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"Penelitian ini bertujuan untuk mengevaluasi perhitungan dosis berdasarkan citra Cone Beam Computed Tomography (CBCT) pada pasien dengan diagnosa tumor otak. Perencanaan dan perhitungan dosis berdasarkan citra CBCT fraksinasi ke-16 yang dilakukan terhadap 13 pasien yang disinari menggunakan pesawat linac Elekta Versa HD dan 7 pasien yang disinari menggunakan pesawat linac Halcyon 2.0. Perencanaan dan perhitungan dosis dilakukan pada Treatment Planning System (TPS) Eclipse dan TPS Monaco. Hasil perhitungan dosis berdasarkan citra CBCT dibandingkan dengan citra Computed Tomography (CT) simulator. Penelitian ini memiliki beberapa tahapan, (1) kalibrasi Hounsfield Unit (HU) citra CBCT menggunakan fantom CIRS CT electron density 062M untuk melakukan perhitungan dosis di TPS dengan nilai HU yang sesuai, (2) proses pengumpulan data citra pasien yang memenuhi kriteria penelitian dan dilanjutkan dengan proses registrasi dan perencanaan citra CBCT, (3) analisis Dose Volume Histogram (DVH) untuk mengevaluasi kualitas perencanaan dengan parameter dosis yaitu Conformity Index (CI) dan Homogeneity Index (HI), (4) analisis dosis Organ at Risk (OAR) terhadap dose-constraint (batas dosis) untuk OAR batang otak, kiasma, sumsum tulang belakang, saraf optik, mata dan lensa. Nilai CI pada perencanaan berdasarkan CT tidak berbeda secara signifikan, Berdasarkan CBCT dari pesawat linac Elekta Versa HD diperoleh CI sebesar 0,05±0,21 (p=0,08) dan -0,01 ± 0,06 (p=0,02) berdasarkan CBCT dari pesawat linac Halcyon 2.0. Sementara itu, nilai HI pada perencanaan berdasarkan CBCT diamati berbeda secara signifikan terhadap CT, Berdasarkan CBCT dari pesawat linac Elekta Versa HD diperoleh HI sebesar 0,25 ± 0,43 (p=0,01) dan 0,08 ± 0,04 (p=0,01) berdasarkan CBCT dari pesawat linac Halcyon 2.0.

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This research aims to evaluate dose calculations based on Cone Beam Computed Tomography (CBCT) images in patients diagnosed with brain tumors. Planning and dose calculations based on the 16th fraction of CBCT images were performed on 13 patients irradiated using Elekta Versa HD linear accelerator and 7 patients irradiated using Halcyon 2.0 linear accelerator. The planning and dose calculations were conducted using the Treatment Planning System (TPS) Eclipse and TPS Monaco. The results of the dose calculations based on CBCT images were compared with the Computed Tomography (CT) simulator images. The research comprised several stages: (1) calibration of Hounsfield Unit (HU) of CBCT images using CIRS CT electron density 062M phantom to perform dose calculations in TPS with appropriate HU values, (2) data collection of patient images meeting the research criteria followed by image registration and CBCT planning, (3) analysis of Dose Volume Histogram (DVH) to evaluate planning quality using dose parameters such as Conformity Index (CI) and Homogeneity Index (HI), (4) analysis of dose to Organs at Risk (OAR) against dose constraints for OARs such as brainstem, chiasm, spinal cord, optic nerves, eyes, and lenses. The CI values for the planning based on CT were not significantly different. Based on CBCT from Elekta Versa HD linear accelerator, the CI obtained was 0.05 ± 0.21 (p=0.08), and based on CBCT from Halcyon 2.0 linear accelerator, the CI obtained was -0.01 ± 0.06 (p=0.02). However, the HI values for planning based on CBCT significantly differed from CT. Based on CBCT from Elekta Versa HD linear accelerator, the HI obtained was 0.25 ± 0.43 (p=0.01), and based on CBCT from Halcyon 2.0 linear accelerator, the HI obtained was 0.08 ± 0.04 (p=0.01)."

"Latar Belakang: Tumor sistem saraf pusat (SSP) meningkatkan tekanan intrakranial dan menyebabkan berbagai gangguan neurologis yang dapat memengaruhi status gizi pasien. Status gizi memengaruhi imunitas bawaan dan adaptif. Pada hampir semua jenis keganasan kadar asam amino rantai cabang (AARC) didapatkan rendah. Asam amino rantai cabang meningkatkan imunitas dengan meningkatkan fagositik neutrofil, proliferasi limfosit, sintesis protein, menjaga jalur pensinyalan yang sensitif terhadap nutrisi. Rasio neutrofil limfosit (RNL) menggambarkan keseimbangan sistem imunitas dengan inflamasi. Peningkatan RNL dihubungkan dengan penurunan respon imun tubuh, terapi, harapan hidup dan prognosis. Penelitian ini dilakukan untuk mengetahui hubungan asupan AARC terhadap RNL pada pasien tumor SSP.Metode: Penelitian ini merupakan studi potong lintang pada pasien tumor SSP yang dirawat di RSCM. Karakteristik subjek berupa usia, jenis kelamin, jenis tumor, defisit neurologis, status performa karnofsky, indeks massa tubuh (IMT), status gizi berdasarkan ASPEN, penyakit komorbid, status infeksi, kemoterapi, radiasi, dan atau kemoradiasi, terapi glukokortikoid, asupan energi dan protein, asupan AARC, serta nilai RNL. Dilakukan analisis hubungan antara dua kelompok asupan AARC yang dibagi sesuai median populasi penelitian terhadap RNL.Hasil: Terdapat 66 subjek penelitian dengan median usia 48 tahun, mayoritas subjek perempuan (56,1%), dengan jenis tumor sekunder sebanyak 38 subjek (57,6%). Defisit neurologis tertinggi berupa nyeri kepala (60,6%), proporsi status performa karnofsky terganggu sedang-berat (60,6%). Proporsi IMT estimasi normal sebanyak 34,8%, rerata IMT 23,46 ± 4,95 kg/m2, dengan mayoritas malnutrisi (54,5%) berdasarkan kriteria ASPEN. Mayoritas subjek tidak memiliki komorbid (65,2%), tidak infeksi (80,3%), tidak menjalani kemoterapi, radiasi dan atau kemoradiasi (84,8%), serta tidak mendapat glukokortikoid (71,2%). Rerata asupan energi 1519 kkal, protein 65 g/hari, median AARC 9 g/hari. Terdapat perbedaan bermakna nilai RNL (p=0,047) pada kelompok asupan AARC <9 g/hari (median RNL 4,9); pada kelompok asupan AARC ≥9 g/hari (median RNL 3,1).

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Background: Central nervous system (CNS) tumors increase intracranial pressure and cause various neurological disorders that can affect the nutritional status of patients. Nutritional status influences both innate and adaptive immunity. In almost all malignancies, low levels of branched-chain amino acids (BCAA) are observed. Branched-chain amino acids enhance immunity by increasing neutrophil phagocytosis, lymphocyte proliferation, protein synthesis, and maintaining nutrient-sensitive signaling pathways. The neutrophil lymphocyte ratio (NLR) reflects the balance of the immune system with inflammation. An elevated NLR is associated with decreased body immune response, therapy outcomes, life expectancy, and prognosis. This study aims to determine the relationship between BCAA intake and NLR in CNS tumor patients.

Method: This is a cross-sectional study on CNS tumor patients treated at RSCM. Subject characteristics include age, gender, tumor type, neurological deficits, Karnofsky performance status, body mass index (BMI), nutrition status based on ASPEN, comorbidities, infection status, chemotherapy, radiation, and/or chemoradiation, glucocorticoid therapy, energy, and protein intake, BCAA intake, and NLR values. The analysis examines the relationship between two groups of BCAA intake divided according to the study population's median with NLR.

Results: There were 66 study subjects with a median age of 48 years, mostly female subjects (56,1%), with 38 subjects (57,6%) having secondary tumors. The highest neurological deficit was headache (60,6%), and the majority have a moderately to severely impaired Karnofsky performance status (60,6%). The proportion of estimated normal Body Mass Index (BMI) was 34.8%, with a mean BMI of 23,46 ± 4,95 kg/m2, and the majority were malnourished (54,5%) based on ASPEN criteria. Most subjects had no comorbidities (65,2%), no infections (80,3%), did not undergo chemotherapy, radiation, and/or chemoradiation (84,8%), and did not receive glucocorticoids (71.2%). The mean energy intake was 1519 kcal, protein intake 65 g/day, and the median BCAA was 9 g/day. There was a significant difference in the NLR values (p=0,047) between the group with BCAA intake <9 g/day (median NLR 4,9) and the group with BCAA intake ≥9 g/day (median NLR 3,1).

Conclusion: BCAA intake is related to NLR values in CNS tumor patients. Higher BCAA intake is associated with lower NLR values."

"Tumor sistem saraf pusat (SSP) dapat menurunkan massa otot dan massa bebas lemak akibat defisit neurologis yang terjadi serta efek sistemik karena keganasan. Penurunan massa bebas lemak dan massa otot dengan inflamasi saling memengaruhi serta dikaitkan dengan prognosis yang buruk. Penelitian ini bertujuan untuk mengetahui korelasi indeks massa bebas lemak (FFMI) dengan indeks inflamasi imun sistemik (SII) pada pasien tumor SSP. Studi ini merupakan studi potong lintang pada pasien dewasa dengan diagnosis tumor SSP di RSUPN Dr. Cipto Mangunkusumo. Pengukuran FFMI menggunakan bio impedance analysis (BIA). Nilai SII didapatkan dari hasil pemeriksaan laboratorium darah perifer lengkap. Terdapat 74 pasien tumor SSP dengan mayoritas perempuan (59,5%) dan lokasi tersering adalah tumor di otak (79,7%). Proporsi jenis tumor primer maupun sekunder adalah sama (50%). Median indeks massa tubuh (IMT) yaitu 22,85 kg/m2 (11,99–37,60 kg/m2) dengan kategori IMT terbanyak adalah berat badan normal (33,8%). Rerata FFMI yaitu 16,05±3,12 kg/m2 dengan 51,4% pasien memiliki FFMI yang rendah. Median SII sebesar 1140,9 (103,6–8745,6). Tidak didapatkan korelasi antara FFMI dengan SII pada pasien tumor SSP. Pada analisis tambahan didapatkan korelasi negatif bermakna antara FFMI dengan SII pada wanita (r=- 0,351; p=0,019), sebaliknya pada pria tidak ditemukan adanya korelasi (r=-0,096; p=0,613).

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Central nervous system (CNS) tumors can reduce muscle mass and fat-free mass due to neurological deficits and systemic effects of malignancy. Decreased fat-free mass and muscle mass with inflammation are mutually influential and associated with poor prognosis. This study aimed to determine the correlation between fat-free mass index (FFMI) and systemic immune inflammation index (SII) in patients with CNS tumors. This is a cross-sectional study of CNS tumors adult patients at Dr. Cipto Mangunkusumo National General Hospital. FFMI measurements were obtained using bioimpedance analysis (BIA). SII values obtained from complete peripheral blood laboratory examination results. There were 74 patients with CNS tumors, with the majority being female (59.5%), and the most common location was brain tumors (79.7%). The proportion of primary and secondary tumor types was equal (50%). The median body mass index (BMI) was 22.85 kg/m2 (11.99– 37.60 kg/m2), with the majority falling under the normal weight category (33.8%). The mean FFMI was 16.05±3.12 kg/m2, with 51.4% of patients having a low FFMI. The median SII was 1140.9 (103.6–8745.6). There was no correlation between FFMI and SII in patients with CNS tumors. In additional analysis, a significant negative correlation was found between FFMI and SII in women (r=-0.351; p=0.019), whereas in men, no correlation was found (r=-0.096; p=0.613)."