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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."

"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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"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 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."

"[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 "

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Latar Belakang: Kanker menjadi salah satu penyebab kematian utama dan dapat menghalangi upaya  peningkatan harapan hidup seseorang. Terdapat 20 juta kasus baru di seluruh dunia dan 9,7 juta kematian akibat kanker pada tahun 2022. Terdapat hambatan non medis yang dialami pasien dalam proses perawatan kanker, dan menyebabkan penundaan perawatan yang sedang dijalani, yang akan mempengaruhi kualitas pengobatan dan kualitas hidup pasien. Keberadaan Patient Navigator (PN) diharapkan dapat memberikan solusi. Terdapat  beberapa literatur yang mengaitkan dengan penundaan terapi pada beberapa jenis kanker, namun belum ada yang membahas perannya pada pasien yang menjalani radioterapi secara menyeluruh. Tujuan: Untuk mengetahui hubungan peran navigasi pasien dengan tingkat interupsi terapi pasien radioterapi. Metode: Merupakan penelitian kohort restrospektif dengan analisis chi square. Data pasien diambil secara total sampling untuk melihat pola kepatuhan pasien sebelum dan sesudah adanya program PN (Februari 2021-Mei 2024). Dan dilakukan random sampling pada sejumlah 50 responden dari total 235 pasien populasi, untuk mengetahui hubungan peran PN terhadap interupsi terapi. Pasien dilakukan wawancara dan pengisian kuisioner serta pengambilan data sekunder dari data tunda sinar pasien. Hasil: Dari hasil penelitian, domisili merupakan karakteristik yang dapat mempengaruhi tingkat interupsi terapi pasien (p-Value 0,044). Dan gambaran kepatuhan pasien dalam menjalani terapi radiasi,  menunjukkan penurunan semenjak kehadiran program PN. Hambatan atau kendala yang dialami pasien radioterapi paling banyak adalah hambatan fisik (56%). Upaya yang dilakukan tim PN dalam menavigasi pasien terbanyak adalah memberikan dukungan emosional kepada pasien (90%). Sejumlah 73% responden menilai program tersebut sangat baik. Terdapat hubungan yang bermakna antara peran navigasi pasien dengan interupsi terapi pasien radioterapi (p-Value <0,001). Kesimpulan: Navigasi pasien berperan dalam membantu mengatasi kendala-kendala non medis yang dialami pasien dalam proses pengobatan kanker. Pemberian navigasi pasien yang berkesinambungan, berperan dalam meningkatkan kepatuhan pasien dalam menjalani terapi radiasi di RSCM.

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Background: Cancer is one of the leading causes of death and inhibit the efforts to increase patient's life expectancy. There were 20 million new cases worldwide and 9.7 million deaths from cancer in 2022. There are non-medical barrier experienced by patients in the cancer treatment process, and cause delays in ongoing treatment, which will affect the quality of treatment and the patient's quality of life. The existence of Patient Navigator (PN) is expected to provide a solution. Some study of PN has found the relation with interuption’s therapy in some types of cancer, but no one has discussed its role in all types cancer patients undergoing radiotherapy. This study aims to determine the relationship between the role of patient navigation and the therapy interruption of radiotherapy patients. Methods: This study used retrospective cohort with chi square analysis. Patient data was taken on a total sampling basis to see patient compliance patterns before and after the PN program (February 2021-May 2024). And random sampling was carried out on a total of 50 respondents from 235 population patients, to find out the relationship between the role of PN and therapy interruptions. Patients were interviewed and filled out questionnaires as well as taking secondary data from the radiotherapy patient's delay data. Results: Domicile is a characteristic that can affect the level of patient therapy interruption (p-Value 0.044). The pattern of undergoing radiation therapy patient’s compliance indicate decreasing number since the presence of the PN program. The most common barrier or obstacle experienced by radiotherapy patients is physical barriers (56%). The effort made by the PN team in navigating the most patients was to provide emotional support (90%). Total 73% of respondents considered the program very good. There was a significant relationship between the role of patient navigation and the interruption therapy of radiotherapy patient (p-Value <0.001). Conclusion: Patient navigation plays a role in helping to overcome non-medical patients barrier in the cancer treatment process. Providing continuous patient navigation have role in improving patient compliance in undergoing radiation therapy at RSCM.

 

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"Studi retrospektif ini bertujuan untuk mengetahui perbandingan respon terapi radiasi antara teknik konvensional 2D dengan pengecilan lapangan radiasi teknik 2D, 3DCRT atau brakiterapi pada pasien kanker nasofaring stadium dini (stadium I – IIa). Dari 20 sampel didapatkan respon komplit pada 17 pasien (85%) dan respon parsial pada 3 pasien (15%) (p=0.219). Efek samping akut yaitu dermatitis radiasi grade 3-4 adalah 5% (p=0.435), mukositis grade 3-4 adalah 15% (p=0.510) dan xerostomia grade 3-4 adalah 0% (p=0.517). Secara statistik tidak didapatkan perbedaan bermakna tetapi secara klinis mempunyai kesan ada kecenderungan bahwa dengan pengecilan lapangan radiasi teknik brakiterapi dan 3DCRT lebih baik dalam hal efek samping akut mukositis dibanding teknik 2D.

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This retrospective study aimed to compare the response of radiation therapy between 2D conventional technique with the booster of 2D, 3DCRT or brachytherapy techniques in patients with early-stage nasopharyngeal cancer (stage I - IIa). From 20 sample, obtained complete response in 17 patients (85%) and partial response in 3 patients (15%) (p = 0.219). Side effects of acute radiation dermatitis grade 3-4 is 5% (p=0.435) , mucositis grade 3-4 is 15% (p=0.510) and xerostomia grade 3-4 is 0% (p=0.517). The result showed no satistically significant but clinically there is a tendency that with the booster of brachytherapy and 3DCRT techniques, are better compared with 2D technique in terms of acute mucositis side effects."

"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."

"Latar Belakang: Insiden kanker serviks di RSCM masih tinggi, sebagian besar datang pada stadium lanjut, dan angka harapan hidup yang masih rendah. Jika respon radiasi komplit dan eradikasi tumor lokoregional dapat tercapai pada pasien kanker serviks, diperkirakan dapat meningkatkan kesintasan. Oleh karena itu, kami bermaksud mengadakan penelitian terhadap respon terapi radiasi dan karakteristik klinis serta patologi yang berhubungan pada pasien kanker serviks di RSCM. Metode: Penelitian kohort ini dilakukan dengan menggunakan data sekunder terhadap 123 pasien kanker serviks stadium IIA-IIIB yang menjalani radiasi kuratif definitif sesuai protokol standard bulan Januari 2014-Des 2015 di RSUPN CiptoMangunkusumo. Dilakukan pencatatan karakteristik klinis dan patologis sebelum radiasi, Dicatat juga efek samping akut gastrointestinal, traktus genitourinaria, dan hematologis selama menjalani protokol radiasi sampai 3 bulan pasca radiasi. Data respon tiga bulan pasca radiasi lengkap berdasarkan klinis dan pemeriksaan ultrasonografi transrektal/transvaginal dicatat dan diklasifikasikan sesuai Response Evaluation Criteria in Solid Tumors RECIST. Hasil: Dari 123 kasus, 84 kasus 68,29 diperoleh respon komplit, 30 kasus 24,39 respon parsial, 6 kasus 4,88 respon stabil, dan 3 kasus 2,44 respon progresif. Berdasarkan efek samping akut gastrointestinal, tidak didapatkan efek samping derajat 0 pada 99 kasus 80,49, derajat 1 pada 20 kasus 16,26, derajat 2 pada 4 kasus 3,25, derajat 3 pada 0 kasus 0. Berdasarkan efek samping akut genitourinaria, tidak didapatkan efek samping derajat 0 pada 105 kasus 85,37, derajat 1 pada 17 kasus 13,82, derajat 2 pada 1 kasus 0,81, dan derajat 3 pada 0 kasus 0. Berdasarkan efek samping akut hematologis, tidak didapatkan efek samping derajat 0 pada 108 kasus 87,80, derajat 1 pada 15 kasus 12,20, derajat 2 pada 0 kasus 0, dan derajat 3 pada 0 kasus 0. Dengan membandingkan kelompok respon komplit dan tidak respon parsial, stabil, progresif didapatkan faktor usia dengan p=0,266 RR 0,87;IK95 0,67-1,12, klasifikasi tekanan darah dengan p=0,882 RR 0,98; IK95 0,76-1,27, Indeks Masa Tubuh dengan p= 0,397 RR 1,06;IK95 0,83-1,34, kadar hemoglobin dengan p= 0,193 RR 0,71;IK95 0,40-1,27, jumlah leukosit darah dengan p=0,969 RR=1,00; IK95 0,78-1,29, kadar albumin darah dengan p= 0,198 RR 0,73;IK95 0,44-1,20, stadium FIGO dengan p=0,526 RR 1,08; IK95 0,85-1,38, diameter tumor terbesar dengan p=0,034 RR 1,30; IK95 1,03-1,63, jenis histopatologis dengan p=0,159 RR 1,18;IK95 0,90-1,55, dan derajat diferensiasi dengan p=0,469. Pada analisa multivariat, didapatkan hubungan bermakna antara diameter tumor p=0,036;RR 2,64; IK95 1,07-6,56 dengan respon radiasi komplit. Kesimpulan: Gambaran respon radiasi kuratif definitif pada kanker serviks stadium IIA-IIIB di RSCM adalah 68,29 respon komplit, 24,39 respon parsial, 4,88 respon stabil, dan 2,44 progresif. Efek samping akut gastrointestinal, genitourinaria, dan hematologis pada umumnya tidak terjadi selama dan sampai 3 bulan pasca radiasi, yaitu 80,49 tidak mengalami efek samping akut gastrointestinal, 85,37 tidak mengalami efek samping akut genitourinaria, dan 87,80 tidak terjadi efek samping akut hematologi. Sebagian besar efek samping akut yang terjadi berderajat rendah yaitu grade 1 dan 2 traktus gastrointestinal, masing-masing 16,26 dan 3,25, grade 1 dan 2 traktus genitourinaria, yaitu masing-masing 13,82 dan 0,81, dan grade 1 hematologi, yaitu 12,20. Terdapat hubungan bermakna antara diameter tumor terbesar dengan respon komplit radiasi. Tidak terdapat hubungan bermakna antara usia, Indeks Masa Tubuh, kadar hemoglobin, jumlah leukosit darah, kadar albumin serum, stadium FIGO, jenis histopatologis, dan derajat diferensiasi dengan respon terapi radiasi.

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Background: The incidence of cervical cancer was still high in RSCM, whom most of them was found in advanced stage. The issue that still become a problem related to radiotherapy on those patients was non satisfying local tumor control, which range 20 50. If we can reach complete response and eradication of locoregional tumor on cervical cancer patients, it is estimated that the survival rate will increase. Therefore, we conducted a research to find out response of radiotherapy and related clinic pathologic characterictics on cervical cancer patients in our hospital.

Methods: This cohort study used secondary data on 123 patients of cervical cancer stage IIA IIIB who had undergone radiation therapy based on standard protocol in our hospital, during Januari 2014 to Dec 2015. The clinical factors of those patients, such as age, Body Mass Index, blood pressure, hemoglobin level, blood leucocyte count, serum albumin, largest tumor diameter FIGO staging and pathologic characteristic, i.e histopathology and grading were recorded. During radiation protocol until 3 months post radiation, we also noted any side effects of gastrointestinal tract, genitourinary tract, and hematologic. Evaluation of radiotherapy response was based on Response Evaluation Criteria in Solid Tumors RECIST.

Results: Among 123 cases, 84 cases or 68.29 was complete response, 30 cases or 24.39 was partial response, 6 cases or 4.88 was stabile response, and 3 cases or 2.44 was progressive. Based on gastrointestinal side effect, there was no side effect or grade 0 on 99 cases 80.49, grade 1 on 20 cases 16.26, grade 2 on 4 cases 3.25, grade 3 on 0 case 0. Based on side effect of genitourinary, there was no side effect or grade 0 on 105 cases 85,37, grade 1 on 17 cases 13.82, grade 2 on 1 case 0.81, grade 3 on 0 case 0. Based on hematologic side effects, there was no side effect on 108 cases 87.80, grade 1 on 15 cases 12.20, grade 2 on 0 case 0, grade 3 on 0 case 0. On bivariate analysis, p of each factors were age p 0.266 RR 0.87 0.67 1.12, Body Mass Index p 0.397, blood pressure classification p 0.658 RR 0.98 0.76 1.27, largest tumor diameter p 0.034 RR 1.30 1.03 1.63, haemoglobin level p 0.193 RR 0.98 0.76 1.27, blood leucocyte count p 0.969 RR 1.00 0.78 1.29, FIGO staging II vs III p 0.526 RR 1.08 0.85 1.38, histopathology result squamous cell carcinoma vs nonsquamous cell carcinoma p 0.159 RR 1.18 0.90 1.55, and grading p 0.469. on multivariate analysis, tumor diameter was statistically significant, with p 0.036 RR 2.64 1.07 6.56.

Conclusion: Most of definitive curative radiotherapy response on cervical cancer stage IIA IIIB was complete 68.29. Partial response was 24.49, stable response was 4.88, and progressive was 2.44. The Acute side effect of gastrointestinal tract, genitourinary tract, and hematologic were commonly can be tolerable during and 3 months post radiation therapy. Clinico pathologic characteristic that significantly related to complete response of radiotherapy were largest tumor diameter."