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"AbstrakBased on data from the Hospital Information System (HIS) in 2007, breast cancer is the top ranked diagnosed cancer in Indonesia. Estrogen receptor alpha (ERα) is associated with breast cancer because it is found in high levels in cancer tissues. Curcumol, curcumenol, isocurcumenol of white tumeric rhizomes (Curcuma zedoaria (Christm.) Roscoe), and β-sitosterol from seeds of pumpkin (Cucurbita pepo L.) have been reported to have inhibitory activity against cancer cells. This study presents the in silico study of these compounds as inhibitors of ERα.Methods: Docking simulations are carried out in this paper to visualize molecular-level interactions between the four compounds with ERα. Docking simulations between estradiol and tamoxifen on ERα are carried out as well.Results: Docking results indicated that curcumol, curcumenol, isocurcumenol, and β-sitosterol showed inhibitory activity againts estrogen receptor alpha (ERα). The order of potency is shown consecutively by isocurcumenol, curcumol, curcumenol, and β-sitosterol with values 0.584 M, 1.36 M, 1.61 M, and 7.35 M respectively. Curcumenol and estradiol interacts with ERα through hydrogen bonds and hydrophobic interactions, whereas curcumol, isocurcumenol, β-sitosterol and tamoxifen through hydrophobic interactions in succession.Conclusion: Natural products containing all four compounds have the potential to be used as drugs or adjuvant drugs in breast cancer therapy."

"Latar belakang. Reseptor estrogen β (RE β) dapat berperan dalam progresi kanker payudara sesuai teori karsinogenesis multistep. Reseptor estrogen β berperan sebagai supresor tumor dan ekspresinya menurun seiring progresifitas tumor. Atypical ductal hyperplasia (ADH) adalah lesi proliferatif intraduktal payudara yang memiliki risiko 4-5 kali menjadi karsinoma payudara. Diperlukan penanda prediktif ADH yang dapat menjadi karsinoma atau tidak. Tujuan penelitian ini adalah untuk mengetahui penanda potensi ganas pada lesi ADH melalui ekspresi RE β. Bahan dan cara. Penelitian menggunakan metode potong lintang, analitik dan deskriptif. Sampel terdiri atas 24 kasus ADH tanpa karsinoma dan 24 kasus ADH yang disertai karsinoma. Dilakukan pulasan RE β dan penilaian dilakukan menggunakan H score. Hasil. H score RE β pada ADH yang disertai karsinoma lebih rendah secara bermakna dibandingkan ADH tanpa karsinoma (p 0,006). RE β dinyatakan tinggi bila H score ≥ 229,2. Kesimpulan. REβ potensial dijadikan penanda prediktif ADH yang akan menjadi karsinoma.

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Background. Estrogen receptor β (ER β) have a role in breast cancer progression through multistep carcinogenesis. ER β is a tumor supressor and its expression decreases during the tumor progression. Atypical ductal hyperplasia (ADH) is an intraductal proliferative lesion of the breast and has 4-5 times of a risk in becoming a carcinoma. The aim of this study is to obtain a marker that can predict malignant potential in ADH through expression of ER β.

Patients and methods. This is a descriptive-analytic cross-sectional study using 24 cases of ADH without carcinoma and 24 cases of ADH with carcinoma. Estrogen receptor β status were assessed by immunohistochemistry and the H score was calculated.

Results. Estrogen receptor β H score in ADH with carcinoma is significantly lower than ADH without carcinoma (p 0,006). ER β is catagorized as high if the H score ≥ 229,2.

Conclusion. ER β can potentialy be used as a malignant predictive marker in ADH."

"Latar belakang. Hubungan antara hormon estrogen pramenopause dan reseptor estrogen masih belum diketahui. Hormon estrogen memiliki faktor risiko penyebab kanker payudara. Sedangkan reseptor estrogen berperan dalam menentukan rencana pengobatan lebih lanjut pada pasien kanker payudara. Pasien dengan reseptor estrogen tinggi memiliki prognosis yang lebih baik. Jika hormon estrogen pramenopause dapat mempengaruhi reseptor estrogen, maka hormon estrogen dapat dimanipulasi untuk mendapatkan prognosis yang lebih baik. Metode. Penelitian ini dilaksanakan di Bagian Onkologi Departemen Bedah FK UI - RSCM dari bulan Desember 2021 sampai Mei 2022. Jenis penelitian ini adalah studi potong lintang, dengan sampel sebanyak 32 subjek. Subyek penelitian diambil berdasarkan kriteria inklusi dan eksklusi. Setelah itu data dikumpulkan dan dilakukan analisis menggunakan SPSS dengan uji korelasi Pearson jika berdistribusi normal dan Spearman jika berdistribusi tidak normal. Hasil. Estradiol subjek memiliki kisaran 15,3-89,8 pg/mL. Reseptor estrogen memiliki kisaran luas 10-90%. Uji korelasi Spearman antara estradiol dan reseptor estrogen menunjukkan nilai p = 0,864 dan koefisien korelasi negatif 0,032. Kesimpulan. Hormon estrogen secara statistik tidak berhubungan dengan reseptor estrogen pada pasien kanker payudara pramenopause, sehingga menggambarkan bahwa prognosis pasien kanker payudara tidak berhubungan dengan hormon estrogen yang diproduksi oleh tubuh.

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Background. The relationship between the premenopausal estrogen hormone and estrogen receptors is still not known. The hormone estrogen has a risk factor for causing breast cancer. Meanwhile, the estrogen receptor plays a role in determining further treatment plans in breast cancer patients. Patients with high estrogen receptors have a better prognosis. If the premenopausal estrogen hormone can affect the estrogen receptor, then the estrogen hormone can be manipulated to get a better prognosis.

Method. This research was conducted at the Oncology Division of the Department of Surgery, FK UI - RSCM from December 2021 to May 2022. This was cross-sectional study research, with a sample of 32 subjects. Research subjects were taken based on inclusion and exclusion criteria. After that, the data was collected and analysis was done using SPSS with the Pearson correlation test if the distribution was normal and Spearman if the distribution was not normal.

Results. The estradiol of the subjects has a range of 15.3 − 89.8 pg/mL. Estrogen receptors ​​have a wide range of 10-90%. The Spearman correlation test between the estradiol and the estrogen receptor showed a p-value = 0.864 and a negative correlation coefficient of 0.032.

Conclusion. Estrogen hormone is not statistically associated with estrogen receptors in premenopausal breast cancer patients, thus illustrating that the prognosis of breast cancer patients is not related to the estrogen hormone produced by the body."

"Latar belakang dan tujuan: Kanker payudara adalah kanker yang sering didiagnosis dan menjadi penyebab kematian akibat kanker yang paling tinggi pada perempuan di dunia. Berdasarkan data registrasi di Rumah Sakit Kanker Dharmais pada tahun 2003-2007, kanker payudara menjadi keganasan terbanyak yaitu sebesar 40,58% dari seluruh kanker. Berbagai tatalaksana dilakukan sesuai dengan protokol pengobatan yang berlaku di RS Kanker Dharmais. Meskipun telah banyak kemajuan dalam penanganan kanker payudara, tetapi masih sering dijumpai rekurensi baik rekurensi lokal, regional maupun perluasan ke organ lain. Adanya rekurensi sering dihubungkan dengan meningkatnya resiko kematian, dimana dikatakan pada kanker payudara resiko kematian 5% lebih tinggi. Penelitian ini bertujuan untuk melihat hubungan hasil pemeriksaan Estrogen - Progresteron Reseptor (ER-PR), Human Epidermal Growth Factor Reseptor-2 (Her2), dan Indeks Proliferasi (KI-67) terhadap rekurensi kanker payudara berdasarkan hasil pencitraan 18F-FDG PET/CT, pada pasien - pasien kanker payudara yang telah dilakukan terapi sesuai prosedur. Metode: Penelitian ini merupakan proses analisis dengan desain retrospektif cohort study pada pasien yang didiagnosis kanker payudara yang telah di terapi sesuai prosedur dan sembuh, serta telah dilakukan pemeriksaan 18F-FDG PET/CT. Hasil: Uji Mutlak Fisher KI-67 didapatkan hasil nilai yang signifikan yang berarti tidak hubungan bermakna antara hasil imunohistokimia KI-67 tinggi dengan rekurensi kanker payudara. Kesimpulan: Hasil penelitian ini tidak menunjukkan hubungan yang bermakna antara kanker payudara subtipe Luminal B dan Triple Negative dengan rekurensi kanker payudara dan Tidak terdapat hubungan yang bermakna antara hasil ER positif, PR positif ataupun Her2 positif terhadap rekurensi kanker payudara.

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Background and purpose: Breast cancer is frequently diagnosed cancer and cause of cancer deaths in women are highest in the world. Based on registration data in Dharmais Cancer Hospital in the years 2003-2007, breast cancer is a malignancy that is equal to 40.58% majority of all cancers. Various management of treatment carried out in accordance with the applicable protocol Dharmais Cancer Hospital. Although progress has been made in the treatment of breast cancer, but recurrence is common both local recurrence, regional and extension to other organs. Recurrence is often associated with increased risk of death, which is said in the breast cancer death risk 5% higher. This study aimed to examine the relationship examination Estrogen - progesterone receptors (ER-PR), Human Epidermal Growth Factor Receptor-2 (Her2), and proliferation index (Ki-67) against the recurrence of breast cancer based on imaging of 18F-FDG PET / CT , in patients - patients who have breast cancer therapy according to the procedure.

Methods: This study is the retrospective analysis of a cohort study design in patients diagnosed with breast cancer who had been in therapy according to the procedure and recovery, and has been examined 18F-FDG PET / CT.

Results: Absolute Fisher Test KI-67 showed significant value, which means there is significant relationship between the results of immunohistochemical high KI-67 with a recurrence of cancer.

Conclusion: The results of this study showed no significant association between breast cancer subtypes Luminal B and Triple Negative breast cancer with recurrence and There is a significant association between the results of ER positive, PR positive and Her2 positive breast cancer on recurrence."

"Tujuan: untuk menganalisis penanda biologi CXCR4, IL11-RA, TFF1 dan MLF1P, klinikopatologi dan profil ekspresi genetik mRNA sebagai penanda peningkatan kejadian metastasis tulang pada pasien kanker payudara stadium lanjut.Metode: studi ini merupakan penelitian potong lintang. Analisis dilakukan pada total 92 pasien kanker payudara, terdiri atas 46 pasien metastasis tulang dan 46 pasien dengan metastasis nontulang. Analisis imunohistokimia dan microarray, dilakukan pada 81 sampel formalin fixed paraffin embedded (FFPE) dari 81 pasien yang didapat. Data dikumpulkan melalui rekam medis, pemeriksaan imunohistokimia (IHK), dan microarray dengan nanoString nCounterTM.Hasil: artikel ini merupakan bagian satu dari dua tahap pelaporan hasil penelitian. Pada tahap satu diperoleh hasil analisis IHK, IL11-RA dengan cut-off ≥103,5 menunjukkan peningkatan kejadian metastasis tulang, dengan OR 3,803 (95 % interval kepercayaan [IK], 1,375-10,581), p=0,010, dan MLF1P dengan cut-off ≥83,0 menunjukkan peningkatan kejadian metastasis tulang, dengan OR 2,784 (95% IK, 1,009-7,681), p=0,048. Status ER+ menunjukkan peningkatan kejadian metastasis tulang, dengan OR 7,640 (95 % IK, 2,599-22,459), p<0,000. AUC gabungan IL-11RA, MLF1P dan ER+, mempunyai ketepatan hampir 80% (meningkat dibandingkan AUC masing-masing secara terpisah), untuk membedakan dan menjelaskan kejadian metastasis tulang, pada kanker payudara stadium lanjut.Kesimpulan: IL11-RA, MLF1P dan ER+, merupakan determinan peningkatan kejadian metastasis tulang pasien kanker payudara stadium lanjut.

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Aim: to analyze expression of biomarkers CXCR4, IL11-RA, TFF1 and MLF1P, and clinico pathology in advanced breast cancer patients with bone metastatic.Methods: this is a cross-sectional study. Analysis was done against a total of 92 breast cancer patients, including 46 bone metastatic patients and 46 non-bone metastatic patients. Immunohistochemistry and microarray analysis was performed in 81 formalin fixed paraffin embedded (FFPE) samples from 81 patients were used. Data were collected through medical records, immunohistochemistry (IHC), and microarray with nanoString nCounterTM. Results: this article is part one of a two stage reporting research results. In part one we got the results of the IHC analysis, IL11-RA with cut-off ≥103.5 showed OR 3.803 (95 % confidence interval [CI], 1.375-10.581), p=0.010, MLF1P with cut-off ≥83.0 OR 2.784 (95% CI, 1.009-7.681), p=0.048, and ER+ OR 7.640 (95 % CI, 2.599-22.459), p<0.000, were associated with bone metastastic incidences in advanced breast cancer, and were statistically significantly different. A combination of IL-11RA, MLF1P and ER+, showed an accuracy of approaching 80% to discriminate between bone metastatic and non bone metastatic in advanced breast cancer patients.Conclusion: IL11-RA, MLF1P, and ER+ were the determinants that were associated with increasing bone metastasis incidence."

"Pasien dengan kanker payudara banyak yang mengalami gangguan dan hampir seluruhnya mengalami depresi yang dapat memperberat gejala fisik, meningkatkan gangguan fungsional, dan membuat kepatuhan berobat menjadi rendah. Kami melakukan tinjauan pustaka yang tersedia di PubMed tentang prevalensi, besar gangguan, kemampuan coping, dan metode penatalaksanaan depresi berat pada wanita dengan kanker payudara dari tahun 1978 sampai 2010. Diagnosis dan penatalaksanaan episode depresi pada wanita dengan kanker payudara merupakan tantangan karena gejala yang tumpang tindih dan kondisi penyerta. Depresi berat sering disepelekan dan penatalaksanaan tidak adekuat pada pasien kanker payudara. Tinjauan ini menekankan pada masalah dalam identifikasi dan pengelolaan depresi pada pasien kanker payudara dengan latar klinis.

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AbstractMany of breast-cancer patients experience distress and most of them experience depression which may lead to amplification of physical symptoms, increased functional impairment, and poor treatment adherence. We did a review on available literature from PubMed about prevalence, distress magnitudes, coping styles, and treatment methods of major depression in women with breast cancer from 1978 to 2010. Diagnosis and treatment of depressive episodes in women with breast cancer is challenging because of overlapping symptoms and co-morbid conditions. Major depression is often under-recognized and undertreated among breast cancer patients. This review highlighted the issues on identifying and managing depression in breast cancer patients in clinical settings."

"ABSTRAK Latar Belakang: EORTC menekankan pentingnya menilai kualitas hidup pasien kanker. Saat ini, di Indonesia, belum ada kuesioner yang reliabel dan valid untuk menilai kualitas hidup pasien kanker payudara secara akurat. Tujuan: membuktikan bahwa EORTC-QLQ-BR23 merupakan kuesioner yang reliabel dan valid digunakan di Indonesia Metode: Penelitian dimulai dengan menerjemahkan EORTC-QLQ-BR23 ke dalam bahasa Indonesia dan kemudian diujicobakan pada 10 responden. Setelah itu, EORTC QLQ-BR23 hasil terjemahan digunakan pada penelitian utama. Test-retest dinilai dengan Intraclass Correlation Coeficient (ICC). Konsistensi internal dinilai dengan cronbach alpha. Construct validity dinilai dengan multi-trait scaling analysis. Validitas kriteria dinilai dengan melihat korelasi antara domain EORTC-QLQ-C30 dan EORTC-QLQ-BR23 dengan SF36. Hasil: Telah dilakukan pengambilan data terhadap 100 pasien kanker payudara dari September ? Oktober 2015. Nilai ICC (interval 1 jam) pada semua domain sangat baik (ICC > 0,8). Nilai cronbach alpha > 0,7 pada hampir semua domain. Multi-trait scaling analysis menunjukkan korelasi cukup tinggi antara skor pertanyaan dengan skor domainnya sendiri. Uji validitas kriteria, didapatkan 19 korelasi dengan r > 0,3 antara domain EORTC-QLQ-C30 dan EORTC-QLQ-BR23 dengan SF36. Simpulan: EORTC-QLQ-BR23 merupakan kuesioner yang reliabel dan valid digunakan di Indonesia.ABSTRACT Background: EORTC emphasize the importance of assessing quality of life in cancer patients. In Indonesia, there has been no reliable and valid questionnaire to assess quality of life of breast cancer patients accurately. Objective: To prove that EORTC-QLQ-BR23 is reliable and valid questionnaire used in Indonesia. Methods: Study began with the EORTC-QLQ-BR23 translated into Indonesian and then tested on 10 respondents. Indonesian version of EORTC-QLQ-BR23 is used in main study. Test-retest was assessed with intraclass correlation coeficient (ICC). Internal consistency was assessed by Cronbach alpha. Construct validity was assessed by multi-trait scaling analysis. Criteria validity assessed by looking at correlation between EORTC-QLQ-C30 and EORTC-QLQ-BR23 with SF36. Results: Data collection were done on 100 breast cancer patients from September to October 2015. ICC value (1 hour interval) in all domains of EORTC-QLQ-BR23 is very good (ICC> 0.8). Cronbach alpha values >0.7 in almost all EORTC-QLQ-BR23 domains. Multi-trait scaling analysis showed a high correlation between scores of questions with a score of his own domain. Criteria validity test, obtained 19 correlation with r>0,3 between domains EORTC-QLQ-C30 and EORTC-QLQ-BR23 with SF36. Conclusion: EORTC-QLQ-BR23 is a reliable and valid questionnaire used in Indonesia.;Background: EORTC emphasize the importance of assessing quality of life in cancer patients. In Indonesia, there has been no reliable and valid questionnaire to assess quality of life of breast cancer patients accurately. Objective: To prove that EORTC-QLQ-BR23 is reliable and valid questionnaire used in Indonesia. Methods: Study began with the EORTC-QLQ-BR23 translated into Indonesian and then tested on 10 respondents. Indonesian version of EORTC-QLQ-BR23 is used in main study. Test-retest was assessed with intraclass correlation coeficient (ICC). Internal consistency was assessed by Cronbach alpha. Construct validity was assessed by multi-trait scaling analysis. Criteria validity assessed by looking at correlation between EORTC-QLQ-C30 and EORTC-QLQ-BR23 with SF36. Results: Data collection were done on 100 breast cancer patients from September to October 2015. ICC value (1 hour interval) in all domains of EORTC-QLQ-BR23 is very good (ICC> 0.8). Cronbach alpha values >0.7 in almost all EORTC-QLQ-BR23 domains. Multi-trait scaling analysis showed a high correlation between scores of questions with a score of his own domain. Criteria validity test, obtained 19 correlation with r>0,3 between domains EORTC-QLQ-C30 and EORTC-QLQ-BR23 with SF36. Conclusion: EORTC-QLQ-BR23 is a reliable and valid questionnaire used in Indonesia."

"Fetus seperti organ-at-risk (OAR) lainnya diketahui sangat radiosensitif, maka perlu dilakukan perencanaan radioterapi yang tepat untuk menjaga fetus menerima dosis di bawah dosis ambangnya. Simulasi Monte Carlo menggunakan PRIMO diketahui memberikan akurasi yang tinggi dalam probabilitas untuk produksi partikel menggunakan mesin linac Varian Unique. Hasil kecocokkan kurva profil berkas dan percentage depth dose (PDD) pada simulasi PRIMO terhadap commissioning BDC secara berurutan memiliki ketidakpastian sebesar 2,93 ± 0,09% dan 0,51 ± 0,02%. Setelah PRIMO memproduksi partikel yang menyesuaikan kondisi lapangan linac Varian Unique, penyinaran dilakukan menggunakan fantom khusus yang tersusun atas gabungan fantom CIRS dan fantom air balok. Fantom dirancang pada kedalaman 22 cm yang mewaliki trimester 2. Penyinaran payudara menggunakan teknik empat lapangan: 1) Tangensial I (Medio Lateral), 2) Tangensial II (Latero Medial), 3) Supraclavicula, dan 4) Axilla. Rentang persentase dosis pada PRIMO diamati 0,03 – 0,28% di kedalaman 2 cm, 0,03 – 0,26% di kedalaman 5 cm, dan 0,03 – 0,25% di kedalaman 10 cm. Hasil simulasi PRIMO dibandingkan terhadap hasil treatment planning system (TPS) dan penelitian Mulyaningsih [8] dengan kondisi fantom dan lapangan yang sama. Simulasi PRIMO dan Mulyaningsih [8] memiliki kesesuaian pada jarak pengukuran 32 – 26 cm dan mengalami tren yang serupa yaitu kenaikan persentase dosis yang drastis pada jarak pengukuran di bawah 24 cm.

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Fetus like any other organ-at-risks is known to be highly radiosensitive, therefore an accurate radiotherapy planning is necessary to keep the fetal dose below the threshold. PRIMO Monte Carlo simulation is used as it gives excellent accuracy in terms of particle production using the Varian Unique linac. The commissioning results of both the beam profile and the percentage depth dose in sequence are having uncertainties of 2.93±0.09% and 0.51±0.02%. After PRIMO produces the particles that suit the condition of Varian Unique linear accelerator, the treatment uses a special configurated phantom consisting CIRS and water phantom. The phantom has a depth of 22 cm that resembles pregnancy age of the 2nd trimester. The treatment configures a four-field technique: 1) Tangential I (Latero Medial), 2) Tangential II (Medio Lateral), 3) Supraclavicula, and 4) Axilla. The dose percentage range of PRIMO is measured 0.03–0.28% in the depth of 2 cm, 0.03–0.26% in the depth of 5 cm, and 0.03–0.25% in the depth of 10 cm. The result of PRIMO simulation is then compared with the treatment planning system (TPS) and the thesis performed by Mulyaningsih [8] under the same condition. PRIMO simulation and Mulyaningsih [8] governs likeliness in the measuring distance range of 32–26 cm and inhabits a similar trend in the measuring distance below 24 cm, that in particular is a drastic increasing dose percentage."

"Kemoterapi neoajuvan (KNA) merupakan salah satu modalitas terapi pada kanker payudara lanjut lokal (KPD-LL). Beberapa studi telah menunjukkan KNA dapat meningkatan kesintasan keseluruhan bila didapatkan respons patologis komplet, namun efektifitasnya dihambat oleh kemoresistensi yang dapat dimediasi oleh P-glycoprotein (Pgp). Tujuan dari studi ini adalah untuk mengkaji hubungan antara ekspresi Pgp dengan respons terhadap KNA pada pasien KPD-LL. Studi kohort prospektif multisentra dilakukan di RSUPN Dr. Cipto Mangunkusumo dan RSUD Koja pada periode September 2018 sampai Mei 2019. Analisis imunohistokimia dilakukan pada sampel biopsi untuk menilai ekspresi Pgp secara semikuantitatif. Respons klinis dinilai pascakemoterapi tiga siklus dengan menggunakan kriteria WHO. Subjek yang dinilai operabel pascaKNA menjalani operasi mastektomi radikal modifikasi. Respons patologis dinilai pada spesimen bedah dengan menggunakan kriteria Miller-Payne. Pgp didapatkan positif pada 21/27 subjek (77,8%) dan lemah/negatif pada 6/27 subjek (22,2%). Respons patologis komplet hanya didapatkan pada satu pasien dengan Pgp negatif. Tidak ada perbedaan secara statistik antara subjek dengan Pgp positif dan Pgp negatif dalam hal respons klinis maupun respons patologis. Hasil studi ini menunjukkan bahwa mayoritas pasien KPD-LL mengekspresikan Pgp, namun Pgp tidak dapat digunakan sebagai prediktor respons terhadap KNA, baik klinis maupun patologis.

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Neoadjuvant chemotherapy (NACT) is one of the modalities used to treat locally advanced breast cancer (LABC). Studies have shown that it can improve overall survival if pathological complete response is achieved, but it is impeded by chemoresistance of which can be mediated by P-glycoprotein (Pgp). The aim of this study is to explore the association between Pgp expression and response to NACT. A multicenter prospective cohort study was carried out in Dr. Cipto Mangunkusumo General Hospital and Koja General Hospital from September 2018 to May 2019. Immunohistochemical analyses of the biopsy samples were done to semiquantitatively measure Pgp expression. Clinical response was evaluated after three cycles NACT using WHO response criteria. Subjects, who were deemed operable post-NACT, underwent modified radical mastectomy. Afterwards, the surgical specimens were evaluated for pathological response following Miller-Payne criteria. Pgp was strongly expressed in 21/27 subjects (77.8%) and weak/negative in 6/27 subjects (22.2%). pCR was seen only in one Pgp negative subject. There was no difference between Pgp positive and negative subjects in terms of clinical response and pathological response. The results show, Pgp is expressed in the majority of LABC patients, but it cannot be used as a predictor of response to NACT, either clinically or pathologically."