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"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."

"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 "

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

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

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

"Latar Belakang: 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."

"Kanker kepala dan leher merupakan kanker yang menggambarkan berbagai tumor ganas yang berasal dari saluran aerodigestif atas, yang meliputi kanker pada mata, telinga, rongga hidung, sinus paranasal, nasofaring, orofaring, hipofaring, laring, kelenjar saliva, dan kelenjar tiroid. Penelitian ini bertujuan untuk mengetahui pengaruh terapi akupunktur manual terhadap kadar MDA dan skor NAS dibandingkan dengan akupunktur manual sham pada penderita kanker kepala dan leher pasca terapi radiasi. Uji klinis acak tersamar tunggal dengan kontrol dilakukan terhadap 30 pasien kanker kepala dan leher yang dibagi secara acak menjadi kelompok akupunktur manual n=15 dan kelompok akupunktur manual sham n=15. Pemeriksaan kadar MDA dilakukan sebelum perlakuan dan setelah sesi ke-12. Penilaian skor NAS dilakukan pada saat sebelum perlakuan, setelah sesi ke-6, dan setelah sesi ke-12. Hasil penelitian menunjukkan tidak terdapat perbedaan bermakna antara kelompok akupunktur manual dengan kelompok akupunktur manual sham terhadap penurunan kadar MDA sebelum dan sesudah perlakuan p=0,787. Terdapat perbedaan bermakna antara kelompok manual dengan akupunktur manual sham terhadap penurunan skor NAS sebelum dan sesudah perlakuan yang diukur pada sesi ke-6 p=0,001 dan sesi ke-12 p=0,003. Kesimpulan penelitian ini terapi akupunktur manual efektif untuk menurunkan skor NAS, namun kurang efektif untuk menurunkan kadar MDA pada penderita kanker kepala dan leher pasca terapi radiasi.

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Head and neck cancer encompasses a wide range of malignant tumours arising from the upper aerodigestive tract, includes eyes, ears, nasal cavities, paranasal sinuses, nasopharynx, oropharynx, hypopharynx, larynx, salivary glands, and thyroid gland.

This study aims to determine the effect of manual acupuncture therapy on MDA levels and NAS scores compared with manual sham acupuncture in patients with head and neck cancer post radiation therapy. Single blinded randomized clinical trials with control were performed on 30 head and neck cancer patients divided randomly into manual acupuncture groups n = 15 and the sham manual acupuncture group n = 15. The examination of MDA levels is performed before treatment and after the 12th session. Assessment of NAS scores is performed before the treatment, after the 6th session, and after the 12th session.

The result showed no significant difference between manual acupuncture group and sham manual acupuncture group to decrease MDA level before and after treatment p = 0,787. There was a significant difference between manual group and sham manual acupuncture on NAS score decrease before and after treatment measured at 6th session p = 0,001 and 12th session p = 0,003.

The conclusion: manual acupuncture therapy effectively decrease NAS scores, but statistically less effective to reduce levels of MDA in patients with head and neck cancer after radiotherapy."

"Pada kanker kepala dan leher ditemukan adanya peningkatan kadar radikal bebas dan penurunan aktivitas antioksidan, yaitu Superoksida Dismutase SOD. Salah satu terapi utama pada pasien kanker kepala dan leher adalah terapi radiasi. Efek tidak langsung terapi radiasi adalah meningkatkan kadar radikal bebas. Selain itu efek samping terapi radiasi menyebabkan penurunan kualitas hidup. Penelitian ini dibagi secara acak menjadi dua kelompok, yaitu kelompok akupunktur manual n=15 dan kelompok akupunktur manual sham n=15. Penelitian ini menggunakan titik GV20 Baihui, LI4 Hegu, ST36 Zusanli, SP6 Sanyinjao, dan LR3 Taichong. Terapi dilakukan tiga kali seminggu selama 30 menit sebanyak 12 kali. Hasil penelitian ini menunjukkan bahwa selisih skor SOD tidak ada perbedaan bermakna secara statistik antara kedua kelompok p=0.695 tetapi adanya perbedaan bermakna secara statistik pada selisih skor Organization for Research and Treatment of Cancer EORTC QLQ-C-30 sebelum dan setelah dua belas kali terapi antara kedua kelompok.

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In head and neck cancer found an increase in free radical levels and decreased antioxidant activity, namely Superoxide Dismutase SOD . One of the main therapies in head and neck cancer patients is radiation therapy. The indirect effect of radiation therapy is to increase the levels of free radicals. In addition, side effects of radiation therapy lead to a decrease in the quality of life.

The study was randomly divided into two groups, the manual acupuncture group n = 15 and the manual acupuncture group sham n = 15. This study uses GV20 Baihui point, LI4 Hegu, ST36 Zusanli, SP6 Sanyinjao, and LR3 Taichong. Therapy is done three times a week for 30 minutes as much as 12 times.

The results of this study showed that there was no statistically significant difference in the difference between the two groups p = 0.695 but there was a statistically significant difference in the difference between the QLQ-C-30 Organization for Research and Treatment of Cancer EORTC score before and after twelve times of therapy between the two groups p "

"[ABSTRAKLatar belakang dan tujuan: efek samping radioterapi pada kulit, yang disebut dengan radiodermatitis, merupakan masalah bagi pasien keganasan kepala dan leher yang menjalani radioterapi. Efek samping yang terjadi dapat menurunkan kepatuhan pasien berobat, sehingga dapat meningkatkan angka putus terapi. Dua studi pendahulu telah mempelajari light emitting diode (LED) untuk mengurangi kejadian radiodermatitis dengan hasil yang berlawanan. Penelitian ini ingin mempelajari lebih lanjut mengenai efektivitas LED untuk menurunkan kejadian radiodermatitis.Metode: pada kelompok perlakuan, subjek penelitian (SP) mendapat tambahan fototerapi LED segera setelah radioterapi selesai. Fototerapi LED diberikan selama radioterapi berlangsung. Penilaian derajat radiodermatitis dilakukan oleh peneliti setiap lima kali radioterapi dijalani, menggunakan kriteria menurut Common Terminology Criteria for Adverse Event (CTCAE) yang dimodifikasi.Hasil: kejadian radiodermatitis antara kelompok kontrol dan perlakuan hampir sama dan tidak berbeda bermakna secara statistik. Berdasarkan analisis kecenderungan, terlihat bahwa terjadi peningkatan persentase jumlah SP dengan radiodermatitis pada kelompok kontrol sebesar dua kali lipat saat rerata dosis radiasi kumulatif 34 Gy, sedangkan pada kelompok perlakuan baru meningkat saat rerata dosis radiasi kumulatif 44 Gy. Rasa gatal, lesi eritematosa, dan hiperpigmentasi lebih dahulu dialami oleh kelompok kontrol. Pada pemantauan 2 minggu pasca radioterapi terlihat bahwa persentase SP dengan radiodermatitis menurun lebih cepat pada kelompok perlakuan.Kesimpulan: fototerapi LED tidak dapat menurunkan kejadian radiodermatitis pada pasien keganasan kepala dan leher, namun mempunyai kecenderungan untuk menurunkan kejadian radiodermatitis saat rerata dosis radiasi kumulatif 34 Gy hingga mencapai dosis 44 Gy. Fototerapi LED juga dapat menunda terjadinya rasa gatal, lesi eritematosa, dan hiperpigmentasi, serta mempercepat penyembuhan radiodermatitis. Diperlukan studi lebih lanjut untuk membuktikan hipotesis ini dengan memperhitungkan saran dari peneliti.

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ABSTRACTBackground and objectives: radiation dermatitis remains a common problem in patients with head and neck cancer. This side effect causes discomfort, pain, and may lead to treatment delay. Two previous studies using light emitting diode (LED) phototherapy to prevent radiation dermatitis have been reported, with a completely different result. This study sought to further evaluate the effectiveness of LED phototherapy in lessening radiation dermatitis.Method: in the LED treatment group, all subjects with head and neck cancer received LED phototherapy after each radiation treatment. Reactions were evaluated every five treatments by the author, using the modified Common Terminology Criteria for Adverse Event (CTCAE) criteria.Results: instances of radiodermatitis amongst the control and the treated group has no clinical or statistical differences. Based on trend analysis, the fourth week of the study (mean cumulative radiation dose 34 Gy) shows a two-fold increase in the number of subject developing radiodermatitis in the control group. On the other hand, the treated group experiences an increase in the number of subject developing radiodermatitis on the fifth week (mean cumulative radiation dose 44 Gy). The control group experiences itching sensation, erythematous and hyperpigmented lesion sooner than the treated group. Two weeks after radiation therapy, the percentage of subject experiencing radiodermatitis decreases faster.Conclusions: LED phototherapy did not reduce the incidence of radiation dermatitis, but there is a patterned trend which show LED phototherapy may reduce radiation dermatitis when the mean cumulative radiation dose 34 Gy until it reaches 44 Gy. LED phototherapy tend to delay development of itching sensation, erythematous and hyperpigmented lesion, also accelerate radiodermatitis healing process. Further study needed to prove this hypothesis.;Background and objectives: radiation dermatitis remains a common problem in patients with head and neck cancer. This side effect causes discomfort, pain, and may lead to treatment delay. Two previous studies using light emitting diode (LED) phototherapy to prevent radiation dermatitis have been reported, with a completely different result. This study sought to further evaluate the effectiveness of LED phototherapy in lessening radiation dermatitis.Method: in the LED treatment group, all subjects with head and neck cancer received LED phototherapy after each radiation treatment. Reactions were evaluated every five treatments by the author, using the modified Common Terminology Criteria for Adverse Event (CTCAE) criteria.Results: instances of radiodermatitis amongst the control and the treated group has no clinical or statistical differences. Based on trend analysis, the fourth week of the study (mean cumulative radiation dose 34 Gy) shows a two-fold increase in the number of subject developing radiodermatitis in the control group. On the other hand, the treated group experiences an increase in the number of subject developing radiodermatitis on the fifth week (mean cumulative radiation dose 44 Gy). The control group experiences itching sensation, erythematous and hyperpigmented lesion sooner than the treated group. Two weeks after radiation therapy, the percentage of subject experiencing radiodermatitis decreases faster.Conclusions: LED phototherapy did not reduce the incidence of radiation dermatitis, but there is a patterned trend which show LED phototherapy may reduce radiation dermatitis when the mean cumulative radiation dose 34 Gy until it reaches 44 Gy. LED phototherapy tend to delay development of itching sensation, erythematous and hyperpigmented lesion, also accelerate radiodermatitis healing process. Further study needed to prove this hypothesis., Background and objectives: radiation dermatitis remains a common problem in patients with head and neck cancer. This side effect causes discomfort, pain, and may lead to treatment delay. Two previous studies using light emitting diode (LED) phototherapy to prevent radiation dermatitis have been reported, with a completely different result. This study sought to further evaluate the effectiveness of LED phototherapy in lessening radiation dermatitis.Method: in the LED treatment group, all subjects with head and neck cancer received LED phototherapy after each radiation treatment. Reactions were evaluated every five treatments by the author, using the modified Common Terminology Criteria for Adverse Event (CTCAE) criteria.Results: instances of radiodermatitis amongst the control and the treated group has no clinical or statistical differences. Based on trend analysis, the fourth week of the study (mean cumulative radiation dose 34 Gy) shows a two-fold increase in the number of subject developing radiodermatitis in the control group. On the other hand, the treated group experiences an increase in the number of subject developing radiodermatitis on the fifth week (mean cumulative radiation dose 44 Gy). The control group experiences itching sensation, erythematous and hyperpigmented lesion sooner than the treated group. Two weeks after radiation therapy, the percentage of subject experiencing radiodermatitis decreases faster.Conclusions: LED phototherapy did not reduce the incidence of radiation dermatitis, but there is a patterned trend which show LED phototherapy may reduce radiation dermatitis when the mean cumulative radiation dose 34 Gy until it reaches 44 Gy. LED phototherapy tend to delay development of itching sensation, erythematous and hyperpigmented lesion, also accelerate radiodermatitis healing process. Further study needed to prove this hypothesis.]"

"Studi kasus serial ini bertujuan untuk memberikan tatalaksana nutrisi pada pasien kanker kepala dan leher yang menjalani terapi kemoradiasi. Status nutrisi seorang pasien kanker merupakan salah satu prediktor dalam menentukan QOL dan survival, tetapi status nutrisi pada kasus serial ini dipengaruhi oleh banyak faktor antara lain metabolisme sel kanker, perubahan metabolisme dalam tubuh, efek samping radiasi, efek samping kemoterapi, serta faktor-faktor lain seperti psikis dan ekonomi. Serial kasus ini merupakan empat pasien kanker kepala dan leher berusia 30-57 tahun yang sedang menjalani kemoradioterapi dan telah mengalami penurunan berat badan bahkan sebelum dilakukan kemoradioterapi. Dalam perjalanan penyakitnya pasien mengalami efek samping terapi yang mempengaruhi status nutrisi pasien. Kebutuhan nutrisi pasien pada kasus serial ini dihitung menggunakan rumus Harris Benedict dengan faktor stres 1,5 dan diberikan protein sebanyak 1,5-2,0 g/kgBB/hari serta lemak 25-30%. Pemberian mikronutrien disesuaikan dengan RDA. Hasil dari kasus serial ini menunjukkan bahwa pasien yang status nutrisinya dapat dipertahankan menghasilkan outcome yang lebih baik daripada pasien yang status nutrisinya menurun. Untuk itu pada kasus keganasan kepala dan leher yang menjalani kemoradiasi sebaiknya diberikan konseling dan terapi nutrisi sejak awal sebelum timbul efek samping kemoradioterapi.

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This case studies aims to provide nutritional management of head and neck cancer patients undergoing chemoradiation therapy. Nutritional status of a patient's cancer is one of the predictors in determining QOL and survival. Nnutritional status is influenced by many factors, such as cancer cell metabolism, metabolic changes, the side effects of radiation and chemotherapy, as well as other factors such as psychological and economic. This is a case series of four head and neck cancer patients aged 30-57 years who were undergoing chemoradiotherapy and has lost weight even before chemoradiotherapy. In the course of illness of patients experience side effects of therapy affects the nutritional status of patients. Nutritional needs of patients in the case series were calculated using the Harris Benedict formula and stress factor 1.5. Protein was given 1.5 to 2.0 g protein/kgBW/day and 25-30% of fat. Micronutrient was provide as RDA. Results of this case series suggests that the nutritional status of patients who can be maintained produced better outcomes than patients whose nutritional status declined. For it is in the case of head and neck malignancies who underwent chemoradiation should be given counseling and nutrition therapy early before any side effects of chemoradiotherapy."

"Latar belakang: Kanker kepala dan leher merupakan salah satu kanker yang berisiko tinggi malnutrisi. Pada kanker kepala dan leher stadium lanjut lokal, radioterapi dengan atau tanpa kemoterapi merupakan terapi pilihan dan berkaitan dengan berbagai efek samping yang berperan dalam penurunan asupan makan dan berefek negatif pada status nutrisi. Tata laksana nutrisi bertujuan untuk mengurangi risiko malnutrisi, mendukung keberhasilan terapi kanker, meningkatkan kualitas hidup, serta menurunkan angka morbiditas dan mortalitas. Pemberian terapi nutrisi berupa konsultasi individu yang meliputi perhitungan kebutuhan energi, makronutrien, mikronutrien, dan nutrien spesifik, serta pemberian medikamentosa bila diperlukan. Metode: Pasien pada serial kasus ini berjumlah empat orang dengan rentang usia 3055 tahun. Dua dari empat pasien mendapat kombinasi kemoterapi. Hasil skrining keempat pasien dengan malnutrition screening tools (MST) didapatkan skor ≥2. Kebutuhan energi total dihitung menggunakan persamaan Harris-Benedict yang dikalikan dengan faktor stres sebesar 1,4. Pemantauan yang dilakukan berupa anamnesis keluhan subyektif dan analisis asupan, pemeriksaan fisik, antropometri, massa otot skelet, massa lemak, kekuatan genggam tangan, dan hasil laboratorium. Pemantauan dilakukan secara rutin dengan frekuensi satu kali per minggu untuk menilai pencapaian target nutrisi. Hasil: Terapi nutrisi dapat meningkatkan asupan protein dan nutrien spesifik, namun tidak dapat mencegah penurunan BB, massa otot skelet, dan kekuatan genggam tangan pada pasien kanker kepala dan leher stadium lanjut lokal yang menjalani terapi radiasi dengan atau tanpa kemoterapi. Kesimpulan: Tata laksana nutrisi pada pasien kanker kepala dan leher stadium lanjut lokal yang menjalani terapi kanker dapat memberikan efek positif pada asupan nutrien pasien.

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Introduction: Head and neck cancer is one of malignancy with higher risk of malnutrition. Treatment of choice for locally advanced head and neck cancer is radiotherapy with or without chemotherapy and is associated with various side effects that may decrease food intake and negatively affect nutritional status. The aim of nutrition management is to reduce the risk of malnutrition, to support the success of cancer therapy, to enhance the quality of life, and to reduce morbidity and mortality. Nutrition therapy in the form of consultation includes calculation of energy needs, macronutrient, micronutrient, and specific nutrients, as well as drug therapy when needed.

Methods: This case series consist of four patients between 3055 years old. Half of the patients received combination with chemotherapy. All patients had screening score with malnutrition screening tools (MST) ≥2. The total energy requirement was calculated using Harris-Benedict equation then multiplied with stress factor 1.4. Monitoring was done by anamnesis of subjective complaints and food intake, physical examination, anthropometric, muscle mass, fat mass, hand grip strength, and laboratory results. Monitoring was performed frequently once a week to assess the accomplishment of nutritional target.

Results: Nutrition therapy could improve intake of protein and specific nutrients, but couldn't prevent weight loss, a decrease in muscle mass and hand grip strength in locally advanced head and neck cancer patients receiving radiation therapy with or without chemotherapy.

Conclusion: Nutrition management in locally advanced head and neck cancer patients receiving anticancer therapy positively affect patient's nutrient intake."