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"Anemia merupakan salah satu efek samping yang paling sering dialami pasien kanker yang diterapi dengan cisplatin dosis tinggi. Penelitian ini bertujuan untuk mengamati perkembangan anemia dan menentukan faktor-faktor yang berpengaruh terhadap anemia pada pasien yang diterapi cisplatin. Dilakukan pengumpulan data pada pasien kanker kepala dan leher yang menjalani kemoterapi berbasis cisplatin antara Desember 2002 hingga Desember 2005. Insidensi dan faktor risiko anemia dianalisis dengan mencakup faktor usia, jenis kelamin, kadar Hb awal, klirens kreatinin awal, dan metastasis jauh. Stratifikasi menurut usia dan jenis kelamin dilakukan terhadap kadar Hb awal dan CrCl awal. Analisis multivariat digunakan untuk mengidentifikasi prediktor independen anemia. Dari 86 pasien, 26 (30,2%) mengalami anemia, ditandai kadar hemoglobin < 11 g/dL. Kadar hemoglobin turun secara signifikan setelah siklus pertama, dan terus menurun. Usia > 55 tahun (RR = 2.2, 95% CI, 1.2-4.0), jenis kelamin perempuan (RR = 2.0, 95% CI, 1.2-3.8), kadar Hb awal ≤ 13 g/dL (RR = 4.2, 95% CI, 1.9-9.4) dan CrCl awal < 50 mL/menit (RR = 2.9, 95% CI, 1.7-5.1) berkorelasi dengan insidensi anemia (P < 0.05). Pada analisis multivariat, kadar hemoglobin awal dan klirens kreatinin awal merupakan faktor risiko independen anemia. Akan tetapi, terdapat efek perancu pada klirens kreatinin awal pada stratifikasi menurut usia (aRR = 2.2, 95% CI, 1.1-4.7). Kadar hemoglobin awal merupakan prediktor terkuat dari anemia. Kadar hemoglobin awal ≤ 13 g/dL ke bawah dan klirens kreatinin awal < 50 g/dL merupakan prediktor independen anemia akibat cisplatin, sehingga keduanya bernilai penting terhadap upaya prevensi anemia.

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AbstractCisplatin is well-known for its effectiveness against cancer, as well as its toxicity to human tissues. Of several documented side effects, anemia was reported to have significant association with decreased quality of life. This study was conducted to investigate development of cisplatin-induced anemia, and to identify independent factors contributing to anemia. Clinical data from head and neck cancer patients treated with high-dose cisplatin between December 2002 and December 2005 were obtained in this study. Incidence and risk factors of anemia were assessed in a model including age, sex, baseline hemoglobin level, baseline creatinine clearance, and occurrence of distant metastases. Multivariate logistic regression was used to define independent predictors of anemia. Among 86 eligible patients, 26 (30.2%) developed anemia, defined as Hb level lower than 11 g/dL. Age > 55 years old (RR = 2.2, 95% CI, 1.2-4.0), female sex (RR = 2.0, 95% CI, 1.2-3.8), baseline Hb ≤ 13 g/dL (RR = 4.2, 95% CI, 1.9-9.4) and baseline CrCl < 50 mL/min (RR = 2.9, 95% CI, 1.7-5.1) were significantly correlated with incidence of anemia (P < 0.05). In multivariate analysis, baseline Hb and baseline CrCl were identified as independent risk factors for anemia. However, considerable confounding was observed in baseline CrCl after stratified by age (aRR = 2.2, 95% CI, 1.1-4.7). Thus, baseline Hb level was the strongest predictor of anemia. The findings suggested that baseline Hb and CrCl were useful to recognize cisplatin-treated patients at risk for anemia who might benefits from preventive measures."

"Imaging is crucial in the multidisciplinary approach to head and neck cancer management. The rapid technological development of recent years makes it necessary for all members of the multidisciplinary team to understand the potential applications, limitations, and advantages of existing and evolving imaging technologies. It is equally important that the radiologist has sufficient clinical background knowledge to understand the clinical significance of imaging findings. This book provides an overview of the findings obtained using different imaging techniques during the evaluation of head and neck neoplasms, both before and after therapy. All anatomic areas in the head and neck are covered, and the impact of imaging on patient management is discussed in detail. The authors are recognized experts in the field, and numerous high-quality images are included. This second edition provides information on the latest imaging developments in this area, including the application of PET-CT and diffusion-weighted magnetic resonance imaging."

"Kuantitas dan kualitas asupan protein belum sepenuhnya diketahui perannya terhadap kualitas hidup. Prognostic Nutritional Index (PNI) juga belum diketahui dapat mencerminkan kualitas hidup dan apakah bisa ditingkatkan dengan asupan protein. Penelitian dengan desain potong lintang ini bertujuan untuk mengetahui korelasi antara asupan protein dengan PNI dan kualitas hidup serta korelasi PNI dengan kualitas hidup pada pasien kanker kepala leher dengan radioterapi di Departemen Radioterapi Rumah Sakit dr. Cipto Mangunkusumo, Jakarta. Sebanyak 61 subjek didapatkan dari consecutive sampling. Rerata usia subjek adalah 46,3 ± 12,4 dan 65,6% subjek berada pada kanker stadium IV dan mendapatkan terapi kemoradiasi. Sebanyak 32,8% subjek yang memiliki status gizi kurang. Median asupan protein adalah 1,42 (0,26-4,11) g/kg/hari. Nilai PNI pada subjek penelitian memiliki median 45,9 (29,4-54,2). Hasil penelitian menunjukkan adanya korelasi bermakna antara kuantitas asupan protein berdasarkan Food Frequency Questionnaire (FFQ) semikuantitatif dan beberapa aspek gejala pada kualitas hidup yaitu pada aspek pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37;p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). Kualitas asupan protein tidak berkorelasi bermakna dengan kualitas hidup. PNI berkorelasi bermakna terhadap 1 aspek fungsional yaitu physical function (r=0,378; p=0,003) dan 2 aspek gejala yaitu opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Meskipun tidak signifikan secara statistik, namun PNI memiliki arah korelasi yang positif terhadap aspek fungsional lainnya dan memiliki arah korelasi negatif terhadap aspek gejala lainnya yang berarti semakin tinggi PNI maka aspek fungsional semakin baik dan gejala semakin ringan. Studi ini tidak menemukan adanya korelasi bermakna antara asupan protein, baik kualitas maupun kuantitasnya, terhadap PNI. Hasil ini diduga berkaitan dengan penemuan bahwa sebagian besar penderita masih memiliki pola asupan yang mampu mencukupi kebutuhan kalori dan protein harian. Diperlukan studi prospektif yang menelusuri aspek prognostik kanker kepala leher dari segi kualitas hidup untuk mengetahui apakah PNI dapat memprediksi aspek kualitas hidup dengan lebih rinci.

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Quality and quantity of protein intake has not been well understood that it can affect quality of life. Moreover, Prognostic Nutritional Index (PNI) also has not been well studied upon its usage to reflect quality of life of head and neck cancer patients undergoing radiotherapy. This cross sectional study was aimed to determine the correlation between protein intake and PNI and also the correlation between PNI and quality of life in head and neck cancer patients undergoing radiotherapy at Radiotherapy Department, dr. Cipto Mangunkusumo General Hospital, Jakarta. Total of 61 subjects were recruited with consecutive sampling method with mean age of 46,3 ± 12,4 years old and 65,6% subjects were on stage IV cancer and were getting a combination of chemo and radiotherapy. Only 32,8% subjects were on low nutritional status. Median of total protein intake was 1,42 (0,26-4,11) g/kg/day. Median of PNI was 45,9 (29,4-54,2) among subjects. The result of the study showed a significant correlations between quanitity of protein intake based on semiquantitative Food Frequency Questionnaire (FFQ) with several aspects of quality of life, that were pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37; p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). This aspects were all symptomatics. PNI was significantly correlated with 1 functional aspect, which was Physical function (r=0.378; p=0,003) and 2 symptomp aspects, which were opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Although not statistically significant, but there were positive direction of correlation with other functional aspects and negative direction of correlation with other symptomps aspects. This implicates that the higher the PNI, the lower the symptoms and the better the functional status of head and neck cancer patients undergoing radiotherapy. This study did not show a significant correlation between quality and quantity of protein intake with PNI. An adequate intake of calorie and protein in most subjects were found in this study which might explain the result. More studies, preferably prospective one, may be needed to show the usage of PNI to reflect quality of life, especially involving quality of life progresivity."

"Kadar CRP serum dapat digunakan sebagai prediktor penurunan berat badan dan indikator prognostik inflamasi. Penelitian ini dilakukan untuk mengetahui korelasi kadar CRP serum dengan penurunan berat badan dan mukositis oral pada pasien kanker kepala leher yang menjalani radioterapi. Penelitian ini adalah penelitian observasional dengan desain potong lintang pada pasien kanker kepala leher yang telah menjalani terapi radiasi minimal 25 kali di Departeman Radioterapi RSUPNCM Jakarta dengan usia ge;18 ndash;65 tahun. Hasil penelitian menunjukkan bahwa sebagian besar subyek 71,2 memiliki kadar CRP serum normal, mengalami penurunan berat badan ge;5 dalam waktu sebulan 76,9 dengan rerata penurunan berat badan -9,42 7,76 , dan juga mengalami mukositis oral 65,4 dengan persentase terbanyak yaitu derajat 1 59,6 . Tidak terdapat mukositis oral derajat 3 dan 4. Tidak terdapat korelasi antara kadar CRP serum dengan penurunan berat r=0,166; p=0,239 , dan mukositis oral r=0,137; p=0,331 . Kesimpulan adalah kadar CRP serum saat radioterapi tidak memengaruhi penurunan berat badan dan mukositis oral. Sebagian besar subyek tetap mengalami penurunan berat badan selama menjalani radioterapi sehingga pemasangan NGT yang lebih awal yaitu sebelum terapi radiasi dimulai NGT profilaksis perlu dilakukan, namun hal ini membutuhkan penelitian lebih lanjut.

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Serum CRP levels can be used as a predictor of weight loss and prognostic indicator of inflammation. This study was conducted to determine the correlation of serum CRP levels with weight loss and oral mucositis in patients with head and neck cancer undergoing radiotherapy. This study was an observational study in the head and neck cancer patients who have undergone radiation therapy at least 25 times at the Department of Radiotherapy RSUPNCM Jakarta with aged ge 18 ndash 65 years old. Our study results showed that most of the subjects 71,2 had normal serum CRP levels, weight loss of ge 5 in one month 76,9 , and also experienced oral mucositis 65,4 . Mostly had grade 1 oral mucositis 59,6 . There were no grade 3 and 4 oral mucositis.There were no correlation between serum CRP levels with weight loss r 0,166 p 0,239 , and oral mucositis r 0,137 p 0.331 . In conclusion, serum CRP levels did not influence weight loss and oral mucositis in patients with head and neck cancer undergoing radiotherapy. Most of the subjects still experienced weight loss during radiotherapy. Therefore, NGT prophylaxis is needed, but this requires further study."

"Albumin serum, berat badan dan kekuatan genggaman merupakan parameter penilaian status gizi yang berhubungan dengan kadar protein tubuh. Penelitian ini dilakukan untuk mengetahui korelasi antara kadar albumin serum terhadap persentase penurunan berat badan dan kekuatan genggaman. Penelitian dengan desain potong lintang pada pasien kanker kepala leher dengan usia ≥18–65 tahun yang telah menjalani radiasi ≥25 kali di Departemen Radioterapi RSUPNCM. Hasil penelitian menunjukkan sekitar 55,76% subjek memiliki kadar albumin <3,4 g/dL. Rerata penurunan berat badan selama radiasi – 9,42 ± 7,76%, dengan 79,6% subyek mengalami penurunan berat badan ≥5%. Rerata kekuatan genggaman tangan dominan 39,48 ± 9,15 kg. Tidak terdapat korelasi antara kadar albumin serum dengan persentase penurunan berat badan (r = - 0,129; p = 0,364) dan kekuatan genggaman tangan (r = 0,048; p = 0,733). Kesimpulan, kadar albumin serum tidak memengaruhi penurunan berat badan dan kekuatan genggaman selama radiasi. Sangat penting untuk mempertahankan status gizi selama menjalani radioterapi salah satunya dengan pemakaian NGT di awal radiasi. Diperlukan penelitian lebih lanjut dengan desain kohort prospektif untuk mendapatkan data yang lebih konklusif.

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Serum albumin, body weight and hand grip strength is a parameter of assessment of nutritional status related to body protein. This study was conducted to determine the correlation between serum albumin levels with the percentage of weight loss and hand grip strength. A cross sectional study design in the head neck cancer patients with ge 18 65 years of age who have undergone radiation at least 25 times in the Department of Radiotherapy RSUPNCM. The results showed approximately 55,76 of the subjects had levels of albumin below 3,4 g dL. Mean weight loss during radiation ndash 9,42 7,76 , with 79,6 of subjects experienced weight loss ge 5 . Mean dominant hand grip strength 39,48 9,15 kg. There is no correlation between serum albumin levels with percentage of body weight loss r 0,129 p 0,364 and hand grip strength r 0,048 p 0,733 . Conclussion, serum albumin levels did not affect body weight loss and handgrip strength during radiation. It is essential for head and neck cancer patients undergoing radiotherapy to maintain nutritional status with NGT in the initial radiation. Further research with prospective cohort design is needed to obtain more conclusive data. Keywords Serum albumin, weight loss percentage, handgrip strength, head and neck cancer, radiotherapy "

"Penelitian ini merupakan penelitian potong lintang di Departemen Radioterapi Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Jakarta, yang bertujuan untuk mengetahui korelasi antara kadar asam lemak omega-3 terhadap massa otot dan kekuatan genggam pada subjek kanker kepala leher yang mendapatkan radioterapi. Kaheksia kanker sering terjadi pada kanker kepala leher akibat peningkatan sitokin proinflamasi yang menyebabkan hipermetabolisme, peningkatan kebutuhan nutrisi, anoreksia, penurunan massa otot dan berat badan. Asam lemak omega-3 berperan dalam menurunkan inflamasi, meningkatkan massa otot, dan kekuatan genggam. Dari 52 subjek yang sudah mendapatkan radioterapi ge;25 kali, 57 adalah laki-laki dengan rerata usia di atas 50 tahun. Lokasi kanker paling banyak di area nasofaring, sebagian besar sudah berada pada stadium IV dan mendapatkan kombinasi radioterapi dan kemoterapi. Sebesar 38,5 dan 32,7 subjek berada pada kategori indeks massa tubuh normal dan kurang. Data yang diperoleh dari penelitian ini dapat memberikan gambaran kurangnya asupan energi, protein, lemak, dan asam lemak omega-3, serta massa otot sebagian besar subjek yang tergolong kecil 28,4 4,7 , dengan kekuatan genggam sebagian besar subjek tergolong normal, dan kadar asam lemak omega-3 plasma seluruh subjek yang tergolong rendah 2,5 0,8 . Data tersebut menunjukkan adanya masalah nutrisi pada pasien kanker kepala leher. Terdapat korelasi yang kuat antara kadar asam lemak omega-3 plasma terhadap massa otot r =0,6, p 50?60 Gy dan 50 Gy.

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This cross sectional study conducted in the Department of Radiotherapy Dr. Cipto Mangunkusumo Hospital, aimed to investigate the correlation between omega 3 fatty acids plasma levels with muscle mass and hand grip muscle strength in subjects with head and neck cancer undergoing radiotherapy. Cancer cachexia is common in head and neck cancer as a result of the increasing of proinflammatory cytokines that cause hipermetabolisme, increased nutritional needs, anorexia, decreased muscle mass and body weight. Omega 3 fatty acids play a role in reducing inflammation, as well as improving muscle mass and hand grip. There were 52 subjects who had received radiotherapy ge 25 times, 57 were male with a mean age of 50 years. Most cancer sites were at nasopharynx area, mostly in stage IV and received a combination of radiotherapy and chemotherapy. There were 38,5 of the subjects in the normal body mass index and 32,7 were in low body mass index. The data from this study showed inadequate intake of energy, protein, fat, and omega 3 fatty acids, as well as muscle mass majority was small 28,4 4,7 , with most of the hand grip classified as normal, and the plasma levels of omega 3 fatty acids all of the subjects were low 2,5 0,8 . The data showed that there were nutritional problems in patients with head and neck cancer. There was strong correlation of plasma levels of omega 3 fatty acids with muscle mass r 0,8, p 50 60 Gy and 50 Gy. "

"Glutamin merupakan asam amino yang berperan penting dalam menjaga homeostasis dari fungsi sel tertentu, di antaranya adalah proliferasi sel limfosit. Penurunan kadar glutamin plasma terjadi pada hewan coba dengan kanker, yang berdampak pada peningkatan kerentanan terhadap infeksi. Beberapa penelitian melaporkan bahwa suplementasi glutamin dapat mencegah terjadinya mukositis oral akibat radiasi, sehingga dapat meningkatkan kualitas hidup pasien kanker kepala leher dengan radioterapi. Penelitian dengan desain potong lintang ini dilakukan di Departemen Radioterapi RSUPN dr. Cipto Mangunkusumo, Jakarta, yang bertujuan untuk mengetahui korelasi antara kadar glutamin plasma terhadap total lymphocyte count TLC dan kualitas hidup pada pasien kanker kepala leher dengan radioterapi. Dari total 52 subjek yang mengikuti penelitian ini, didapatkan median usia 50,50 18-62 tahun dan 63,46 adalah subjek laki-laki. Nasofaring merupakan lokasi kanker tersering. Sekitar 70 subjek berada pada stadium IV dan mendapatkan kombinasi radioterapi dan kemoterapi. Status gizi sebagian besar subjek masih tergolong normal. Hasil penelitian ini menunjukkan bahwa tidak ada korelasi antara kadar glutamin plasma terhadap TLC dan kualitas hidup pada pasien kanker kepala leher dengan radioterapi. Meskipun demikian, beberapa data dalam penelitian ini dapat memberikan gambaran mengenai adanya masalah nutrisi yang dialami pasien kanker kepala leher dengan radioterapi. Data tersebut antara lain lebih dari 60 subjek memiliki asupan kalori dan protein harian yang kurang, kemudian didapatkan juga kadar glutamin plasma semua subjek yang sangat rendah, dengan rerata 7,77 3,32 ?mol/l. Beberapa faktor yang diduga menjadi penyebab terjadinya hal tersebut adalah proses penyakit kanker, lokasi pertumbuhan kanker, efek samping terapi, serta kebutuhan yang sangat tinggi akan glutamin untuk fungsi fisiologis tubuh.

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Glutamin is an amino acid that plays an important role in maintaining the homeostasis of many cells, including the proliferation of lymphocytes. A decrease in plasma glutamine level was observed in rats with cancer, which could increase the susceptibility to infection. Several studies showed that glutamine supplementation could prevent oral mucositis induced by radiation, so this could increase the quality of life of head and neck cancer patients receiving radiotherapy. This cross sectional study conducted at Radiotherapy Department, RSUPN dr. Cipto Mangunkusumo, Jakarta, aimed to investigate the correlations of plasma glutamin level with total lymphocyte count TLC and quality of life in head and neck cancer patients receiving radiotherapy. A total of 52 subjects participated in this study, with median age 50,50 18 62 years old and 63,46 subjects were male. Nasopharynx was the most common site affected. About 70 subjects were at stage IV cancer and receiving a combination of radiotherapy and chemotherapy. Most of the subjects had a normal nutritional status according to body mass index BMI.

The results of this study showed no correlations of plasma glutamine level with TLC and quality of life in head and neck cancer patients receiving radiotherapy. However, data from this study revealed nutritional problems that happened in head and neck cancer patients receiving radiotherapy. These data include more than 60 of subjects had below normal limit daily calorie and protein intakes, and the plasma glutamine level of all subjects was very low, with mean 7,77 3,32 mol l. Several factors predicted to be the cause of these problems are the process of the disease, cancer growth location, side effects of therapy, as well as a high need of glutamine for physiological functions of the body. "

"Latar belakang: Pasien kanker kepala leher (KKL) yang mendapatkan kemoradiasi berisiko mengalami malnutrisi dan meningkat hingga 88 % saat akhir kemoradiasi. Efek samping kemoradiasi berupa xerostomia, mukositis, mual atau muntah menambah penurunan status nutrisi dan kapasitas fungsional. Monitoring status nutrisi melalui penilaian berat badan (BB) dan kekuatan genggam tangan (KGT) sebagai cara sederhana dan minimal invasif dibandingkan alat pemeriksaan lain seperti pengukur komposisi tubuh dan Dual Energy X-Ray Absorptiometry (DEXA). Belum diketahui frekuensi kunjungan optimal ke poli gizi selama menjalani kemoradiasi. Metode: Penelitian ini menggunakan metode potong lintang, dilakukan di Radioterapi RSCM (IPTOR RSUPNCM).Penelitian ini bertujuan melihat korelasi frekuensi kunjungan pasien KKL yang menjalani kemoradiasi terhadap BB dan KGT, dengan kriteria inklusi adalah pasien KKL dewasa, usia 19 hingga 59 tahun, yang menjalani kemoradiasi pada 10 fraksi terakhir, dan bersedia masuk dalam penelitian. Pengukuran BB menggunakan timbangan merk Omron® Karada-HBF-375, kekuatan genggam tangan menggunakan Jamar® handgrip pada tangan kanan dominan subjek. Hasil: Rerata BB 55,65±12,34 kg, rerata KGT 29,24±10,74 kg, dan rerata frekuensi 1 kali. Rerata asupan energi 1225,96±501,22 kkal, protein median 41 g, rerata lemak 33,5±18,8g dan KH 182,2±78,3g. Korelasi antara frekuensi kunjungan terhadap BB (r= 0,61, p= 0,66) dan KGT (r=0,06, p= 0,64). Kesimpulan: Tidak terdapat korelasi antara frekuensi kunjungan terhadap BB dan KGT.

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Background: Head and neck cancer patients who get chemoradiated are at risk of malnutrition and an increase in malnutrition of up to 88% at the end of chemoradiation. Side effects of chemoradiation in the form of xerostomia, mucositis, nausea or vomiting add to the decrease : Luana Lidwina in nutritional status and functional capacity. Monitoring nutritional status, one of which is carried out by assessing body weight (BW) and hand-holding strength (HGS). BW and HGS assessments are a simple and minimally invasive way for people with head and neck cancer (HNC) compared to other examination tools such as body composition measuring devices, Dual Energy X-Ray Absorptiometry (DEXA), and require high costs. It is not yet known the frequency of optimal visits of HNC patients to the nutrition poly during the moradiation period.

Methods: This study used the cross section method, conducted in RSCM Radiotherapy (IPTOR RSUPNCM). This study aims to see a correlation between the frequency of visits by HNC patients undergoing morbidity to BW and HGS. Subjects included as inclusion criteria were adult HNC patients, ages 19 to 59, who underwent chemoradiation in the last 10 fractions, and were willing to enter the study to be taken. BW measurements using omron® Karada- HBF-375 brand scales, hand grip strength using Jamar® handgrip on the dominant right hand of the subject.

Result: The weight of the subjects had an average of 55.6 5±12.34 kg, HGS had an average of 29.24±10.74 kg, and an average frequency of 1 time. Average energy intake 1225.96±501.22 kcal, median protein 41 g, average fat 33.5±18.8g and KH 182.2±78.3g. Correlation between the frequency of visits to BW (r= 0.61, p= 0.66) and HGS (r=0.06, p= 0.64).

Conclusion: There was no correlation between the frequency of visits to BB and KGT."

"Pasien kanker kepala-leher berisiko tinggi mengalami malnutrisi disebabkan oleh perubahan metabolisme, lokasi tumor, serta gejala toksisitas akut akibat kemoradiasi. Terapi medik gizi secara dini sejak pasien terdiagnosis kanker untuk mencapai asupan energi dan protein yang adekuat, didukung asupan branched-chain amino acid (BCAA) dan eicosapentaenoic acid (EPA) sesuai target, serta aktivitas fisik dapat menjaga massa otot dan status gizi pasien. Acute kidney injury (AKI) merupakan efek toksisitas obat kemoterapi berbasis platinum yang sering dialami pasien. Kondisi tersebut dapat menghambat optimalisasi pemberian nutrisi khususnya protein pada pasien kanker. Tiga dari empat pasien serial kasus sudah mengalami penurunan berat badan drastis, juga pre-kaheksia atau kaheksia sebelum mendapat terapi medik gizi. Selama menjalani kemoradiasi, asupan keempat pasien mengalami penurunan akibat gejala toksisitas akut yang semakin memberat mulai minggu ke-2 radiasi, sehingga tiga dari empat pasien tidak dapat mencapai target asupan energi dan protein pada sebagian besar pemantauan, dengan kisaran antara 6–41 kkal/kgBB/hari dan 0,3–1,6 g/kgBB/hari. Pemberian oral nutrition supplements (ONS) dan nutrisi enteral melalui nasogastric tube (NGT) membantu pemenuhan makronutrien, mikronutrien, serta nutrien spesifik. Berbagai studi menyatakan bahwa pasien yang mendapat terapi medik gizi disertai konseling nutrisi rutin mengalami penurunan berat badan lebih sedikit selama menjalani kemoradiasi. Keempat pasien serial kasus ini mengalami penurunan berat badan >10% selama menjalani kemoradiasi, terutama dari penurunan massa otot. Pasien juga mengalami penurunan kapasitas fungsional dan kualitas hidup. Dua orang pasien yang mendapat terapi medik gizi sejak sebelum kemoradiasi disertai asupan nutrien spesifik sesuai target, dengan rentang asupan BCAA 3,5–16,2 g/hari dan EPA 1–1,38 g/hari, mengalami penurunan berat badan dan kualitas hidup relatif lebih sedikit dibanding dua pasien lainnya. Dibutuhkan asupan energi ≥30 kkal/hari dan asupan protein ≥1,2 g/hari disertai peningkatan aktivitas fisik untuk mempertahankan atau meningkatkan massa otot. Penurunan asupan masih dapat terjadi hingga beberapa minggu pascakemoradiasi, sehingga pemberian terapi medik gizi juga harus dilanjutkan setelah terapi kanker selesai.

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Patients with head and neck cancer are at risk of malnutrition as a result of the metabolic alteration, site of their cancer, also acute toxicity following chemoradiation therapy. Early nutrition intervention consisted of adequate energy, protein, BCAA, and EPA intake, including physical activity initiated immediately after diagnosis was made, may maintain skeletal muscle mass and nutritional status. Platinum-based chemotherapy drug-induced nephrotoxicity can hinder the optimization of protein intake in cancer patients. Three out of four patients in this case series had experienced severe weight loss, also pre-cachexia and cachexia before initiation of nutrition intervention. Energy and protein intake of three patients remained insufficient until the end of chemoradiation therapy, ranged from 6–41 kcal/kg/day and 0,3–1,6 g/kg/day. These inadequacies were mainly caused by acute radiation toxicities that worsen as radiation went on. Oral nutrition supplements and enteral tube feeding may help to achieve adequate macronutrient, micronutrient, and specific nutrient intake. A number of studies demonstrated that regular dietary counseling during chemoradiation was associated with less weight loss. All patients in this case series suffered from weight loss >10%, mainly from skeletal muscle loss. Functional status and quality of life during chemoradiation therapy were also reduced. Better quality of life and less weight loss were seen in two patients who received early nutrition intervention and reached the daily intake target of specific nutrient, ranged from 3,5–16,2 g/day for BCAA and 1–1,38 g/day for EPA. Energy intake ≥30 kcal/day and protein intake ≥1,2 g/day combined with increased physical activity are needed to maintain or increase muscle mass. Side effects of radiation can last for months after treatment; therefore, nutrition intervention should be continued to maintain good nutrition after radiation therapy."

"Gen P53 atau TP53 merupakan gen yang memicu pembentukan protein tumor p53 yang berfungsi sebagai tumor suppressor. Polimorfisme genetik p53 berpengaruh terhadap erjadinya kanker kepala dan leher (KKL). Penelitian ini bertujuan untuk mengidentifikasi keterkaitan antara polimorfisme gen p53 dengan kanker kepala dan leher di Indonesia. Analisis dengan PCR-RFLP (enzim BstUI) pada 50 sampel penderita KKL dan 50 sampel non KKL untuk melihat polimorfisme gen p53. Persentase distribusi genotip polimorfisme P53 pada sampel KKL sebesar 70% dan pada sampel non KKL sebesar 58%. Terdapat perbedaan bermakna pada distribusi genotip polimorfisme gen p53 antara penderita KKL dengan non KKL (p value = 0.004).

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The gene P53 or TP53 is a gene that targets the formation of p53 tumor protein that functions as a tumor suppressor. Genetic polymorphism of p53 gene has been associated with the development of head and neck cancer. This study aims to identify the relationship between p53 gene polymorphism with head and neck cancer in Indonesia. Analysis with PCR-RFLP (BstUI enzyme) in 50 samples of head and neck cancer patients and 50 control samples to see p53 gene polymorphism. The percentage of polymorphic genotype in HNC samples is 70% and in non HNC is 58%. There are significant differences in the genotype distribution of p53 gene polymorphisms between HNC patients and non-HNC patients (p value = 0.004)."