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"Radiotherapy is one of treatment's modalities for head and neck malignancies. Its successful rate in curing cancer is undeniable. However, the patient will suffer several side effects or oral complications due to the treatment. If this condition is not properly managed, it can lead to the decline of patient's quality of life. There are 4 aspects that can be used as indicators of quality of life for the case of head and neck that must be aware of which are: (1) disturbing pain, (2) problem in chewing and swallowing, (3) problem in oral communication, (4) patient's emotion. In order to maintain patient's quality of life, patients must have the willingness to recover and follow all instructions suggested by the medical staffs in charge and receive full support of the family and health personnel which include oncology radiotherapist, dentists, and all the paramedics involved."

"Latar Belakang: Gangguan pada aksis hipotalamus hipofisis merupakan salah satu efek samping lanjut akibat radiasi yang dapat menyebabkan terjadinya hipogonadism. Namun sedikit diketahui tentang pengaruh dosis radiasi di hipofisis dengan risiko terjadinya hipogonadism.Tujuan: Untuk mengetahui adakah perubahan hormon FSH, LH dan testosteron pada pasien pasca radiasi serta mengetahui hubungan antara dosis radiasi di hipofisis dengan perubahan nilai hormon tersebut.Metode: Penelitian retrospektif pada pasien yang telah menjalani radiasi lebih dari 1 tahun yang lalu. Dosis radiasi di hipofisis didapatkan dari data pada Treatment Planning System (TPS) saat perencanaan radiasi dan nilai hormon FSH, LH, dan testosteron didapatkan dari pemeriksaan laboratorium.Hasil: Didapatkan 20 pasien yang masuk dalam kriteria inklusi dan eksklusi pada penelitian ini dengan rerata usia 40,2±6,66 tahun, median follow up 20,5 (13-66) bulan dan median Dmax hipofisis 49,81 (2,72-73,34) Gy. Tidak didapatkan kasus dengan defisiensi FSH dan LH, namun didapatkan 1 kasus (5%) dengan defisiensi testosteron. Rerata nilai hormon FSH adalah 10,65±5,42 mIU/mL, LH 6,25±2,51 mIU/mL, dan testosteron 4,83±1,40 ng/mL. Terdapat korelasi positif antara Dmax hipofisis dengan FSH (r 0,409) dan korelasi negatif antara Dmax hipofisis dengan LH (r -0,230) dan testosteron (r -0,302). Pada subgrup analisis didapatkan pada kelompok dengan Dmax hipofisis >60 Gy terdapat median nilai FSH yang lebih tinggi (p 0,015) serta median nilai LH dan testosteron yang lebih rendah dibandingkan pada kelompok dengan Dmax hipofisis ≤60 Gy.<Kesimpulan: Gangguan pada aksis hipotalamus hipofisis dapat menyebabkan perubahan nilai hormon FSH, LH, dan testosteron. Dosis radiasi di hipofisis berhubungan dengan perubahan nilai hormon tersebut.

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Background: Disruption of the hypothalamic-pituitary axis is one of the late side effects of radiation which can cause hypogonadism. However, little information about the influence of radiation dose in pituitary due to risk of hypogonadism.

Objectives: To determine changes of patient's FSH, LH, testosterone after radiation and relationship between radiation dose in pituitary.

Methods: Retrospective study of patients who underwent radiation more than 1 year ago. The radiation dose of pituitary is obtained from data in Treatment Planning System (TPS) and values ​​of the FSH, LH,

Results: There were 20 patients who met the inclusion and exclusion criteria in this study with mean age of 40.2 ± 6.66 years, median follow-up of 20.5 (13-66) months and median Dmax pituitary of 49.81 (2.72-73 .34) Gy. There were no cases with FSH and LH deficiency, but there was 1 case (5%) with testosterone deficiency. The mean FSH value was 10.65 ± 5.42 mIU/mL, LH 6.25 ± 2.51 mIU/mL, and testosterone 4.83 ± 1.40 ng/mL. There is positive correlation between pituitary Dmax and FSH (r 0.409) and negative correlation with LH (r -0.230) and testosterone (r -0.302). In the subgroup analysis, it was found that in the Dmax pituitary >60 Gy there was a higher median FSH value (p 0.015) and lower median LH and testosterone values ​​than in the Dmax pituitary ≤60 Gy.

Conclusion: Disorders of the hypothalamic-pituitary axis can cause changes in the values ​​of FSH, LH, testosterone. The radiation dose of pituitary is related to changes in hormone values."

"Latar belakang: Risiko kaheksia pada pasien kanker kepala dan leher KKL meningkat akibat tumor itu sendiri, letak tumor, dan pemberian terapi medis. Penurunan berat badan akibat efek samping radioterapi atau kemoradioterapi dapat menurunkan angka kesintasan dan kualitas hidup, serta meningkatkan angka morbiditas dan mortalitas. Terapi medik gizi klinik bertujuan mencegah malnutrisi bertambah berat, memperbaiki kualitas hidup, dan mendukung outcome terapi yang baik. Terapi medik gizi klinik berupa konsultasi individu, meliputi pemberian nutrisi adekuat sesuai kebutuhan energi, makronutrien, mikronutrien, dan nutrien spesifik, serta terapi medikamentosa dan edukasi.Metode: Pasien pada serial kasus ini berjumlah empat orang, berusia 32 ndash;53 tahun. Satu orang pasien dengan diagnosis karsinoma lidah dan 3 orang dengan kanker nasofaring. Dua dari 4 pasien menjalani kemoradioterapi. Semua terdiagnosis kaheksia pada awal pemeriksaan. Kebutuhan energi total dihitung menggunakan persamaan Harris-Benedict untuk kebutuhan basal dikalikan faktor stres 1,5. Pemantauan meliputi keluhan subjektif dan pemeriksaan objektif tanda vital, kondisi klinis, antropometrik, massa otot, massa lemak, kekuatan genggam tangan, Karnofsky Performance Status, analisis asupan, dan laboratorium . Pemantauan dilakukan secara berkala setiap minggu untuk menilai pencapaian target pemberian nutrisi.Hasil: Terapi medik gizi klinik pada keempat pasien meningkatkan asupan energi, protein, dan nutrien spesifik asam amino rantai cabang dan eicosapentaenoic acid . Penurunan BB, massa otot, dan kapasitas fungsional yang terjadi pada pasien hanya minimal.Kesimpulan: Terapi medik gizi klinik pada pasien KKL dengan kaheksia dalam radioterapi atau kemoradioterapi dapat meningkatkan asupan nutrisi dan meminimalkan penurunan status gizi pasien lebih lanjut.

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Introduction: The risk of cachexia of head and neck cancer HNC is increased because of the tumor itself, site of the tumor, and side effects of cancer treatment. Weight loss during radiotherapy or chemoradiotherapy will decrease the survival rates and quality of life, and increase morbidity and mortality rates. The purpose of medical therapy in clinical nutrition is to prevent further malnutrition during therapy, improve quality of life, and support the good outcome of cancer treatment. Individual medical therapy in clinical nutrition include adequate energy, macro and micronutrient, and specific nutrients requirements, pharmacotherapy and education.

Methods: Four HNC patients in this case series aged between 32 and 53. One patient diagnosed squamous cell carcinoma of the tongue and 3 patients with nasopharyngeal cancer. Two of four patients received chemoradiotherapy. Total energy requirement was calculated using Harris Benedict equation for basal energy need multipled by stress factor of 1,5. Monitoring include subjective complaints and objective examination vital sign, physical examination, anthropometric, muscle mass, fat mass, handgrip strength, Karnofsky Performance Status, dietary analysis, and laboratory. Monitoring was performed routinely every week to assess achievement of the nutrition therapy target.

Results: Medical therapy in clinical nutrition to four patients can increase the intake of energy, protein, and specific nutrients branched chain amino acid and eicosapentaenoic acid. The decreased of weight, muscle mass, and functional capacity during radiotherapy or chemoradiotherapy were only minimal.

Conclusion: Medical therapy in clinical nutrition for HNC patients with cachexia on radiotherapy or chemoradiotherapy can increase nutrition intake and minimalized further malnutrition."

"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. "

"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."

"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 362-367Information on reliable factors to predict patient outcome is important for deciding upon the best treatment to increase loco-regional control, overall survival and quality of life of patients with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to investigate the role of clinico-pathological parameters as predictors of disease recurrence in patients with HNSCC. We studied fifty patients who were seeking treatment for primary HNSCC in Westmead Hospital between 2002-2004. Univariate analysis was used to identify any significant association between clinico-pathological parameters and disease recurrence. It was showed that age (p=0.008), cTNM stage (p=0.02), size of tumour (p=0.009) and positive tumour margin (p=0.002) predicted the risk of the development of disease recurrence. In agreement with other studies we found that some traditional factors influenced disease recurrence. A longer follow-up study should be performed to assess the significance of these factors on overall survival as well as separate studies on prognostic indicators for patients with histologically negative lymph node."

"Latar Belakang: Kanker kepala dan leher terdapat 10 dari keseluruhan kasus kanker di seluruh tubuh. Efek samping akibat terapi kanker berdampak signifikan pada kualitas hidup pasien. Instrumen yang sering digunakan untuk menilai kualitas hidup pasien kanker kepala dan leher salah satunya adalah University of Washington Quality of Life UW-QOL. Hingga saat ini belum pernah dilakukan adaptasi kuesioner UW-QOL ke bahasa Indonesia. Tujuan: Penelitian ini bertujuan mendapatkan instrumen UW-QOL adaptasi bahasa Indonesia yang valid dan reliabel untuk menilai kualitas hidup pasien kanker kepala dan leher. Metodologi: Penelitian ini berdesain potong lintang, dilakukan di poliklinik THT FKUI/RSCM dr. Cipto Mangunkusumo terhadap pasien kanker kepala dan leher usia dewasa. Hasil: Uji validitas menggunakan uji korelasi Spearman dengan korelasi bermakna pada seluruh butir pertanyaan di tingkat signifikansi p

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Background: Head and neck cancer accounts for 10 of all cancer cases throughout the body.. Side effects due to cancer therapy have a significant impact on patient quality of life. The University of Washington Quality of Life UW QOL is the most frequent intruments used to assess the quality of life of head and neck cancer patients. At present, the Indonesian version of UW QOL questionnaire is not available.

Objective: This study aims to obtain a valid and reliable Indonesian adaptation of UW QOL to assess the quality of life of head and neck cancer patients.

Method: Cross sectional study was conducted in ORL HNS Department outpatient clinic dr. Cipto Mangunkusumo hospital towards 41 adult patients with head and neck cancer.

Result: The validity test using Spearman correlation test with significant correlation in all questions items at the level of significance p"

"Saliva is essential for preservation of oral health. It aids in preparation of the initial food bolus, assist in taste and swallowing, and lubricates the oral mucosa. In addition it has antiviral, antifungal, and antibacterial properties. Consequently, salivary gland dysfunction can lead to complaints of oral dryness (xerostomia). Diseases of the thyroid gland, hyperthyroidism and hypothyroidism, and their treatment have also been suggested to cause salivary gland dysfunction. In addition head and neck radiation therapy, treatment for head and neck cancers can cause irreversible salivary gland function. This case study, reported one patient with thyroid cancer in which the thyroid gland has been removed and received head and neck radiation therapy."

"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 "

"ABSTRAKRadiotherapy as a treatment modality aside from other modalities such as surgery and chemotherapy has been achieved not far off the discovery of X ray at the end of 19th century. Combined external radiation and brachytherapy on the treatment of oral cavity malignancies has shown good result with reasonable toxicities. Mechanism of radiotherapy, radiophysics and radiobiology will be discussed briefly on this paper. The indications of radiotherapy and toxic effects may arise will also be discussed."