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"Pendahuluan : Radioterapi stereotaktik adalah suatu bentuk terapi radiasi yang membutuhkan akurasi tinggi. Selain imobilisasi yang baik, dibutuhkan verifikasi untuk memastikan akurasi dan untuk mengetahui kesalahan sistematik dan acak dalam pemberian radiasi. Margin Planning Target Volume (PTV) dibuat untuk memastikan target radiasi mendapatkan cakupan dosis radiasi yang diinginkan.Metode penelitian : Penelitian ini merupakan studi retrospektif yang menggunakan data verifikasi dengan X-ray Volumetric Imaging (XVI) dari 10 pasien yang menjalani radioterapi stereotaktik di Departemen Radioterapi Rumah Sakit Cipto Mangunkusumo (RSCM) dengan fiksasi bite-block antara bulan Januari 2013 sampai dengan Oktober 2013. Penyimpangan yang didapat digunakan untuk menghitung kesalahan sistematik dan kesalahan acak. Margin PTV didapat dengan memasukkan kesalahan sistematik dan kesalahan acak yang didapat ke dalam formulasi Stroom.Hasil : Sebanyak 42 hasil XVI dianalisa. Pada penelitian ini didapatkan besar kesalahan sistematik dan kesalahan acak pada pasien yang menjalani radioterapi stereotaktik di RSCM adalah sebesar 0.61 mm dan 1.27 mm untuk sumbu laterolateral, 1.13 mm dan 2.41 mm untuk sumbu kraniokaudal, serta 0.71 mm dan 0.15 mm untuk sumbu anteroposterior. Margin PTV yang diperoleh sebesar 2.11 mm, 3.95 mm dan 2.22 mm untuk masing-masing sumbu laterolateral, kraniokaudal dan anteroposterior.Kesimpulan : Hasil penelitian memberikan rekomendasi margin PTV yang dapat digunakan di Departemen Radioterapi RSCM. Terdapat margin PTV yang cukup besar untuk sumbu kraniokaudal. Diperlukan upaya tambahan untuk meningkatkan akurasi radiasi sehingga margin yang diberikan tidak terlalu besar.

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Introduction : Stereotactic radiotherapy is a technique to administer precisely directed irradiation that tightly conforms to a target volume. Beside immobilisation, verfication is needed to ensure the accuracy and to calculate the systematic and random error. Planning Target Volume (PTV) margin is delineated to ensure adequate target volume coverage.

Methods : This is a retrospective study using X-ray Volumetric Imaging (XVI) data of 10 patients who have had stereotactic radiotherapy with bite-block fixation between January 2013 and October 2013 in the Department of Radiotherapy in Cipto Mangunkusumo Hospital. The translation errors were used to calculate the systematic and random error. PTV margin was acquired by using these errors in Stroom formula.

Results : A total of 42 XVI were analyzed. Systematic and random errors were respectively 0.61 mm and 1.27 mm in laterolateral direction, 1.13 mm and 2.41 mm in craniocaudal direction, and 0.71 mm and 0.15 mm in anteroposterior direction. PTV margin were 2.11 mm, 3.95 mm and 2.22 mm in laterolateral, craniocaudal and anteroposterior direction respectively.

Conclusions : The result gave PTV margin recommendation that can be used in Department of Radiotherapy in Cipto Mangunkusumo Hospital. There was a quite large PTV margin in craniocaudal direction. Some efforts and evaluations are needed to improve the accuracy of stereotactic radiotherapy to reduce the PTV margin.

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"Pendahuluan : Radioterapi pada kanker kepala dan leher menggunakan teknik Three-dimensional Conformal Radiotherapy (3DCRT) atau Intensity-modulated Radiotherapy (IMRT) membutuhkan akurasi yang tinggi dalam pelaksanaannya. Upaya ini dilakukan dengan mengetahui kesalahan set-up melalui proses verifikasi yang disesuaikan dengan beban kerja setiap unit radioterapi. Dengan demikian dapat diterapkan margin CTV-ke-PTV yang ideal untuk mendapatkan dosis yang adekuat pada area target radiasi. Metode penelitian : Penelitian ini merupakan studi potong lintang yang mengambil data verifikasi menggunakan Cone Beam Computed Tomography (CBCT) dari 9 pasien kanker kepala dan leher yang mendapatkan radioterapi dengan teknik 3DCRT/IMRT di Departemen Radioterapi Rumah Sakit Cipto Mangunkusumo (RSCM) antara bulan Oktober 2013 hingga Desember 2013. Pergeseran pada lapangan radiasi yang didapatkan dari hasil verifikasi dalam lima fraksi awal dianalisis untuk memperoleh kesalahan sistematik dan kesalahan acak, yang selanjutnya dihitung untuk mendapatkan margin CTV-ke-PTV. Hasil : Sebanyak 135 data verifikasi CBCT dianalisa. Besar kesalahan sistematik dan kesalahan acak yang didapatkan berturut-turut sebesar 1.5 mm dan 2.7 mm pada sumbu laterolateral, 2.2 mm dan 3.1 mm pada sumbu kraniokaudal, serta 2.2 mm dan 1.9 mm untuk sumbu anteroposterior. Margin CTV-ke-PTV yang diperoleh sebesar 4.9 mm, 6.6 mm dan 5.8 mm untuk masing-masing sumbu laterolateral, kraniokaudal dan anteroposterior. Kesimpulan : Verifikasi menggunakan CBCT dalam lima fraksi awal merupakan metode yang efektif untuk deteksi dan koreksi kesalahan set-up. Hasil penelitian dapat digunakan sebagai rekomendasi pemberian margin CTV-ke-PTV dan menunjukkan pemberian margin sebesar 5 mm sudah cukup adekuat dalam pelaksanaan radioterapi kanker kepala dan leher dengan teknik 3DCRT/IMRT di Departemen Radioterapi RSCM. Diperlukan upaya tambahan untuk meningkatkan koreksi kesalahan set-up dengan memperhitungkan beban kerja unit radioterapi.

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Introduction : Three-dimensional Conformal Radiotherapy (3DCRT) or Intensity Modulated Radiotherapy (IMRT) for head and neck cancer is a highly accurate procedure. Verification is needed to detect and correct set-up errors, adjusted according to workload of each radiotherapy center. Therefore, an ideal CTV-to-PTV margin can be applied to ensure adequate target volume coverage.

Methods : This is a cross-sectional study using Cone Beam Computed Tomography (CBCT) verification data of 9 head and neck cancer patients treated with 3DCRT/IMRT in Department of Radiotherapy, Cipto Mangunkusumo Hospital between October 2013 and December 2013. Translation errors from the first five fractions were analyzed to count for systematic and random errors. These errors were then calculated to acquire CTV-to-PTV margin.

Results : A total of 135 CBCT data were analyzed. Systematic and random errors were respectively 1.5 mm and 2.7 mm in laterolateral direction, 2.2 mm and 3.1 mm in craniocaudal direction, and 2.2 mm and 1.9 mm in anteroposterior direction. CTV-to-PTV margin were 4.9 mm, 6.6 mm and 5.8 mm in laterolateral, craniocaudal and anteroposterior direction, respectively.

Conclusions : CBCT verification in first five fractions was effective in detecting and correcting set-up errors. The calculated CTV-to-PTV margin can be used as recommended margin and showed that 5 mm margin was adequate in planning 3DCRT/IMRT technique for head and neck cancer in Department of Radiotherapy, Cipto Mangunkusumo Hospital. An extra effort might be done to improve the correction of set-up errors adjusted to workload."

"ABSTRAK. Imobilisasi pasien merupakan unsur yang penting untuk keakuratan geometri pada teknik radiasi stereotaktik. Terapi radiasi stereotaktik merupakan salah satu layanan unggulan, namun masih terbatasnya data perbedaan imobilisasi/akurasi pasien yang menggunakan G frame dan double mask. Metode. Penelitian ini merupakan studi komparatif cross sectional untuk mengetahui perbandingan pergeseran geometri pada verifikasi antara G frame dan double mask pada terapi radiasi dengan teknik stereotaktik. Penelitian dilakukan pada bulan Februari ndash; Maret 2016 di Departemen Radioterapi RSCM dengan pengambilan subjek menggunakan metode retrospektif konsekutif. Variabel yang dinilai adalah nilai pergeseran geometris pada proses verifikasi stereotactic radiosurgery yang menggunakan G frame dan stereotaktik radioterapi yang menggunakan double mask. Analisis yang digunakan untuk melihat perbandingan pergeseran geometri pada verifikasi antara G frame dan double mask adalah T-test. Hasil. Angka rerata pergeseran geometri pada pasien radioterapi stereotaktik dengan menggunakan imobilisasi Double mask untuk sumbu laterolateral sebesar 0,4 0,3 mm untuk sumbu kraniokaudal 0,5 0,4 mm dan sumbu anteroposterior 0,5 0,4 mm dan imobilisasi G. frame untuk laterolateral 0,3 0,2 mm, untuk kraniokaudal 0,3 0,4 mm dan untuk anteroposterior 0,4 0,3 mm. Kesimpulan. Tidak terdapat perbedaan yang signifikan rerata pergeseran geometri antara imobilisasi double mask dengan G frame sebagai baku emas.

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ABSTRACTIntroduction. Patient immobilization is an important element for geometric accuracy in stereotactic radiation techniques. Stereotactic radiation therapy is one of the superior services, but the data about the immobilization accuracy difference between using G frame and double mask is still limited.Materi and Method. This comparative cross sectional study to compare the geometrical errors during verification between radiation therapy using G frame and double mask with stereotactic technique, was conducted in February March 2016 in the Department of Radiotherapy RSCM. The subjects using the retrospective method consecutively. The variables assessed were the geometrical errors on verification process of stereotactic radiosurgery using G frame and stereotactic radiotherapy using a double mask. The analysis using to compare the geometrical errors on verification between G frame and double mask is T test.Results. The mean values of geometrical error stereotactic radiotherapy using Double mask immobilization axis 0.4 0.3 mm on laterolateral, 0.5 0.4 mm on craniocaudal axis and 0.5 0.4 mm on anteroposterior. As for G frame immobilization 0.3 0.2 mm on laterolateral axis, 0.3 0.4 mm on craniocaudal axis and to 0.4 0.3 mm anteroposterior axis.Conclusion. There were no significant difference of geometrical error mean values between the double mask with G frame immobilizations as the gold standard. "

"Pendahuluan : Radioterapi stereotaktik adalah suatu bentuk terapi radiasi yang membutuhkan akurasi tinggi. Selain imobilisasi yang baik, dibutuhkan verifikasi untuk memastikan akurasi dan untuk mengetahui kesalahan sistematik dan acak dalam pemberian radiasi. Margin Planning Target Volume (PTV) dibuat untuk memastikan target radiasi mendapatkan cakupan dosis radiasi yang diinginkan. Metode penelitian : Penelitian ini merupakan studi retrospektif yang menggunakan data verifikasi dengan X-ray Volumetric Imaging (XVI) dari 10 pasien yang menjalani radioterapi stereotaktik di Departemen Radioterapi Rumah Sakit Cipto Mangunkusumo (RSCM) dengan fiksasi bite-block antara bulan Januari 2013 sampai dengan Oktober 2013. Penyimpangan yang didapat digunakan untuk menghitung kesalahan sistematik dan kesalahan acak. Margin PTV didapat dengan memasukkan kesalahan sistematik dan kesalahan acak yang didapat ke dalam formulasi Stroom. Hasil : Sebanyak 42 hasil XVI dianalisa. Pada penelitian ini didapatkan besar kesalahan sistematik dan kesalahan acak pada pasien yang menjalani radioterapi stereotaktik di RSCM adalah sebesar 0.61 mm dan 1.27 mm untuk sumbu laterolateral, 1.13 mm dan 2.41 mm untuk sumbu kraniokaudal, serta 0.71 mm dan 0.15 mm untuk sumbu anteroposterior. Margin PTV yang diperoleh sebesar 2.11 mm, 3.95 mm dan 2.22 mm untuk masing-masing sumbu laterolateral, kraniokaudal dan anteroposterior. Kesimpulan : Hasil penelitian memberikan rekomendasi margin PTV yang dapat digunakan di Departemen Radioterapi RSCM. Terdapat margin PTV yang cukup besar untuk sumbu kraniokaudal. Diperlukan upaya tambahan untuk meningkatkan akurasi radiasi sehingga margin yang diberikan tidak terlalu besar.

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Introduction : Stereotactic radiotherapy is a technique to administer precisely directed irradiation that tightly conforms to a target volume. Beside immobilisation, verfication is needed to ensure the accuracy and to calculate the systematic and random error. Planning Target Volume (PTV) margin is delineated to ensure adequate target volume coverage.

Methods : This is a retrospective study using X-ray Volumetric Imaging (XVI) data of 10 patients who have had stereotactic radiotherapy with bite-block fixation between January 2013 and October 2013 in the Department of Radiotherapy in Cipto Mangunkusumo Hospital. The translation errors were used to calculate the systematic and random error. PTV margin was acquired by using these errors in Stroom formula.

Results : A total of 42 XVI were analyzed. Systematic and random errors were respectively 0.61 mm and 1.27 mm in laterolateral direction, 1.13 mm and 2.41 mm in craniocaudal direction, and 0.71 mm and 0.15 mm in anteroposterior direction. PTV margin were 2.11 mm, 3.95 mm and 2.22 mm in laterolateral, craniocaudal and anteroposterior direction respectively.

Conclusions : The result gave PTV margin recommendation that can be used in Department of Radiotherapy in Cipto Mangunkusumo Hospital. There was a quite large PTV margin in craniocaudal direction. Some efforts and evaluations are needed to improve the accuracy of stereotactic radiotherapy to reduce the PTV margin."

"[Tujuan: Untuk mengetahui profil pasien kanker rektum di Departemen Radioterapi RSCM. Metode: Dilakukan penelitian restrospektif deskriptif analitik terhadap 144 pasien kankerrektum yang menjalani radiasi di Departemen Radioterapi RSCM periode Januari 2009Januari2014, dilihat karakteristik pasien dan tumor. Respons radiasi dinilai menggunakanmetode RECIST 1.1. Hubungan antara OTT dan DTT dengan respons radiasi dinilai dengankorelasi Spearman dan analisis kesintasan dihitung dengan kurva Kaplan Meier. Hasil: Pasien laki-laki sebesar 65.9%, median usia 53 (23-81) tahun dengan mayoritas beradapada kelompok usia 50-59 tahun. Tipe histopatologi terbanyak adalah adenokarsinoma(88.8%) dan pasien paling banyak datang dengan stadium IIIB (25.0%). Kemoradiasidilakukan pada 29.8% pasien, dengan toksisitas radiasi akut terbanyak adalah pada kulit(derajat I) sebesar 20.1%. Respons radiasi yang dinilai dengan metode RECIST 1.1menunjukkan respons terbanyak adalah stabil (71.4%). Tidak ditemukan korelasi antara OTTdan DTT dengan respons radiasi. Dari 118 pasien, didapatkan analisis kesintasan keseluruhan3 dan 5 tahun masing-masing adalah 65% dan 45% dengan median survival 59 bulan. Padakelompok pasien yang menjalani radiasi panjang, analisis kesintasan keseluruhan 3 dan 5tahun masing-masing adalah masing-masing 91% dan 78%. Kesimpulan: Karakteristik pasien rektum di Departemen Radioterapi RSCM yang berbedadengan berbagai studi sebelumnya hanya usia. Respons radiasi yang paling banyak dijumpai adalah stabil. Tidak ditemukan korelasi antara OTT dan DTT dengan respons radiasi.;Purpose: To obtain the profile of rectal cancer patients in Department of Radiotherapy, National General Hospital of Cipto Mangunkusumo.Method: A restrospective study was conducted over 144 rectal cancer patients undergone radiation therapy in Department of Radiotherapy, National General Hospital of CiptoMangunkusumo during period of January 2009 to January 2014. The characteristics ofpatients and tumour were assessed. The radiation response was evaluated with the RECIST1.1 method. The correlation between OTT and DTT with radiation response was analyzedwith Spearman?s correlation and the survival analysis was determined using Kaplan-Meiercurve. Result: The majority of patients were male (65.9%), with median age of 53 (23-81) years oldwhere most patients belonged to age group of 50-59 years old. The most frequenthistopathologic type found was adenocarcinoma (88.8%) with most patients were in stageIIIB (25.0%). Chemoradiation was performed in 29.8% of patients, and grade I skin toxicitywas the most frequent acute side effect of radiation found (20.1%). Radiation responseassessed with the RECIST 1.1 method showed stable disease as the mostly seen response(71.4%). There was no correlation found between OTT and DTT with radiation response.Overall survival from 118 patients for 3 and 5 years were 65% and 45%, respectively, withmedian survival of 59 months. In the group of patients underwent long-course radiotherapy,the overall survival for 3 and 5 years were 91% and 78%, respectively. Conclusion: The sole characteristic of rectal cancer patients in Department of Radiotherapy atCipto Mangunkusumo Hospital that is different from previous studies is the age group wheremost patients were in. Stable disease is the most frequent radiation response. There was no correlation found between OTT and DTT with radiation response., Purpose: To obtain the profile of rectal cancer patients in Department of Radiotherapy, National General Hospital of Cipto Mangunkusumo.Method: A restrospective study was conducted over 144 rectal cancer patients undergone radiation therapy in Department of Radiotherapy, National General Hospital of CiptoMangunkusumo during period of January 2009 to January 2014. The characteristics ofpatients and tumour were assessed. The radiation response was evaluated with the RECIST1.1 method. The correlation between OTT and DTT with radiation response was analyzedwith Spearman’s correlation and the survival analysis was determined using Kaplan-Meiercurve. Result: The majority of patients were male (65.9%), with median age of 53 (23-81) years oldwhere most patients belonged to age group of 50-59 years old. The most frequenthistopathologic type found was adenocarcinoma (88.8%) with most patients were in stageIIIB (25.0%). Chemoradiation was performed in 29.8% of patients, and grade I skin toxicitywas the most frequent acute side effect of radiation found (20.1%). Radiation responseassessed with the RECIST 1.1 method showed stable disease as the mostly seen response(71.4%). There was no correlation found between OTT and DTT with radiation response.Overall survival from 118 patients for 3 and 5 years were 65% and 45%, respectively, withmedian survival of 59 months. In the group of patients underwent long-course radiotherapy,the overall survival for 3 and 5 years were 91% and 78%, respectively. Conclusion: The sole characteristic of rectal cancer patients in Department of Radiotherapy atCipto Mangunkusumo Hospital that is different from previous studies is the age group wheremost patients were in. Stable disease is the most frequent radiation response. There was no correlation found between OTT and DTT with radiation response.]"

"ABSTRAK Peningkatan angka morbiditas dan mortalitas akibat penyakit kanker di Indonesia menunjukkan bahwa permasalahan kanker ini semakin besar dan kompleks Salah satunya adalah adanya keterlambatan pasien kanker untuk mendapatkan terapi definitif yang disebabkan oleh faktor faktor yang berasal dari pasien sendiri Penelitian ini merupakan studi analisis deskriptif menggunakan metode campuran kuantitatif dan kualitatif untuk mengetahui data insidens keterlambatan terapi karena keterlambatan pasien pada pasien kanker yang dirujuk ke Departemen Radioterapi RSUPN Dr Cipto Mangunkusmo pada bulan Mei Agustus 2015 serta mengevaluasi faktor faktor apa saja yang mempengaruhi keterlambatan pasien tersebut Terdapat 294 orang pasien yang diikutsertakan dalam penelitian ini setelah mendapatkan persetujuan tertulis Sebagian besar pasien 71 4 adalah perempuan dan 141 orang 48 bekerja sebagai ibu rumah tangga Rentang umur terbanyak adalah 36 50 tahun yaitu sebanyak 132 pasien 44 9 dan hampir seluruh pasien 91 8 telah menikah Keterlambatan terapi didapatkan pada 153 orang pasien 52 dan 67 orang di antaranya 43 8 memiliki riwayat pengobatan alternatif yang dilakukan dalam interval waktu setelah timbul keluhan pertama kali dan atau setelah pasien melakukan konsultasi medis pertama kali Analisis statistik menunjukkan adanya hubungan yang signifikan antara faktor usia p 0 047 pendidikan p 0 047 dan riwayat pengobatan alternatif p 0 0001 dengan keterlambatan terapi Adanya rasa takut untuk berobat secara medis atau menjalani tindakan medis menjadi alasan 51 orang pasien untuk memilih pengobatan alternatif Oleh karena itu diperlukan pengawasan dan evaluasi terhadap pengobatan alternatif terutama yang menyangkut kualitas efikasi dan keamanannya ABSTRACT Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety ;Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety ;Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety "

"Pasien kanker serviks berisiko tinggi mengalami malnutrisi. Asupan makanan yang tidak adekuat, peningkatan kebutuhan, penurunan aktivitas fisik dan hiperkatabolisme, mendorong terjadinya malnutrisi. Kondisi ini dapat terjadi selama sakit maupun pada saat pengobatan, yang dapat memengaruhi status gizi pasien. Prevalensi malnutrisi pada pasien kanker serviks sebesar 48−66% dan meningkat hingga 82% setelah mendapat terapi. Pasien kanker serviks, 25% mengalami cachexia dan 33−69% mengalami sarkopenia. Penurunan massa otot yang merupakan penyusun utama massa bebas lemak (MBL), secara negatif memengaruhi efektivitas terapi dan kelangsungan hidup pasien. Bioelectrical impedance analysis (BIA) adalah alat tervalidasi untuk mengukur MBL sebagai bagian dari diagnosis malnutrisi, namun tidak selalu tersedia di fasilitas kesehatan. Penelitian menunjukkan bahwa kekuatan genggam tangan (KGT) dapat dijadikan sebagai prediktor MBL. Pengukuran KGT dengan handheld dynamometers (HHD) yang relatif murah, valid, dan andal, masih jarang digunakan. Penelitian ini bertujuan untuk melihat hubungan antara KGT dan MBL pada pasien kanker serviks yang menjalani radioterapi di Poliklinik Radioterapi RSCM. Penelitian menggunakan desain potong lintang pada subjek usia 18−60 tahun. KGT dinilai menggunakan Jamar digital HHD. MBL dinilai menggunakan BIA single frequency Omron® HBF−375. Terdapat 54 subjek dengan median usia 49 tahun, mayoritas stadium III, tidak terdapat metastasis dan komorbid, dan mendapat radioterapi saja. Mayoritas subjek tergolong BB lebih, dengan rerata asupan energi 20,79 ± 6,70 kkal/kgBB/hari, median asupan protein 0,68 (0,05−1,87) g/kgBB/hari, dan rerata asupan lemak 31,22 ± 8,81% dari energi total. Mayoritas asupan energi, protein dan lemak tergolong kurang dibandingkan dengan rekomendasi ESPEN. Rerata KGT 23,54 ± 5,16 kg dan rerata MBL 36,40 ± 6,03 kg. Dilakukan uji korelasi antara KGT dan MBL. Terdapat korelasi positif yang cukup antara KGT dan MBL pada pasien kanker serviks yang menjalani radioterapi (r = 0,346, p = 0,010). KGT berkorelasi positif kuat dengan MBL (r = 0,601, p = 0,001) pada pasien kanker serviks yang hanya menjalani radioterapi (n=28). Pemeriksaan KGT kemungkinan dapat memprediksi MBL, sehingga dapat membantu diagnosis malnutrisi lebih dini dan mencegah luaran buruk pada pasien kanker serviks yang menjalani radioterapi, terutama di fasilitas kesehatan yang tidak tersedia BIA. Penelitian lebih lanjut diperlukan untuk mendapatkan formulasi dalam memprediksi MBL dari KGT.

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Cervical cancer patients are at high risk for malnutrition. Inadequate food intake, increased energy and protein requirements, decreased physical activity and hypercatabolism in cancer patients lead to malnutrition. This condition can occur during illness or during treatment, which can affect the nutritional status of the patient. The prevalence of malnutrition in cervical cancer patients was 48−66% and increased to 82% in patients receiving therapy. Patients with cervical cancer, 25% were cachectic and 33%–69% were sarcopenic. Loss of muscle mass, which are the main constituents of fat free mass (FFM), negatively impact therapeutic efficacy and survival in cervical cancer patients. Bioelectrical impedance analysis (BIA) is a validated tool for measuring FFM, as part of malnutrition, but it is not always available in health facilities. Research shows that hand grip strength (HGS) can be used as a predictor of FFM. HGS measurement with handheld dynamometers (HHD) which is relatively cheap, valid, and reliable, is still rarely used. This study aims to examine the relationship between HGS and FFM in cervical cancer patients undergoing radiotherapy at the Radiotherapy Outpatients Clinic of Dr. Cipto Mangunkusumo Hospital. The study used a cross-sectional design on subjects aged 18−60 years. HGS was assessed using a Jamar digital hand dynamometer. FFM was assessed using the BIA single frequency Omron® HBF−375. A total of 54 study subjects with a median age of 49 years, the majority were in stage III, had no metastases, received radiation therapy only, and had no comorbidities. Most of the subjects were classified as overweight and obes, with a mean of energy intake 20.79 ± 6.70 kcal/kgBW/day, a median of protein intake 0.68 (0.05−1.87) g/kgBW/day, and an average of fat intake 31.22 ± 8.81% of the total energy. The majority of the energy, protein and fat intakes were less than the ESPEN recommendations. The mean HGS in the subjects was 23.54 ± 5.16 kg and the mean FFM was 36.40 ± 6.03 kg. Correlation test was conducted between HGS and FFM. There was a moderately positive correlation between HGS and KGT in cervical cancer patients undergoing radiotherapy (r = 0.346, p = 0.010). HGS was strongly positive correlation with FFM (r = 0.601, p = 0.001) in cervical cancer patients undergoing radiotherapy only (n=28). HGS maybe able to predict FFM for early diagnose of malnutrition and prevent poor outcomes in cervical cancer patients undergoing radiotherapy, especially in health facilities where BIA isn’t available. Further research is needed to get a formulation in predicting FFM from HGS."

"Latar Belakang : Radiasi berperan sebagai salah satu modalitas penatalaksanaan perdarahan pada keganasan. Peranan radiasi sebagai hemostatiks sudah lama digunakan namun masih memerlukan studi lebih lanjut untuk mengevaluasi efektivitasnya, serta ilmu pengetahuan terbaru pada penggunaan parameter biologis dalam penilaiannya. Saat ini di Indonesia masih sedikit publikasi kepustakaan yang memfokuskan tentang radiasi hemostatiks. Penelitian ini bertujuan untuk mengetahui perubahan respon klinis perdarahan berdasarkan skala perdarahan WHO, mengetahui adanya perbedaan rerata kadar von Willebrand Factor (vWF) plasma antara sebelum dan sesudah radiasi, serta mengevaluasi adanya korelasi dari kadar vWF plasma dengan respon penghentian perdarahan menggunakan skala perdarahan WHO pada perdarahan tumor, sebelum dan sesudah diberikan radiasi hemostatiks.Metodologi : Studi ini menggunakan pre-post study design tanpa pembanding, dilakukan di Departemen Radioterapi RSCM pada pasien yang mengalami perdarahan akibat kanker yang mendapat terapi radiasi hemostatiks serta memenuhi kriteria inklusi sejak September 2013 sampai dengan Februari 2014. Pengambilan sampel darah untuk pemeriksaan vWF plasma dan penilaian klinis skala perdarahan WHO dilakukan sebelum dan sesudah radiasi hemostatiks.Hasil : Dari total 23 subyek terpilih, terdapat 2 pasien yang meninggal karena perdarahan. Nilai keberhasilan terapi radiasi hemostatiks yang dilakukan pada subyek adalah sebesar 91,3%. Radiasi hemostatiks mampu menurunkan skala perdarahan WHO dari median 3 menjadi median 1 sesudah radiasi dengan nilai p<0,001. Pemberian radiasi hemostatiks meningkatkan kadar vWF plasma secara bermakna dengan perbedaan rerata 12,38 IU/dL (SD 12,75 IU/dL), nilai p=0,001. Terdapat korelasi yang bermakna antara peningkatan kadar vWF plasma sebelum dan sesudah radiasi dengan penurunan skala perdarahan WHO, p=0,019 (R=-0,533).Kesimpulan : Radiasi hemostatiks terbukti efektif menghentikan perdarahan akibat kanker dan menjadi modalitas pilihan dalam tatalaksana perdarahan akibat kanker. Radiasi mampu menurunkan derajat perdarahan, serta meningkatkan kadar vWF plasma dan terbukti peningkatan vWF plasma berkorelasi bermakna dengan penurunan derajat perdarahan.

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Backgorund : Radiation is one of the modality to treat cancer bleeding. Hemostatics irradiation is already known while still need further investigation to evaluate its effectiveness, including its biological parameter. Von Willebrand Factor plasma is already known has major role as initiator of the platelets adhesion in hemostatics. Publication of references in hemostatics irradiation is still infrequent. This study aims to investigate the changes of clinical response based on WHO bleeding scale before and after radiation, also to examine the difference level of vWF plasma before and after radiation, and to search correlation between bleeding scale response to vWF plasma level before and after hemostatics irradiation.

Methods : This study is pre-post study design without control, held in Department of Radiotherapy Cipto Mangunkusumo National General Hospital, Jakarta in cancer bleeding patients who received hemostatics irradiation according to inclusion criteria, since September 2013-February 2014. Blood samples for vWF examination and clinical scoring for WHO bleeding scale data are taken before and after irradiation.

Result : Overall 23 subjects, including 2 patients died because of the bleeding. The effectiveness of hemostatics irradiation is 91,3%. Radiation hemostatics significantly decrease WHO bleeding scale, from median 3 to median 1, p<0,001. The hemostatics irradiation significantly elevate the level of vWF plasma, mean differences 12,38 IU/dL (SD 12,75 IU/dL), p= 0,001. There is also significant correlation between the decrease of WHO bleeding scale and the elevation level of vWF plasma, p=0,019 (R=-0,533).

Conclussion : Hemostatics radiation is proven effectively to stop the cancer bleeding and chosen modality in treating the cancer bleeding in malignancy. Radiation is clinically able to degrade the bleeding scale, and to elevate the level of vWF plasma. Radiation is also proven significant corelation between elevation of vWF plasma and decrement of bleeding scale."

"ABSTRAKLatar Belakang Peningkatan insidensi tumor metastasis intrakranial setiap tahunnya, juga diikuti oleh meningkatnya angka disabilitas dan mortalitas pada pasien. Terapi standar pada tumor metastasis otak adalah WBRT, SRS, operasi atau kombinasi dari ketiganya. Dengan semua pilihan terapi yang ada, sangat penting untuk memerhatikan prognosis pasien dengan tumor metastasis otak untuk menentukan jenis terapi yang sesuai, salah satunya dengan menggunakan indeks prognosis. Belum terdapat data yang menggambarkan profil demografis dan kesintasan pasien tumor metastasis otak di Indonesia dengan menerapkan indeks prognosis yang sudah ada.Tujuan dan Metode Penelitian ini merupakan studi cohort retrospektif untuk melihat kesesuaian hasil analisis kesintasan pasien tumor metastasis otak di Departemen Radioterapi RSUPN Dr. Cipto Mangunkusumo tahun 2012-2014 dengan data acuan indeks RPA, GPA, dan BSBM.Hasil Terdapat 62 subyek yang diikutsertakan dalam penelitian ini setelah mendapat persetujuan. Median kesintasan keseluruhan mencapai 9,16 bulan. Hasil analisis kesintasan berdasarkan indeks RPA memperlihatkan median kesintasan Kelas I, Kelas II dan Kelas III, secara berurutan 16.3 bulan, 11.2 bulan, dan 4.7 bulan. Karakteristik dan median kesintasan subyek pengamatan berdasarkan indeks GPA, secara berurutan mulai dari GPA 0-1 sampai GPA 3,5-4 adalah 4.3, 10.4, 12.4, dan 16.3 bulan. Hasil penerapan kedua indeks tersebut terlihat sesuai dengan data acuan penelitian pendahulunya. Namun indeks BSBM tidak mampu memperlihatkan hasil yang sesuai saat diterapkan pada populasi sampel penelitian.Kesimpulan Indeks RPA dan GPA dapat digunakan untuk memprediksi prognosis pasien tumor metastasis otak di RSUPN-CM karena memberikan karakterisitik yang sesuai dengan data acuan. Indeks GPA dianggap lebih baik karena menggunakan variabel yang lebih objektif.

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ABSTRACTBackground The incidence of intracranial metastasis has increased annually, which also followed by the increased number of patient rsquo s disability and mortality. Standard therapy in brain metastasis are Whole Brain Radiotherapy WBRT , Stereotactic Radio Surgery SRS , surgery, or combination of all. With all these treatment options available, it is very important to consider the prognosis in order to decide which therapy is appropriate. One of the methods that can be used to determine the prognosis is by using the prognostic indices. Currently, there has been no data or report about the demographic and survival profile of patients with brain metastastis in Indonesia using the available index prognosis.Methods This is a retrospective cohort study to evaluate the survival analysis in patients with brain metastasis that are undergoing treatment in Radiotherapy Department, RSUPN Dr. Cipto Mangunkusumo in 2012 2014 based on RPA, GPA, and BSBM index.Results Sixty two patients are included in this study after obtaining the approved consent. The median of survival rate is 9.16 months. Survival analysis based on RPA index showed median class I, II, and III are 16.3, 11.2, and 4.7 months, respectively. Characteristics and median observer based on GPA, from GPA 0 1 to GPA 3.5 4 are 4.3, 10.4, 12.4, and 16.3 months, respectively. These findings are similar with the previous studies. However, BSBM index does not able to illustrate the result that is appropriate when it is being applied to the subjects of this study.Conclusions RPA and GPA index can be used to predict the prognosis in patients with brain metastasis that are undergoing treatment in RSUPN Dr. Cipto Mangunkusumo because it provides characteristics, which correspond to the reference data. GPA index is considered better because it uses more objective variables."

"Tujuan: Mengetahui kesintasan hidup, respon pengobatan dan faktor yang mungkin mempengaruhi dalam penanganan karsinoma nasofaring stadium lokal lanjut. Metode: Dilakukan penelitian retrospektif deskriptif analitik terhadap 391 pasien karsinoma nasofaring stadium lokal lanjut yang berobat di Departemen Radioterapi RSCM periode Januari 2007-Desember 2011, dilihat karakteristik pasien maupun tumor. Analisis kesintasan dihitung dengan kurva Kaplan Meier dan respon radiasi dianalisa menggunakan uji korelasi Spearman pada pasien yang memenuhi kriteria inklusi. Hasil: Didapatkan 70.6% pasien adalah laki laki, median usia 45 (9-86) tahun. Sebagian besar stadium IVB (32,7%) dengan tipe histopatologis WHO III paling dominan (82,4%) Kesintasan hidup 3 dan 5 tahun untuk masing-masing stadium IIB, III, IVA, IVB berturut-turut adalah 64,9%, 57,6%, 47,4%, 48,0% dan 64,9%, 43,2%, 34,3%, 26,6%. Sedangkan respon komplit untuk masing-masing stadium IIB, III, IVA, IVB berturut-turut 83,3%, 73,3%, 52,6%, 45,8%. Terdapat korelasi bermakna antara respon radiasi dengan stadium (r=0,242;p=0,038) dan antara respon radiasi dan kesintasan hidup (r=-0,251;p=0,031).

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Purpose: To show the overall survival rate, radiation response and factors influenced on locally advanced nasopahryngeal cancer.

Method: Retrospective analytic descriptive study of 391 newly diagnosed locally advanced nasopharyngeal cancer patients from January 2007 till December 2011, to show their characteristics. Overall survival rate were analyzed by Kaplan Meier Survival curve and the radiation response correlation with other factors were analyzed by Spearman correlation test.

Result: Most of the subjects are male (70.6%), with median age 45 (9-86) years old. Mainly on stage IVB (32,79%) with the most hystopalogic was type III WHO (82,4%). All of the subjects were analyzed for 3 and 5 years overall survival, resulted for stage IIB, III, IVA, IVB were 64,9%, 57,6%, 47,4%, 48,0% dan 64,9%, 43,2%, 34,3%, 26,6% respectively. Complete respons for stage IIB, III, IVA, IVB were 83,3%, 73,3%, 52,6%, 45,8%, respectively. There were significant correlation between radiation response and cancer stadium (r=0,242;p=0,038) and between radiation response with overall survival rate (r=-0,251;p=0,031)."