients who meet the inclusion criteria in the Radiotherapy Department of Cipto Mangunkusumo Hospital from July to September 2013. We measure MDA level and CAT activity before irradiation and on 15th fractions using sphectrophotometry. Degree of acute radiation toxicity assessed every week during external beam radiotherapy using RTOG criteria.

Results: The mean of serum MDA levels is 7.6 + / - 1.2 nmol /mL, and the median of CAT activity is 0.95 (0.80 to 1.36) U /mL. We found elevated of serum MDA level to 9.5 +/ - 1.9 nmol /mL (p <0.001) and CAT activity decreased to 0.82 (0.71 to 0.96) U /mL (p <0.001) on the 15th fraction of external beam irradiation. No statistically significant relationship is found between MDA level and CAT activity pre irradiation and its changes to the incidence of acute radiation toxicity.

Conclusion: This study showed that radiation or chemoradiation shown to cause an increase in MDA levels and decrease of CAT activity in locally advanced cervical cancer patients, but MDA levels and CAT activity cannot be a predictor of acute radiation toxicity."

"[ABSTRAKLatar balakang. Sekitar 75% kanker leher rahim datang ke rumah sakit dalam stadium lanjut. Terapi utama kanker serviks stadium lanjut adalah radioterapi. Kombinasi terapi radiasi dengan kemoterapi ternyata tidak menghasilkan respons terapi yang lebih baik, tetapi bahkan menimbulkan efek samping yang lebih berat dibandingkan terapi radiasi saja. Perubahan pola makan saat ini, diduga berpengaruh pada respons terapi. Rasio asupan Polyunsaturated Fatty Acids (PUFA) n-6 : n-3 sekitar 1-2 : 1 dapat melawan pertumbuhan kanker. Beberapa publikasi melaporkan bahwa PUFA n-3 (AL n-3) mempunyai efek pro-apoptosis, anti-inflamasi, anti-proliferatif dan anti-angiogenik. Penelitian ini bertujuan untuk mengetahui apakah suplementasi nutrisi tinggi PUFA bersamaan dengan terapi radiasi dapat meningkatkan respons tumor pada kanker serviks stadium lanjut. Metode. Penelitian ini merupakan Randomized Clinical Trial, double blind pada pasien kanker serviks stadium lanjut, jenis karsinoma sel skuama yang hanya mendapat terapi radiasi di Departemen Radioterapi, Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta. Subjek penelitian diambil secara konsekutif, melalui randomisasi dibagi dua kelompok, yaitu kelompok perlakuan dan kontrol. Selama radiasi subjek penelitian mendapat suplementasi nutrisi mengandung isokalori dan isoprotein dengan rasio AL n-6 : n-3 = 1,27 : 1 dan kontrol. Selama perlakuan dilakukan evaluasi setiap lima kali radiasi, meliputi BB dan efek samping radiasi akut. Parameter yang dinilai adalah respons klinis, respons histopatologis serta perubahan kadar PGE2 dan VEGF serum.Hasil. Sebanyak 31 subjek dari 45 subjek dapat menyelesaikan penelitian. Sebelum perlakuan, status sosio-demografi, pola asupan AL n-6 dan n-3, status gizi dan klinis tidak didapatkan perbedaan bermakna. Setelah perlakuan, didapatkan penurunan kadar PGE2 serum pada kelompok perlakuan, sedangkan kelompok kontrol mengalami kenaikan (p = 0,127). Penurunan kadar VEGF kelompok perlakuan lebih besar dibanding kontrol (p = 0,626). Respons klinis dan respons histopatologis kelompok perlakuan lebih baik dibanding kontrol, dengan kemaknaan masing-masing p = 0,172 dan p = 0,169. Secara statistik belum didapatkan perbedaan yang bermakna pada penurunan kadar PGE2 dan VEGF serum, respons klinis dan respons histopatologis, tetapi didapat kemaknaan klinis yang nyata pada kelompok perlakuan dibanding kontrol. Analisis statistik gabungan dari respons klinis, respons histopatologis, kadar PGE2 dan VEGF serum didapatkan respons tumor total yang bermakna (p = 0,048).Kesimpulan. Suplementasi nutrisi tinggi PUFA dengan rasio asam lemak n-6 : n- 3 = 1,27 : 1 pada kanker serviks stadium lanjut bersama terapi radiasi memberikan respons tumor total yang lebih baik.;

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ABSTRACTBackground . Approximately 75% of uterine cervical cancer came to the hospital in an advanced stage. Primary therapy of advanced cervical cancer is radiotherapy. The combination of radiotherapy with chemotherapy did not give better outcomes, but even cause more severe side effects than radiotherapy. Changes in dietary intake at this time, are supposed to influence the response to therapy. The ratio of n-6 to n-3 polyunsaturated fatty acids (PUFA) about 1-2: 1 can fight cancer growth. Several publications stated that n-3 PUFA has pro- apoptotic effect, anti-inflammatory, anti-proliferative and anti-angiogenic. This study aimed to examine whether radiotherapy combined with daily nutritional supplements enriched PUFA enhance tumor response in advanced cervical cancer.Method. This study was a double-blind Randomized Clinical Trial (RCT) in patients with advanced squamous cell cervical cancer, received radiation only as control group, and those who received nutritional supplementation containing isocaloric and isoprotein with ratio of n-6 : n-3 PUFA = 1.27: 1 as treatment group. This study was performed in the Department of Radiotherapy Dr. Cipto Mangunkusumo General Hospital (RSUPNCM), Jakarta. Evaluation was done every five times radiation, including Karnofsky Perfomance Scale, body weight and side effects of acute radiation. Parameters assessed were clinical and hematological response, histopathological response and changes in the levels of PGE2 and VEGF serum,Results. A total of 31 subjects from 45 subjects participated the study completely. Prior to treatment, socio-demographic status, patterns of n-6 and n-3 PUFA, clinical and nutritional status were analyzed, no significant differences were noted. After treatment, a decrease in serum PGE2 levels in the treatment group was found, while in the control group increased (P = 0.127). VEGF in the treatment group declined higher than controls (P = 0.626). Treatment group showed significant better clinical response and histopathological responses compared to the control group (p = 0.172 and p = 0.169). No significant differences were found in the reduction of PGE2 and VEGF serum levels, clinical response and histopathological response, although from clinical standpoint there is a better significant response in the treatment group than the control. The combined statistical analysis of clinical response, histopathological response, PGE2 and VEGF serum levels obtained total tumor response (P = 0.048). Conclusion. Nutritional supplementation enriched PUFA (ratio of n-6: n-3 PUFA = 1.27 : 1) in advanced cervical cancer receiving radiotherapy gives better total tumor response.;Background . Approximately 75% of uterine cervical cancer came to the hospital in an advanced stage. Primary therapy of advanced cervical cancer is radiotherapy. The combination of radiotherapy with chemotherapy did not give better outcomes, but even cause more severe side effects than radiotherapy. Changes in dietary intake at this time, are supposed to influence the response to therapy. The ratio of n-6 to n-3 polyunsaturated fatty acids (PUFA) about 1-2: 1 can fight cancer growth. Several publications stated that n-3 PUFA has pro- apoptotic effect, anti-inflammatory, anti-proliferative and anti-angiogenic. This study aimed to examine whether radiotherapy combined with daily nutritional supplements enriched PUFA enhance tumor response in advanced cervical cancer.Method. This study was a double-blind Randomized Clinical Trial (RCT) in patients with advanced squamous cell cervical cancer, received radiation only as control group, and those who received nutritional supplementation containing isocaloric and isoprotein with ratio of n-6 : n-3 PUFA = 1.27: 1 as treatment group. This study was performed in the Department of Radiotherapy Dr. Cipto Mangunkusumo General Hospital (RSUPNCM), Jakarta. Evaluation was done every five times radiation, including Karnofsky Perfomance Scale, body weight and side effects of acute radiation. Parameters assessed were clinical and hematological response, histopathological response and changes in the levels of PGE2 and VEGF serum,Results. A total of 31 subjects from 45 subjects participated the study completely. Prior to treatment, socio-demographic status, patterns of n-6 and n-3 PUFA, clinical and nutritional status were analyzed, no significant differences were noted. After treatment, a decrease in serum PGE2 levels in the treatment group was found, while in the control group increased (P = 0.127). VEGF in the treatment group declined higher than controls (P = 0.626). Treatment group showed significant better clinical response and histopathological responses compared to the control group (p = 0.172 and p = 0.169). No significant differences were found in the reduction of PGE2 and VEGF serum levels, clinical response and histopathological response, although from clinical standpoint there is a better significant response in the treatment group than the control. The combined statistical analysis of clinical response, histopathological response, PGE2 and VEGF serum levels obtained total tumor response (P = 0.048). Conclusion. Nutritional supplementation enriched PUFA (ratio of n-6: n-3 PUFA = 1.27 : 1) in advanced cervical cancer receiving radiotherapy gives better total tumor response., Background . Approximately 75% of uterine cervical cancer came to the hospital in an advanced stage. Primary therapy of advanced cervical cancer is radiotherapy. The combination of radiotherapy with chemotherapy did not give better outcomes, but even cause more severe side effects than radiotherapy. Changes in dietary intake at this time, are supposed to influence the response to therapy. The ratio of n-6 to n-3 polyunsaturated fatty acids (PUFA) about 1-2: 1 can fight cancer growth. Several publications stated that n-3 PUFA has pro- apoptotic effect, anti-inflammatory, anti-proliferative and anti-angiogenic. This study aimed to examine whether radiotherapy combined with daily nutritional supplements enriched PUFA enhance tumor response in advanced cervical cancer.Method. This study was a double-blind Randomized Clinical Trial (RCT) in patients with advanced squamous cell cervical cancer, received radiation only as control group, and those who received nutritional supplementation containing isocaloric and isoprotein with ratio of n-6 : n-3 PUFA = 1.27: 1 as treatment group. This study was performed in the Department of Radiotherapy Dr. Cipto Mangunkusumo General Hospital (RSUPNCM), Jakarta. Evaluation was done every five times radiation, including Karnofsky Perfomance Scale, body weight and side effects of acute radiation. Parameters assessed were clinical and hematological response, histopathological response and changes in the levels of PGE2 and VEGF serum,Results. A total of 31 subjects from 45 subjects participated the study completely. Prior to treatment, socio-demographic status, patterns of n-6 and n-3 PUFA, clinical and nutritional status were analyzed, no significant differences were noted. After treatment, a decrease in serum PGE2 levels in the treatment group was found, while in the control group increased (P = 0.127). VEGF in the treatment group declined higher than controls (P = 0.626). Treatment group showed significant better clinical response and histopathological responses compared to the control group (p = 0.172 and p = 0.169). No significant differences were found in the reduction of PGE2 and VEGF serum levels, clinical response and histopathological response, although from clinical standpoint there is a better significant response in the treatment group than the control. The combined statistical analysis of clinical response, histopathological response, PGE2 and VEGF serum levels obtained total tumor response (P = 0.048). Conclusion. Nutritional supplementation enriched PUFA (ratio of n-6: n-3 PUFA = 1.27 : 1) in advanced cervical cancer receiving radiotherapy gives better total tumor response.]"

"Tujuan: Membandingkan distribusi dosis respon akhir RE dan efek samping akut RE teknik konvensional dan teknik konformal pada kasus kanker serviks lokal lanjut Metode Dilakukan studi kohort retrospektif terhadap pasien kanker serviks II B dan III B yang mendapat RE pra brakiterapi di Dept Radioterapi RSCM. Hasil: Didapat 51 pasien menjalani RE teknik konvensional 25 dengan Cobalt 60 26 dengan Linac dan 29 pasien menjalani teknik konformal Sesuai ketentuan ICRU 50 dan 62 prescribed dose dan cakupan volume target teknik konvensional Cobalt lebih kecil p 0 001 dan 1 kasus dari 25 pasien mendapatkan PTV 95 Prescribed dose dan cakupan volume target teknik konvensional Linac lebih besar p 0 001 dibanding teknik konformal Rerata conformity index teknik konvensional sebesar 2 dan teknik konformal 1 02 p 0 001 Dosis dan volume pada buli rektosigmoid dan bowel teknik konvensional lebih besar p 0 001 Respon komplit akhir RE teknik konvensional adalah 42 dan teknik konformal adalah 58 p 0 001 Faktor independen respon akhir RE yaitu stadium FIGO dini dan ukuran tumor sebelum RE kecil le 4cm Pada semua kasus tidak didapatkan efek samping akut lokal yang berat RTOG grade 3 4 Proporsi efek samping ringan RTOG grade 1 2 pada gastrointestinal vesikourinaria dan kulit lebih banyak pada teknik konvensional secara berurutan 72 Vs 28 p 0 002 78 Vs 22 p 0 003 dan 78 Vs 22 p 0 01. Kesimpulan: RE teknik konformal lebih unggul dibanding teknik konvensional dalam distribusi prescribed dose dan cakupan volume target atau organ kritis yang berdampak pada respon tumor akhir RE dan efek samping.

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Purpose: To compare the dose distribution acute tumor response and acute side effects between conventional and conformal techniques EBRT in locally advanced uterine cervical cancerMethods and materials Retrospective cohort study was done in stage II B and III B uterine cervical cancer underwent EBRT before brachytherapy in Dept Radioterapi RSUPN Cipto Mangunkusumo.

Results: Fifety one patients underwent conventional technique EBRT and 29 patients of conformal technique EBRT The average of target prescribed dose and volume coverage of 2 techniques EBRTwas in accordance with criteria of ICRU 50 and 62 smaller p 0 001 only 1 case of Cobalt conventional technique EBRT showed PTV 95 Conformity index of conventional technique EBRT was 2 and conformal technique EBRT was 1 02 p 0 001 Dose and volume of vesicourinary rectosigmoid and distal large bowel of conventional technique EBRT was greater p 0 001 Complete response of conventional technique was 42 and conformal technique was 58 p 0 001 Independent factors were early FIGO stage and tumor size before EBRT le 4cm There were no severe acute side effects RTOG grade 3 4 in both groups Acute side effects RTOG grade 1 2 of conventional techniques was more than conformal gastrointestinal vesikourinaria and skin respectively 72 vs 28 p 0 002 78 vs 22 p 0 003 and 78 vs 22 p 0 01.

Conclusion: Conformal technique EBRT was superior to conventional technique EBRT in prescribed dose distribution target volume coverage and organ at risk dose that impact on acute tumor response and side effects "

"Kanker serviks merupakan salah satu kanker terbanyak pada perempuan dengan jumlah kasus dan kematian yang bermakna, terutama di negara-negara berkembang seperti Indonesia. Penelitian terbaru menyoroti peran mikroRNA (miRNA) dalam karsinogenesis, terutama miR-21 yang terlibat dalam berbagai jenis kanker pada perempuan, termasuk kanker serviks. Selain itu, miR-145, LATS1, dan NF-κB dipercaya memiliki peran dalam radioresistensi. Penelitian ini bertujuan untuk membuktikan pengaruh konsentrasi miR-21, miR-145, Large Tumor Suppressor 1 (LATS1), dan Nuclear Factor Kappa B (NF-kB) serta usia terhadap respons kemoradiasi pada pasien kanker serviks stadium lanjut lokal. Penelitian ini menggunakan desain potong lintang analitik yang dilakukan di Rumah Sakit Cipto Mangunkusumo dari bulan Juli 2017 sampai Juni 2023. Sampel jaringan dari biopsi serviks diambil dan diperiksa menggunakan real-time reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) untuk mendeteksi miR-21 dan miR-145, serta ELISA untuk mendeteksi konsentrasi LATS1 dan NF-kB sebelum pasien menerima terapi kemoradiasi. Pemeriksaan ultrasonografi kemudian dilakukan kembali untuk menilai respons radiasi dengan menggunakan kriteria RECIST 1.1. Dari 140 subjek, ditemukan gambaran histopatologi karsinoma sel skuamosa pada 119 (85%) sampel, dengan distribusi kanker serviks stadium IIIB pada 102 (72,9%) subjek dan stadium IVA pada 38 (27,1%) subjek. Ekspresi miR- 21 di atas cut-off lebih banyak ditemukan pada subjek yang radioresisten (p = 0,010; AUC = 67,6%). Ekspresi miR-145 dan LATS1 di atas cut-off lebih banyak ditemukan pada kelompok radioresisten, masing-masing dengan p = 0,132 (AUC = 38,8%) dan p = <0,001 (AUC = 32,7%). Ekspresi NF-kB di bawah cut-off ditemukan lebih banyak pada kelompok radioresisten (p = 0,009; AUC = 61%), dan usia di bawah cut-off juga lebih banyak ditemukan pada kelompok radioresisten (p = 0,138; AUC = 39,2%). Penelitian ini menunjukkan bahwa ekspresi miR-21 dan LATS1 pra-kemoradiasi yang tinggi serta ekspresi NF-κB yang rendah berhubungan dengan terjadinya radioresistensi. Sebaliknya, konsentrasi miR-145 dan usia tidak berhubungan dengan radioresistensi, sehingga dapat disimpulkan bahwa miR-21 memiliki potensi sebagai biomarker radioresisten pada pasien kanker serviks stadium lanjut lokal dan pemeriksaan kombinasi tidak disarankan.

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Cervical cancer is one of the most common cancers in women with a significant number of cases and deaths, especially in developing countries such as Indonesia. Recent research highlights the role of microRNAs (miRNAs) in carcinogenesis, particularly miR-21, which is involved in various types of cancer in women, including cervical cancer. In addition, miR-145, LATS1 and NF-κB also considered to play a role in radioresistance. This study aims to determine the influence of miR- 21, miR-145, Large Tumor Suppressor 1 (LATS1), Nuclear Factor Kappa B (NF- κB), and age on chemoradiation response in locally advanced cervical cancer patients. This study used an analytical cross-sectional design conducted at Cipto Mangunkusumo Hospital from July 2017 to June 2023. Cervical biopsy tissue samples were collected and examined using real-time reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) to detect miR-21 and miR-145, and ELISA to measure LATS1 and NF-κB concentrations before patients underwent chemoradiation therapy. Ultrasound examination was then re-performed to assess radiation response using RECIST 1.1 criteria. This research obtained a total of 140 samples with histopathological subtype of squamous cell carcinoma found in 119 (85%) samples, with cervical cancer stage IIIB in 102 (72.9%) subjects and stage IVA in 38 (27.1%) subjects. Expression of miR-21 above the cut-off was more prevalent in radioresistant patients (p = 0.010; AUC = 67.6%). Expression of miR-145 and LATS1 above the cut-off were found to be higher in the radioresistant group with p = 0.132 (AUC = 38.8%) and p = <0.001 (AUC = 32.7%), respectively. NF-κB expression below the cut-off were found to be higher in the radioresistant group (p = 0.009; AUC = 61%), and age below the cut-off were also found to be higher in the radioresistant group (p = 0.138; AUC = 39.2%). This study showed that high expression of miR-21 and LATS1 pre-chemoradiation and low expression of NF-κB pre-chemoradiation were all associated with radioresistance, while miR- 145 concentration and age were not associated with radioresistance. This study concluded that miR-21 had the potential to be used as a radioresistant biomarker in patients with local advanced-stage cervical cancer and combination testing was not suggested."

"Pendahuluan: Stres oksidatif selalu terjadi pada pasien kanker dan ditandai dengan kadar Malondialdehyde (MDA) serum yang tinggi dan rendahnya aktivitas antioksidan enzimatik serum katalase (CAT). Penelitian ini menganalisis kadar MDA dan aktifitas enzimatik CAT, yang mewakili status oksidan dan status antioksidan pada pasien dengan kanker serviks uteri stadium lanjut lokal dan bagaimana hubungannya dengan angiogenesis (VEGF), yang bertujuan untuk mengembangkan strategi terapi baru di berbagai kasus keganasan, terutama dalam kasus kanker serviks uteri di masa depan.Metode penelitian: Penelitian ini merupakan studi cross sectional terhadap 16 pasien kanker serviks uteri stadium lanjut lokal (IIB ? IIIB) pada bulan Juli 2013 sampai dengan September 2013 yang memenuhi kriteria inklusi di departemen Radioterapi RSCM. Kadar MDA dan aktifitas enzimatik CAT diperiksa dengan mengambil sampel dari darah sebelum terapi radiasi diberikan. Pemeriksaan angiogenesis diperiksa dengan mengambil sampel biopsi dari jaringan serviks, dan dilakukan pemeriksaan ELISA untuk mendapatkan ekspresi VEGF.Hasil: Pada studi ini didapatkan rerata kadar MDA serum sebesar 7,6 +/- 1,2 nmol/mL, dan median aktivitas CAT sebesar 0,95 (0,80 ? 1,36) U/mL. Ditemukan korelasi positif kuat antara kadar MDA dan ekspresi VEGF dengan koefisien korelasi r = +0.775, dan p < 0.001. Tetapi didapatkan korelasi negatif lemah antara aktivitas enzimatik katalase serum dengan VEGF dengan koefisien korelasi r = -0.310 dan p = 0,909.Kesimpulan: Hasil penelitian ini menunjukkan bahwa stress oksidatif terjadi pada pasien kanker serviks uteri stadium lanjut lokal yang ditandai dengan peningkatan kadar MDA serum yang tinggi dan aktifitas enzimatik katalase yang rendah. Terdapat korelasi positif kuat antara kadar MDA serum dengan VEGF jaringan tetapi didapatkan korelasi negatif yang lemah dan tidak signifikan antara VEGF dengan aktifitas enzim katalase.

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Introduction: Oxidative stress always occurs in cancer patient, which characterized with high level of serum Malondialdehyde (MDA) dan low activity of serum catalase enzymatic antioxidant. This study analyzed the levels of malondialdehyde (MDA) and catalase (CAT), which represents the oxidant and antioxidant status in patients with locally advanced uterine cervical cancer and how it relates to angiogenesis to develop new therapeutic strategies in various malignancies, especially in the case of uterine cervical cancer in the future.

Methods: Sixteen of locally advance cervical cancer stage IIB ? IIIB from July 2013 to September 2013 who had irradiated in Radiotherapy department Cipto Mangunkusumo general hospital and eligible for this cross sectional study. MDA levels serum and catalase enzyme serum activities were examined before radiotherapy. Tissue biopsy is taking before radiotherapy, for VEGF analysis is done by ELISA to asses angiogenesis activity.

Results: In this study, mean MDA level is 7.6 + /- 1.2 nmol / mL and catalase enzyme activity median is 0.95 ( 0.8 to 1.36 ) U / mL . paired t-test shows there is a strong significant positive correlation between MDA and VEGF (r = +0.775, p < 0.001). This suggest that increasing MDA serum levels as free radicals activity in line with increasing VEGF as angiogenesis activity, in the other side there is no correlation between VEGF and catalase enzyme serum activities ( r = -0.310 and p = 0.909).

Conclusion: This study showed that oxidative stress occurs in patients with locally advanced cervical cancer, increasing MDA serum levels as free radicals activity in line with increasing VEGF as angiogenesis activity but at the other side there is no correlation between VEGF and catalase enzyme serum activities."

"Latar Belakang : Kanker serviks stadium awal dapat ditatalaksana dengan baik, namun pada stadium lanjut lokal memiliki prognosis yang buruk. Terapi standar yang tersedia masih kurang optimal dan memiliki efek samping yang mengganggu. Pada keadaan tertentu tumor dapat mengalami metastases atau progresif, salah satunya karena adanya ikatan PD-L1 dengan sel limfosit T sehingga kanker serviks terhindar dari respon imun. Pemberian anti PD-L1 menjadi bagian yang penting dalam pengobatan imunoterapi kanker. Di Indonesia belum tersedia data empirik profil karakteristik yang berkaitan dengan ekspresi PD-L1 serta respon tumor terhadap radiasi pada kanker serviks. Metode: Penelitian ini memeriksa ekspresi PD-L1 intratumoral pada jaringan biopsi karsinoma sel skuamosa serviks pre dan paska radiasi eksterna dengan menggunakan metode ELISA dan IHK, pemeriksaan IHK menggunakan antibodi clone 28-8 dari Abcam. Pemeriksaan CT scan evaluasi sebelum radiasi dan 2 bulan setelah radiasi dipakai sebagai alat untuk menilai respon terapi radiasi. Hasil : Dari 31 pasien yang ikut serta, terdapat 29 pasien yang telah dilakukan pemeriksaan ekspresi PD-L1 sebelum dan sesudah radiasi, selanjutnya hanya 22 pasien yang telah menjalani CT scan evaluasi. Ekspresi PD-L1 ELISA paska radiasi eksterna berbeda bermakna pada tumor berukuran ≥5cm (p=0,015) dan ekspresi PD-L1 IHK berbeda bermakna pada sel tumor berkeratin (p=0,023), pada pasien dengan grade IHK yang difus (+3) resiko relatif untuk respon komplit 0,5 kali dibandingkan dengan grade IHK yang  tidak difus. Uji korelasi perbedaan selisih ekspresi (delta) dan rasio PD-L1 ELISA menunjukkan tidak ada korelasi (R2= 0,217) dan (R2= 0,194) terhadap respons, begitu juga hasil pada hasil pemeriksaan ekspresi PD-L1 IHK tidak ada perbedaan bermakna pada kategori kenaikan, tetap dan penurunan, tetapi ketika kategori dirubah menjadi penurunan dan tidak ada penurunan didapatkan nilai p yang lebih baik (p=0,161 vs p=.0,613).Kesimpulan : Tidak terdapat perbedaan bermakna antara ekspresi PD-L1 pre dan paska radiasi terhadap respon, akan tetapi terdapat tren penurunan kadar PD-L1 IHK berkaitan dengan respon terapi.

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Correlation of Intratumoral PD-L1 Expression Before and After External Radiation to The Radiation Response in Locally Advanced Cervical Cancer.

Background: Early-stage cervical cancer can be managed properly, but at a locally advanced stage it has a poor prognosis. The standard therapy available is still suboptimal and has disturbing side effects. In certain circumstances, tumors can undergo metastases or progressives, one of which is due to the binding of PD-L1 with T lymphocyte cells so that cervical cancer is protected from the immune response. In Indonesia, there is no available empirical data on the characteristic profiles related to PD-L1 expression and tumor response to radiation in cervical cancer.

Method: This study examined intratumoral PD-L1 expression in biopsy tissue of squamous cell carcinoma of cervical cells pre and post external radiation using ELISA and IHC methods, IHC examination using antibody clone 28-8 from Abcam. CT scan evaluation before radiation and 2 months after radiation are used as a tool to assess the response of radiation therapy.

Results: Of the 31 patients who participated, there were 29 patients who had examined the expression of PD-L1 before and after radiation, then only 22 patients who had undergone a CT scan evaluation. Expression of PD-L1 ELISA after external radiation was significantly different in tumors of ≥5cm (p=0.015) and expression of PD-L1 IHC was significantly different in keratinous tumor cells (p = 0.023), in patients with diffuse IHC grade (+3) relative risk to complete response of 0.5 times compared to the grade of IHC which is not diffuse. Correlation test difference in expression difference (delta) and PD-L1 ELISA ratio showed no correlation (R2=0.217) and (R2=0,194) to the response, as well as results on the examination results of PD-L1 IHC expression there was no significant difference in the increased category, constant and decrease, but when the category is changed to decrease and there is no decrease, a better p-value is obtained (p=0.161 vs p=0.613).

Conclusion: There was no significant difference between the expression of PD-L1 pre and post-radiation to the response, but there was a trend of decreasing PD-L1 IHC levels concerning therapeutic response."

"Latar Belakang: Kanker serviks stadium awal dapat ditatalaksana dengan baik, namun pada stadium lanjut lokal memiliki prognosis yang buruk. Terapi standar yang tersedia masih kurang optimal dan memiliki efek samping yang mengganggu. Pada keadaan tertentu tumor dapat mengalami metastases atau progresif, salah satunya karena adanya ikatan PD-L1 dengan sel limfosit T sehingga kanker serviks terhindar dari respon imun. Pemberian anti PD-L1 menjadi bagian yang penting dalam pengobatan imunoterapi kanker. Di Indonesia belum tersedia data empirik profil karakteristik yang berkaitan dengan ekspresi PD-L1 serta respon tumor terhadap radiasi pada kanker serviks.Metode: Penelitian ini memeriksa ekspresi PD-L1 intratumoral pada jaringan biopsi karsinoma sel skuamosa serviks pre dan paska radiasi eksterna dengan menggunakan metode ELISA dan IHK, pemeriksaan IHK menggunakan antibodi clone 28-8 dari Abcam. Pemeriksaan CT scan evaluasi sebelum radiasi dan 2 bulan setelah radiasi dipakai sebagai alat untuk menilai respon terapi radiasi.Hasil: Dari 31 pasien yang ikut serta, terdapat 29 pasien yang telah dilakukan pemeriksaan ekspresi PD-L1 sebelum dan sesudah radiasi, selanjutnya hanya 22 pasien yang telah menjalani CT scan evaluasi. Ekspresi PD-L1 ELISA paska radiasi eksterna berbeda bermakna pada tumor berukuran ≥5cm (p=0,015) dan ekspresi PD-L1 IHK berbeda bermakna pada sel tumor berkeratin (p=0,023), pada pasien dengan grade IHK yang difus (+3) resiko relatif untuk respon komplit 0,5 kali dibandingkan dengan grade IHK yang  tidak difus.Uji korelasi perbedaan selisih ekspresi (delta) dan rasio PD-L1 ELISA menunjukkan tidak ada korelasi (R2 = 0,217) dan (R2 = 0,194) terhadap respons, begitu juga hasil pada hasil pemeriksaan ekspresi PD-L1 IHK tidak ada perbedaan bermakna pada kategori kenaikan, tetap dan penurunan, tetapi ketika kategori dirubah menjadi penurunan dan tidak ada penurunan didapatkan nilai p yang lebih baik (p=0,161 vs p=.0,613)Kesimpulan: Tidak terdapat perbedaan bermakna antara ekspresi PD-L1 pre dan paska radiasi terhadap respon, akan tetapi terdapat tren penurunan kadar PD-L1 IHK berkaitan dengan respon terapi.

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Background: Early-stage cervical cancer can be managed properly, but at a locally advanced stage it has a poor prognosis. The standard therapy available is still suboptimal and has disturbing side effects. In certain circumstances, tumors can undergo metastases or progressives, one of which is due to the binding of PD-L1 with T lymphocyte cells so that cervical cancer is protected from the immune response. In Indonesia, there is no available empirical data on the characteristic profiles related to PD-L1 expression and tumor response to radiation in cervical cancer.

Method: This study examined intratumoral PD-L1 expression in biopsy tissue of squamous cell carcinoma of cervical cells pre and post external radiation using ELISA and IHC methods, IHC examination using antibody clone 28-8 from Abcam. CT scan evaluation before radiation and 2 months after radiation are used as a tool to assess the response of radiation therapy.

Results: Of the 31 patients who participated, there were 29 patients who had examined the expression of PD-L1 before and after radiation, then only 22 patients who had undergone a CT scan evaluation. Expression of PD-L1 ELISA after external radiation was significantly different in tumors of ≥5cm (p=0.015) and expression of PD-L1 IHC was significantly different in keratinous tumor cells (p = 0.023), in patients with diffuse IHC grade (+3) relative risk to complete response of 0.5 times compared to the grade of IHC which is not diffuse. Correlation test difference in expression difference (delta) and PD-L1 ELISA ratio showed no correlation (R2 =0.217) and (R2=0,194) to the response, as well as results on the examination results of PD-L1 IHC expression there was no significant difference in the increased category, constant and decrease, but when the category is changed to decrease and there is no decrease, a better p-value is obtained (p=0.161 vs p=0.613)

Conclusion: There was no significant difference between the expression of PD-L1 pre and post-radiation to the response, but there was a trend of decreasing PD-L1 IHC levels concerning therapeutic response."

"Pendahuluan: Pada penderita kanker selalu terjadi stres oksidatif yang ditandai dengan kadar MDA (malondialdehyde) yang tinggi dan aktivitas katalase yang rendah. Kanker terjadi karena ketidakseimbangan antara proses proliferasi sel dengan apoptosis. Penelitian ini bertujuan untuk mengetahui korelasi antara apoptosis dengan kadar MDA dan aktivitas antioksidan enzimatik katalase pada pasien kanker leher rahim stadium lokal lanjut. Metode penelitian: Penelitian ini merupakan studi cross sectional terhadap 16 pasien kanker leher rahim stadium lokal lanjut yang memenuhi kriteria inklusi dari Juli sampai Agustus 2013. Pengambilan darah pasien dilakukan sebelum radiasi dimulai. Pemeriksaan kadar MDA dan aktivitas katalase dilakukan dengan metode spektrofotometri. Indeks apoptosis dilakukan dengan motode TUNEL. Hasil: Didapatkan rerata indeks apoptosis sebesar 11,1 ± 0,59 sel; rerata kadar MDA serum sebesar 7,97 ± 0,26 nmol/mL dan rerata aktivitas katalase serum sebesar 0,98 ± 0,04 U/mL. Terdapat korelasi positif sedang yang bermakna (r=+0,51; p=0,043) antara indeks apoptosis dengan kadar MDA dan korelasi negatif lemah yang tidak bermakna (r=-0,02; p=0,94) dengan aktivitas katalase. Kesimpulan: Pada penderita kanker leher rahim stadium lokal lanjut terjadi stres oksidatif yang ditandai dengan kadar MDA serum yang tinggi dan aktivitas katalase serum yang rendah dan terjadi peningkatan indeks apoptosis. Terdapat korelasi positif sedang yang bermakna antara indeks apoptosis dengan kadar MDA dan korelasi negatif lemah yang tidak bermakna dengan aktivitas katalase.

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Introduction: Oxidative stress always occurs in cancer patient, which characterized with high level of Malondialdehyde (MDA) and low activity of catalase enzymatic antioxidant. Cancer occurs due to imbalance between cell proliferation and cell death due to apoptosis. The purpose of this study to determine the correlation between apoptosis with MDA level and catalase enzymatic antioxidant activity in patients with locally advanced cervical cancer.

Methods: This is a cross sectional study to 16 locally advanced cervical cancer patients who meet the inclusion criteria from July to August 2013. Blood sampling was done before patients began radiation. MDA level and catalase activity was measured by spectrophotometry. Apoptotic index was conducted by TUNEL method.

Results: The mean of apoptotic index is 11,1 ± 0,59 cell, the mean of serum MDA levels is 7.97 ± 0.26 2 nmol /mL, and the mean of serum catalase activity is 0.98 ± 0.04 U /mL. There was a significant moderate positive correlation (r = +0.51, p = 0.043) between the apoptotic index with serum MDA levels and a non-significant weak negative correlation (r = -0.02, p = 0.94) between the apoptotic index with serum catalase activity.

Conclusion: This study showed that oxidative stress occurs in patients with locally advanced cervical cancer, which characterized with high level of serum MDA and low activity of serum catalase. There is an increase in apoptotic index in patients with locally advanced cervical cancer. There was a significant moderate positive correlation between apoptotic index with MDA levels and a non-significant weak negative correlation with catalase activity."

"Latar Belakang. Kesintasan 3 tahun pasien KNF stadium lokal lanjut di Indonesia lebih rendah dibandingkan luar negeri. Prediktor alternatif dari rasio hemoglobin-trombosit (RHT) lebih sederhana, murah, dan stabil nilainya dibanding rasio dari komponen sel leukosit, namun belum ada studi yang meneliti perannya dalam memrediksi mortalitas tiga tahun pasien KNF stadium ini.Tujuan. Mengetahui peran RHT sebelum terapi dalam memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.Metode. Studi kohort retrospektif yang meneliti 289 pasien KNF stadium lokal lanjut yang diterapi di Rumah Sakit Cipto Mangunkusumo (RSCM) dalam rentang waktu Januari 2012 - Oktober 2016. Nilai RHT optimal didapatkan menggunakan receiver operating curve (ROC). Subjek penelitian dibagi menjadi 2 kelompok, di bawah dan di atas titik potong. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia > 60 tahun, stadium, jenis kelamin, dan indeks massa tubuh) untuk mendapatkan nilai adjusted hazard ratio (HR).Hasil. Nilai titik potong RHT optimal adalah 0,362 (AUC 0,6228, interval kepercayaan (IK) 95% : 0,56-0,69, sensitivitas 61,27%, spesifisitas 60,34%). 48,44% pasien memiliki nilai RHT <0,362 dan memiliki mortalitas tiga tahun lebih besar dibandingkan kelompok lainnya (50%vs31,54%). RHT < 0,362 secara signifikan memrediksi kesintasan tiga tahun (p = 0,003; HR 1,75; IK 95% 1,2-2,55). Pada analisis multivariat, RHT < 0,362 sebelum terapi merupakan faktor independen dalam memrediksi kesintasan tiga tahun pada pasien KNF stadium lokal lanjut (adjusted HR 1,82; IK 95% 1,25-2,65).Simpulan. RHT < 0,362 sebelum terapi dapat memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut

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Background. The 3-year survival of locally advanced nasopharyngeal cancer (NPC) patients in Indonesia is lower than in foreign countries. Alternative predictors from the hemoglobin-platelet ratio (HPR) are easier, cheaper, and stable in value than the ratio of leukocyte cell components, but there are no study conducted to know its potential in predicting three-year survival in locally advanced

nasopharyngeal cancer.

Objective. To determine the role of pre-treatment hemoglobin to platelet ratio in predicting three-year survival of locally advanced nasopharyngeal cancer patients.

Method. Retrospective cohort study that examined 289 locally advanced NPC patients who underwent therapy at the National Government General Hospital-Cipto Mangunkusumo from January 2012 to October 2016. HPR cut-off was determined using ROC, and then subjects were divided into two groups according to its HPR value. The Kaplan-Meier curve was used to determine the three-year survival of the patients and cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Results. The optimal cut-off for HPR was 0,362 (AUC 0,6228, 95% CI: 0,56-0,69, sensitivity 61,27%, specificity 60,34%). Patients with HPR < 0,362 occurred in 48, 44% and had higher three-year mortality (50% vs. 31, 54%). HPR <0.362 significantly predicted the three years of survival (p = 0,003; HR 1, 75; IK 95% 1, 2-2, 55). In multivariate analysis,

it was concluded that pre-treatment HPR < 0,362 was an independent factor in predicting three-year

survival in locally advanced NPC patients (adjusted HR 1, 82; IK 95% 1, 25-2, 65).

Conclusion. Pre-treatment HPR < 0, 362 could predict the three-year survival of locally advanced nasopharyngeal cancer patients."