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"Latar belakang: Aldehyde dehydrogenase 1 (ALDH1) merupakan marker sel punca kanker serviks yang menunjukkan karakteristik radioresisten. Studi ini bertujuan untuk mengetahui hubungan ALDH1 terhadap respon radiasi karsinoma sel skuamosa serviks stadium IIIB.Metode: Sebanyak 58 sampel dari 360 pasien yang didiagnosis karsinoma sel skuamosa serviks stadium IIIB yang mendapat radiasi lengkap periode 2016 – 2021 di RSCM memenuhi kriteria eligibilitas subjek penelitian ini. Pemeriksaan MRI pra-radiasi dan pasca radiasi serta ekspresi ALDH dengan imunohistokimiawi (Santa Cruz®) dilakukan pada 58 sampel blok paraffin. Respon terapi dinilai pada 3 bulan setelah radiasi. Kami membandingkan respon terapi komplet yang dihasilkan pada ekspresi ALDH rendah dan ekspresi ALDH tinggi. Analisis dilakukan dengan software SPSS.Hasil: Nilai titik potong optimal skor ALDH terhadap respon radiasi adalah 166,05 pg/mL yang diperoleh dari analisis kurva ROC. Nilai AUC menunjukkan hasil 0.682 dengan sensitivitas 63,6% dan spesifisitas 64,0%. Skor ALDH ≥166,05 meningkatkan risiko hingga 3,1 kali untuk tidak tercapainya respon komplet (adj OR 3,127, IK 95% 1,034 – 9,456, p = 0,043). Ukuran tumor pre-radiasi (p = 0,593), derajat diferensiasi (p = 0,161), kelainan ginjal pre-radiasi (0,114), dan keratinisasi (p = 0,477) tidak berhubungan dengan respon radiasi.Kesimpulan: Ekspresi ALDH yang tinggi berhubungan dengan respon radiasi tidak komplet pada karsinoma sel skuamosa serviks stadium IIIB. Pasien dengan skor ALDH ≥ 166,05 meningkatkan risiko tidak tercapainya respon komplet hingga 3,1 kali lebih tinggi dibandingkan dengan subjek dengan skor ALDH < 166,05.

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Background: ALDH is cancer stem cell marker that has radioresistance characteristic. This study aims to determine the association between ALDH1 and the radiation response of stage IIIB cervical squamous cell carcinoma.

Methods: A total 58 of 360 patients diagnosed with stage IIIB cervical squamous cell carcinoma who received complete radiation during 2016-2021 at the RSCM met the eligibility criteria for this study. Pre- and post-irradiation MRI examinations and ALDH expression with immunohistochemistry (Santa Cruz®) were performed on 58 paraffin block samples. Therapy response was assessed at 3 months after radiation. We compared the complete response resulting in low and high ALDH expression. The analysis was carried out with SPSS software.

Results: The optimal ALDH score cut-off point on the radiation response was 166.05 pg/mL which was obtained from the analysis of the ROC curve. The AUC value was 0.682 with sensitivity and specificity, 63,6% and 64%, respectively. ALDH score ≥166.05 increased the risk by 2.7 times for not achieving the complete response (OR = 2,656, IK 95% 0,844 – 8,356, p = 0,095). Pre-radiation tumor size (p = 0.593), degree of differentiation (p = 0.161), renal abnormalities (p = 0.114), and keratinization (p = 0.477) were not associated with radiation response.

Conclusions: High ALDH expression was associated with incomplete radiation response in squamous cell carcinoma of cervix stage IIIB"

"Latar Belakang: Kanker serviks merupakan salah satu penyebab kematian tertinggi dari seluruh kasus keganasan di Indonesia. Salah satu penyebab tingginya angka kematian adalah pasien baru mulai mencari pengobatan pada stadium lanjut. Radioterapi tunggal dapat digunakan sebagai tatalaksana kanker serviks stadium lanjut pada pasien yang tidak dapat mentoleransi efek samping kemoterapi. Tetapi, pasien dengan kanker serviks menunjukkan respon yang beragam terhadap radioterapi.Tujuan: Penelitian ini bertujuan untuk menilai hubungan antara densitas CD8+ TILs pada kanker< serviks dengan respon terhadap radioterapi.Metode: Penelitian ini merupakan penelitian kasus kontrol. Kelompok respon radiasi komplet sebagai kasus dan kelompok populasi respon radiasi tidak komplet sebagai kelompok kontrol. Populasi penelitian adalah pasien yang telah didiagnosis sebagai karsinoma sel skuamosa serviks di Departemen Patologi Anatomik FKUI/RSCM dari tanggal 1 Januari 2016 hingga 31 Desember 2021, menerima radioterapi definitif di Departemen Onkologi Radiasi RSCM, dan memiliki data respon radioterapi yang lengkap. Pengambilan sampel dilakukan secara konsekutif. Data dianalisis secara statistik untuk menilai faktor-faktor yang mempengaruhi respon radiasi.Hasil: Didapatkan 40 kasus KSS serviks stadium IIIB yang terdiri atas 20 kasus dengan respon radiasi komplet dan 20 kasus dengan respon radiasi tidak komplet. Median densitas CD8+ iTILs pada kelompok yang mengalami respon komplet lebih tinggi dibandingkan dengan kelompok yang tidak mengalami respon komplet (1099 sel/mm2 vs 920,27 sel/mm2, p = 0,035) Nilai titik potong yang direkomendasikan untuk memprediksi respon terhadap radioterapi adalah 959,32 sel/mm2. Tidak ditemukan hubungan yang bermakna secara statistik antara ukuran tumor, derajat diferensiasi, dan keratinisasi terhadap respon terhadap radioterapi.Kesimpulan: Densitas CD8+ iTILs yang lebih tinggi berhubungan dengan respon terhadap radioterapi pada pasien KSS serviks stadium IIIB.

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Background: Cervical cancer is one of the leading causes of death related to malignancies. One of the contributing factor toward this high mortality rate is that patients are usually diagnosed at an already advanced stage. Radiotherapy can be used as a treatment for advanced cervical patients who cannot tolerate the side effects of chemotherapy. However, patients with cervical cancer show mixed responses to radiotherapy.

Objectives: This study aims to assess the association between CD8+ TILs density in advanced stage cervical cancer and its response to radiotherapy.

Methods: This is a case-control study. The study population were patients diagnosed with stage IIIB uterine cervix squamous cell carcinoma at the Department of Anatomical Pathology Faculty of Medicine University of Indonesia (FMUI)/Cipto Mangunkusumo Hospital (CMH) from January 1st, 2016 up to December 31st, 2021, who received definitive radiotherapy at the Department of Radiation Oncology FMUI/CMH, and had complete radiotherapy response data. Patients with complete response are classified as the response group and those with incomplete response are classified as the control group. Sampling is done consecutively. The data were statistically analyzed to assess the factors influencing radiation response.

Results: Forty cases of stage IIIB uterine cervix squamous cell carcinoma were selected, consisting of 20 cases with complete radiation response and 20 cases with incomplete response. The median CD8+ iTILs density in the complete response group was higher than in the incomplete response group (1099 cells/mm2vs 920,27 cells/mm2, p: 0,035). The recommended cut-off point for predicting radiotherapy response was 959,32 cells/mm2. No statistically significant relationship was found between tumor size, degree of differentiation, and keratinization on response to radiotherapy.

Conclusion: Higher CD8+ iTILs density was associated with better response to radiotherapy in stage IIIB uterine cervix squamous cell carcinoma."

"Latar Belakang : Pasien kanker serviks di Indonesia terbanyak dalam stadium lanjut. Terapi standarnya adalah radiasi. Respons terapi radiasi tidak selalu komplet. MnSOD merupakan garda terdepan melawan radikal bebas yang dihasilkan radiasi. Aktifitas MnSOD dipikirkan dapat digunakan sebagai prediktor respons terapi radiasi. Diperkirakan semakin tinggi aktifitas MnSOD akan semakin buruk respons radiasinya. Tujuan : Menilai aktifitas MnSOD pada biopsi KSS serviks stadium IIIB sebagai prediktor keberhasilan terapi radiasi. Metode : Penelitian potong lintang komparatif ini dilakukan di Divisi Onkologi Ginekologi, Departemen Obstetri dan Ginekologi FKUI, RSCM Jakarta dan Departemen Biokimia dan Biologi Molekuler FKUI. Dilakukan penelusuran data base penelitian sebelumnya untuk mengindentifikasi sampel respons positif dan negatif, dilanjutkan pemeriksaan aktifitas MnSOD dengan sprektrofotometri metode McCord dan Fridovich menggunakan kit RanSOD . Data komparatif yang didapat kemudian di analisis. Hasil : Didapatkan 76 sampel yang memenuhi kriteria inklusi terdiri dari respons positif 47 61,8 negatif 29 38,2 . Dilakukan kategorisasi aktifitas MnSOD dengan titik potong pada nilai 13,126 U/mL. Dengan uji chi-square didapat hubungan bermakna secara statistik antara aktifitas MnSOD pada pasien kanker stadium IIIB dengan respons terapi radiasi. Nilai RR sebesar 1,849 1.075-3.178, IK 95 . Kesintasan dengan analisis bivariat memakai metode Kaplan-Meier: pasien dengan aktifitas MnSOD cutoff < 13,126 U/mL memiliki tingkat kesintasan 1 tahun yang lebih baik 63 dibandingkan dengan pasien kanker serviks IIIB dengan nilai aktifitas MnSOD ge; 14 . Risiko kematian dengan pengujian bivariat metode regresi cox: pasien dengan aktifitas MnSOD cutoff 13,126 U/mL memiliki risiko kematian 1,055 kali IK 95 : 1,003-1,110 dibanding pasien dengan aktifitas MnSOD dibawah nilai cutoff. Dari analisis multivariat terlihat aktifitas MnSOD semakin kuat sebagai prediktor respons terapi radiasi. Kesimpulan : Aktifitas MnSOD tinggi pada jaringan KSS serviks stadium IIIB menghasilkan respons negatif dari terapi radiasi.

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Background: Most of the cervical cancer patients in Indonesia came with advanced stage. Therefore, the choice of treatment is radiotherapy. Although, radiotherapy does not always result in complete response. MnSOD is considered to be one the antioxidant enzyme which has the ability to work against free radicals. Its activity is expected to be acted as response predictor to radiotherapy treatment. It is hypothesized that high MNSOD activity tend to predict poor response of radiotherapy on advanced cervical cancer patients.

Objective : To investigate MnSOD activity on cervical SCC stage IIIB as a predictor of radiotherapy response.

Methods : It is a comparative cross sectional study conducted in the Gynecology Oncology Division, Obstetrics and Gynecology Department, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine, University of Indonesia. Samples were collected from the tissue bank and research database. They were identified and divided into having positive or negative response to radiotherapy. In vitro experiment was conducted to measure the activity of MnSOD. Manganese superoxide dismutase was isolated using McCord and Fridovich method using RanSOD and the activity was analyzed using spectrophotometry. Data was then analyzed using SPSS.20 for comparative study.

Results : Seventy six samples were included in the study 47 61.8 with positive response and 29 38.2 with negative response on radiotherapy. Samples were then divided into having MnSOD activity of 13.126 U mL or 13.126 U mL. Univariate analysis chi square showed that there was statistically significant correlation between MnSOD activity and radiotherapy response in patients with cervical SCC stage IIIB RR 1.849 95 CI 1.075 3.178 . Survival analysis on the first year showed that patients with MnSOD activity 13.126 U mL had better survival than patients with MnSOD activity 13.126 U mL 63 vs 14 , Kaplan Meier study . Hazard ratio for overall survival was 1.055 95 CI 1.003 ndash 1.110 for patients with MnSOD activity of 13.126 U mL. Multivariate analysis showed that MnSOD activity was a strong predictor of radiotherapy response in this study.

Conclusion : This in vitro study showed that high activity of MnSOD was associated with poor response of radiotherapy for patients with cervical squamous carcinoma stage IIIB. "

"Latar belakang: Kanker serviks menduduki peringkat kedua sebagai kanker tersering di seluruh dunia. Karsinoma sel skuamosa KSS adalah jenis histopatologi kanker serviks tersering. Prognosis terapi dan kesintasan KSS serviks menjadi informasi yang penting untuk pasien dan klinisi.Tujuan: 1.Memperbaiki prognosis dan respon terapi radiasi pasien KSS serviks; 2.Mengetahui respon pasca terapi radiasi pada pasien KSS serviks stadium IIIB; 3.Mengetahui prevalensi dan deskripsi sosiodemografi pasien KSS serviks stadium IIIB; 4.Mengetahui perbedaan klinikopatologik pasien KSS serviks stadium IIIB ditinjau dari: diameter massa serviks, derajat diferensiasi sel kanker, dan jenis histopatologi sel kanker; Mengetahui kesintasan 1 tahun setelah menjalani terapi radiasi. Metode: Dilakukan telaah historical kohort pada 76 pasien KSS serviks stadium IIIB di RSCM dari tahun 2016-2017. Pasien dikelompokkan menjadi KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB. Dilakukan analisis univariat, bivariat, dan multivariat. Kesintasan 1 tahun dianalisis dengan menggunakan Kaplan-Meier. Hasil: Prevalensi terbagi menjadi 36 pasien 47,4 dengan pembesaran KGB, dan 40 pasien 52,6 tanpa pembesaran KGB. Respon terapi radiasi pada KSS serviks IIIB dengan pembesaran KGB lebih rendah, RR 4,26 1,96 -9,27, IK 95 . Skor prediktor 2.1 sebagai titik potong untuk menentukan diagnosis respons negatif pada terapi radiasi LR 2,31, sensitivitas 96,3 , spesifisitas 58,3 , dan akurasi 77,3 . Deskripsi sosiodemografi dan klinikopatologi sebanding antara kedua kelompok. Kesintasan 1 tahun KSS serviks stadium IIIB tanpa pembesaran KGB lebih baik HR 9,57. Kesimpulan: Terdapat perbedaan bermakna terhadap respon terapi radiasi antara kelompok KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB.

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Background: Cervical cancer is second rank as the most common cancer worldwide. Squamous cell carcinoma SCC is the most common histopathology type for cervical cancers. The radiotherapy prognostic and survival rate of cervical SCC becomes important information for patients and clinicians.

Objectives: 1 To improve prognostic and radiotherapy respond from SCC; 2 knowing the radiotherapy response in patients stage IIIB cervical SCC with lymph node enlargement LNE compared to without LNE; 3 knowing the prevalence and description of sociodemographic; 4 knowing clinicopathologic differences in stage IIIB cervical SCC patients in terms of: cervical mass diameter, differentiated grade of cancer cells, and histopathologic type of cancer cells. 5 Knowing 1 year survival rate after radiotherapy.

Method: A historical cohort study was undertaken in 76 patients with stage IIIB cervical SCC in RSCM from 2016-2017. Patients are grouped into stage IIIB cervical SCC with LNE and without LNE. Univariate, bivariate, and multivariate analyzes were performed. The 1-year survival was analyzed using Kaplan-Meier.

Results: Prevalence was divided into 36 patients 47.4 with LNE, and 40 patients 52.6 without LNE. The radiotherapy respon for stage IIIB cervical SCC with LNE is worst than without LNE, RR 4.26 1.96-9.27, 95 IK . Predictor score ge;2.1 as the cutoff point to determine negative response on radiotherapy LR 2.31, sensitivity 96.3 , specificity 58.3 , and accuracy 77.3 . Sociodemographic and clinicopathologic descriptions were comparable between the two groups. The 1-year survival of stage IIIB cervical SCC without LNE better than with LNE, HR 9.57 3.28 ndash;27.88 95 IK.

Conclusion: There was a significant difference to radiotherapy response between the stage IIIB cervical SCC with LNE and without LNE."

"Angka kematian kanker serviks masih tinggi karena banyak pasien datang berobat pada tahap lanjut. Respons terapi radiasi pada pasien kanker serviks stadium lanjut bervariasi walau dengan faktor klinikopatologi yang sama seperti stadium, massa tumor, jenis histopatologi, derajat diferensiasi, invasi limfovaskular, reaksi limfosit dan nekrosis. Oleh karena itu dipikirkan faktor prognosis lain seperti faktor apoptosis-survivin, telomerase dan sitokrom c. Penelitian ini bertujuan untuk mengetahui peran survivin, telomerase, dan sitokrom c sebagai prediktor respons terapi radiasi pada kanker serviks stadium lanjut khususnya stadium IIIB.Studi ini bersifat prospektif menggunakan metode nested case control. Pengambilan data dilakukan di Poliklinik Onkologi Departemen Obstetri dan Ginekologi RSCM serta Departemen Patologi Anatomi FKUI pada bulan Januari 2016 hingga Mei 2017. Pada subjek penelitian dilakukan wawancara, pemeriksaan histopatologi dan pemeriksaan biokimia secara ELISA untuk mengetahui kadar survivin, telomerase, sitokrom c, dan MRI pra-radiasi serta pasca-radiasi. Dari 90 subjek penelitian didapatkan rerata usia pasien 50 tahun, rerata massa tumor 6,7 cm dan sebagian besar berkeratin 84,4 , berdiferensiasi baik 81,1 , reaksi limfosit negatif 75,6 dan nekrosis 74,4 . Rerata faktor apoptosis-survivin, telomerase dan sitokrom c adalah 591,2 pg/mL, 5.223,2 pg/mL dan 191,3 ng/mL. Dari analisis bivariat didapatkan variabel yang berhubungan dengan respons terapi secara independen adalah massa tumor p = 0,1 , diferensiasi p = 0,17 , kadar survivin p = 0,01 , kadar telomerase p = 0,08 dan kadar sitokrom c p = 0,47. Hasil analisis multivariat didapatkan hubungan kadar survivin dan kadar telomerase dengan respons terapi radiasi p = 0,01 dan p = 0,07 . Tidak terdapat hubungan kadar sitokrom c dengan respons terapi radiasi p = 0,64 . Dengan model cox regresi survival didapatkan hazard ratio subjek dengan kadar survivin tinggi dan kadar telomerase tinggi terhadap respons terapi radiasi negatif adalah 4,20 dan 1,97.Simpulan: kadar survivin dan telomerase tinggi berhubungan dengan respons terapi radiasi negatif.

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Cervical cancer mortality rate is still high mostly due to patients seeking for help in advanced stage of the disease. Even with the same clinicopathologic features such as stage of the diseases, size of the tumor, histopathological types, level of differentiation, lymphocyte reaction and tumor necrosis, the radiotherapy outcomes still vary from patient to patient. Therefore, we thought another predictive factors like apoptosis inducing factors i.e. survivin, telomerase and cytochrome c as a new predictor of therapeutic resp onses on patients with stage IIIB squamous cell carcinoma of cervix.

This is a prospective study with nested case control method. Data collection was conducted in Oncology Polyclinic, Department of Obstetrics and Gynecology RSCM and Department of Pathological Anatomy of FKUI from January 2016 to May 2017. Subjects were interviewed, conducted histopathological and biochemical examination with ELISA to determine levels of survivin, telomerase, cytochrome c, and patients undergo pre and post radiation MR imaging.

There were 90 patients in this study with the mean of ages was 50 years, mean of tumor size was 6.7 cm and most subjects were keratinizing 84.4 , well differentiated 81.1 , negative lymphocyte reaction 75.6 and tumor necrosis 74.4 . The mean levels of apoptosis inducing factors survivin, telomerase and cytochrome c were 591.2 pg mL, 5,223.2 pg mL, and 191.3 ng mL.

Bivariate analysis showed the independent association between tumor size, level of differentiation, levels of survivin and telomerase p 0.1, p 0.17, p 0.01, p 0.08 . Multivariate analysis showed the correlation between levels of survivin and telomerase with radiation therapeutic response p 0.01 and p 0.07 and there was no association with level of cytochrome c p 0.64 With the survival cox regression models, the hazard ratio of subjects with high levels of survivin and telomerase on the negative radiation therapy responses were 4.20 and 1.97.Conclusion there were association between high levels of survivin and telomerase on the negative radiation therapy response. "

"Aldehida dehidrogenase (ALDH) merupakan enzim yang berperan penting pada metabolisme alkohol. Penurunan aktivitas enzim ALDH lebih berpengaruh pada hipersensitivitas terhadap alkohol daripada penurunan aktivitas alkohol dehidrogenase. Enzim ALDH terdapat dalam beberapa isozim. Di antara isozim-isozim ini, ALDH2 merupakan isozim utama yang mempunyai afinitas yang sangat tinggi terhadap asetaldehida. Dari hasil penelitian terdahulu diketahui bahwa defisiensi ALDH2 dapat diturunkan. Polimorfisme fungsional gen ALDH2 telah diteliti pada satu nukleotida di dalam kodon ke 487. Pada gen yang atipik, kodon ini terdiri dari nukleotida AAA yang menyandi asam amino lisin, sebagai pengganti GAA untuk asam glutamat pada gen wild type. Pada penelitian ini telah dianalisis polimorfisme genetik gen ALDH2 di antara 100 mahasiswa Indonesia dengan menggunakan DNA genom yang diekstraksi dari akar rambut. Untuk tujuan tersebut digunakan metode PCR (Polymerase Chain Reaction) dan RFLP (Restriction Fragment Length Polymorphism). Tiga primer oligonukleotida dirancang untuk dua tahap PCR. Primer reverse (R) dikonstruksi sedemikian rupa sehingga tidak 100% komplementer dengan untai DNA cetakan, dengan tujuan agar dihasilkan situs restriksi EcoRI yang mencakup nukleotida yang variabel pada produk PCR dari gen ALDH2. Penelitian ini membuktikan bahwa 70 subyek (70%) memiliki alel ALDH2 wild type, sedangkan 29 (29%) subyek dengan alel ALDH2 yang atipik heterozigot dan hanya 1 (1%) yang atipik homozigot. Dapat disimpulkan bahwa frekuensi alel ALDH2 yang atipik pada orang Indonesia (31/200) lebih tinggi daripada frekuensi tersebut pada orang Kaukasoid (hanya sekitar 5-10%), namun lebih rendah dibandingkan dengan frekuensi pada orang Mongoloid (40-50%). Hal ini mungkin berkaitan dengan keanekaragaman etnik yang dijumpai pada populasi Indonesia. (Med J Indones 2002; 11: 135-42)

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Aldehyde dehydrogenase (ALDH) plays a pivotal role in the alcohol metabolism. Decreased activity of ALDH enzyme has more influence on the hypersensitivity to alcohol than of alcohol dehydrogenase. ALDH enzyme exists in several isozymes. Among these isozymes, ALDH2 is a major isozyme that has a very high affinity for acetaldehyde. Recent studies suggested that the deficiency of ALDH2 may be inherited. Functional polymorphism of ALDH2 gene has been observed in a nucleotide of the 487th codon. In the atypical gene, this codon consists of AAA nucleotides for lysine, instead of GAA for glutamic acid in the wild type gene. In this study, we have analyzed the genetic polymorphism of ALDH2 gene among 100 Indonesian students using genomic DNA extracted from hair roots. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods were performed for this purpose. Three oligonucleotide primers were designed for two steps PCR. The reverse primer R was intentionally constructed not to be 100% complementary to the template strand, to generate a restriction site for Eco RI within the variable nucleotide in the PCR product of ALDH2 gene. This study indicates that 70 subjects (70%) have wild type, 29 (29%) atypical heterozygote and only 1 (1%) atypical homozygote ALDH2 alleles. Conclusively, the atypical ALDH2 allele frequency in Indonesians (31/200) is higher than in Caucasoids (only about 5-10%), but less than in Mongoloids (40-50%). This may be due to the diverse ethnics of Indonesian population. (Med J Indones 2002; 11: 135-42)"

"Pendahuluan : Kemoradiasi pada kanker rektum menghasilkan radical oxygen species (ROS) yang dapat memicu kematian sel. ALDH1A1 merupakan antioksidan yang mampu mengurangi ROS dan merupakan marker sel punca kanker. Penelitian ini bertujuan untuk mengetahui hubungan kadar ALDH1A1 dengan respon kemoradiasi berdasarkan metode RECIST 1.1 pada pasien kanker rektum stadium lanjut lokal. Metode : Penelitian ini merupakan studi retrospektif terhadap 14 pasien kanker rektum stadium lanjut lokal yang memenuhi kriteria inklusi dari januari 2012 sampai januari 2015. ALDH1A1 diperiksa menggunakan metode ELISA dari sampel blok parafin kanker rektum. Respon pengecilan tumor dari CT scan dan MRI dihitung berdasarkan metode RECIST 1.1. Hasil : Didapatkan rerata kadar ALDH1A1 sebesar 9,014 ± 3,3 pg/mL, rerata persentase respon radiasi 7,89 ± 35,7 % dan diklasifikasikan berdasarkan RECIST didapatkan proporsi respon parsial sebesar 28,6 % , respon stabil sebesar 50% dan respon progresif sebesar 21,4%. Terdapat korelasi negatif kuat yang bermakna (r = - 0,890 dan p < 0,001) antara kadar ALDH1A1 dengan respon kemoradiasi berdasarkan RECIST. Kesimpulan : pada penderita kanker rektum stadium lanjut lokal respon kemoradiasi dipengaruhi oleh kadar ALDH1A1 dalam jaringan tumor. Semakin tinggi kadar ALDH1A1 semakin buruk respon kemoradiasi.

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Introduction : Chemoradiation in rectal cancer produce radical oxygen species (ROS) wich can cause cell death. ALDH1A1 is an antioxidant that can reduce ROS and known as cancer stem cell marker. The purpose of this study is to determine the correlation between ALDH1A1 level with tumor shrinkage using RECIST methode in locally advance rectal cancer.

Methode : This is a retrospective study to 14 locally advance rectal cancer patients who meet the inclusion criteria from january 2012 to january 2015. ALDH1A1 level was measured by ELISA from paraffin embeded tissue. Tumor shrinkage was measured from CTscan or MRI using RECIST 1.1 methode.

Result : The mean ALDH1A1 level is 9,014 ± 3,3 pg/mL, the mean of tumor shrinkage is 7,89 ± 35,7 %, Partial respond proportion is 28,6 % , Stable dissease proportion is 50% and progressive dissease proportion is 21,4%. There was a significant strong negative correlation (r = -0,890, p < 0,001) between ALDH1A1 with tumor shrinkage.

Conclusion : This study showed that tumor shrinkage in locally advanced rectal cancer after chemoradiation is influenced by ALDH1A1 level. The increase od ALDH1A1 level will decrease tumor shrinkage after chemoradiation."

"Kanker serviks merupakan kanker ketiga tersering di seluruh dunia dengan angka kasus baru, morbiditas dan mortalitas yang tinggi. Tujuan dari penelitian ini adalah untuk mengetahui proporsi kesintasan lima tahun pasca radioterapi pasien KSS serviks stadium IIB-IIIB dan hubungannya dengan infeksi HPV serta faktor lain yang mempengaruhi. Penelitian ini merupakan penelitian kohort. Populasi terjangkau adalah pasien karsinoma serviks stadium IIB dan IIIB dengan hasil biopsi serviks KSS yang telah menjalani radioterapi di RSCM dan dilakukan pemeriksan DNA HPV pre dan pasca radiasi pada penelitian terdahulu. Analisis statistik digunakan dengan uji prognostik Kaplan Meier. Dari 31 sampel penelitian pendahuluan, hanya 27 subjek yang dapat didata. Angka kesintasan lima tahun adalah sebesar 35,5%. Tidak didapatkan hubungan yang bermakna antara kesintasan dengan infeksi HPV, infeksi HPV yang menetap, lama radiasi, LVSI, stadium, diferensiasi, ukuran tumor dengan masing-masing nilai p 0,921, 0,586, 0,718, 0,65, 0,139, 0,78, dan 0,139. Terdapat hubungan yang bermakna antara respon radiasi dengan kesintasan, dengan median time survival 2 tahun (p 0,016).

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Cervical cancer is the third most common cancer in the world with high number of new cases, morbidity and mortality rates. The objective of this research is to know the proportion of five year survival rate after radiation of cervical cancer stage IIB-IIIB patient and its relationship with HPV infection and other influencing factors. This research method was cohort study. Research population was patients with biopsy result squamous cell carcinoma stage IIB-IIIB who underwent radiation therapy and have been examined for HPV DNA before and after radiation on previous study. Overall survival was assessed and the relationship between prognosis with HPV infection and other factors was calculated. Statistical analysis was calculated using Kaplan Meier to determine prognostic factors of cervical cancer, as well as the median survival rate. From 31 samples on previous study, only 27 patients has been documented. The five year overall survival rate was 35,5%. There were no statistically significant relationship between cervical cancer survival rate with HPV infection, HPV persistence after radiation, duration of radiation, LVSI, staging, grading, tumor size with p result 0,921, 0,586, 0,718, 0,65, 0,139, 0,78, and 0,139 respectively. There was significant relationship between radiation response and survival rate with median 2-year survival (p 0,016)"

"ABSTRAKLatar Belakang: Kanker serviks stadium lanjut lokal (IIB-IIIB) masih menjadi beban kesehatan di Indonesia saat ini. Radiasi menjadi modalitas utama terapi pada stadium ini. Programmed Death-Ligand 1 (PD-L1) merupakan sebuah ligand yang diekspresikan pada sel tumor yang terkait dengan proses immune escape. Sampai saat ini belum diketahui karakteristik kadar PD-L1 pada karsinoma sel skuamosa (KSS) serviks stadium lanjut lokal serta pengaruh radiasi terhadap ekspresinya. Penelitian ini bertujuan untuk melihat karakteristik PD-L1 intratumoral pada kanker serviks stadium lanjut lokal serta pengaruh radiasi eksterna terhadap ekspresinya. Metode: Dilakukan pemeriksaan kadar PD-L1 pada sampel biopsi serviks dengan 2 metode, yaitu Enzyme Linked Immuno Sorbent Assay (ELISA) dan immunohistokimia (IHK). Pengambilan sampel dilakukan dua kali, yaitu preradiasi dan pascaradiasi eksterna. Dilakukan analisis statistik untuk mengetahui perbedaan kadar antara sebelum dan sesudah radiasi. Selain itu dilakukan analisis untuk melihat kesesuaian antara kadar yang ditunjukkan pada metode ELISA dengan metode IHK. Hasil: Didapatkan 29 sampel KSS serviks stadium lanjut lokal yang memenuhi kriteria inklusi dan eksklusi. Dari pemeriksaan IHK, didapatkan bahwa PD-L1 diekspresikan hampir pada seluruh subjek (96,5%). Didapatkan nilai median PD-L1 ELISA preradiasi 409,19 pg/mg protein (59,80-3011,30), pascaradiasi 444,40 pg/mg protein (27,24-3217,85). Tidak didapatkan perbedaan bermakna antara kedua kelompok tersebut (p = 0,804). Pada analisis receiver operating characteristics (ROC) didapatkan nilai ELISA >400 pg/mg protein bersifat prediktif menyebabkan terjadinya penurunan kadar ELISA pascaradiasi. Terdapat kesesuaian antara kadar PD-L1 metode ELISA dengan metode IHK, dimana nilai ELISA > 499 pg/mg protein cenderung menunjukkan nilai grade 3 pada pemeriksaan IHK. Kesimpulan: PD-L1 diekspresikan positif pada KSS serviks uteri stadium lanjut lokal. Tidak terlalu jelas efek radiasi dalam menyebabkan naik-turunnya ekspresi PD-L1. Pemeriksaan ELISA mempunyai potensi untuk dipertimbangkan mewakili hasil pemeriksaan IHK, namun perlu bukti yang lebih kuat berupa penelitian dengan jumlah sampel yang lebih banyak.

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ABSTRACTBackground: Locally advanced cervical cancer (IIB-IIIB) remains a health burden in Indonesia. Radiation is the main modality of therapy at this stage. PD-L1 is a ligand that is expressed in tumor cells associated with the immune escape process. Until now there is no clear characteristics of PD-L1 levels in locally advanced-stage cervical SCC and the effect of radiation on its expression. This study is aimed to look for the intratumoral PD-L1 characteristics in locally advanced cervical cancer and the effect of external radiation on its expression. Method: PD-L1 levels were examined on cervical biopsy samples using two methods, i.e. ELISA and IHC. Biopsy was carried out twice, preradiation and post-external radiation. Statistical analysis was performed to determine differences in levels between before and after radiation. In addition, an analysis was conducted to see the conformity between the levels indicated in the ELISA method and the IHC method. Results: Twenty nine samples of local advanced cervical SCC were obtained that met the inclusion and exclusion criteria. From the IHC examination, it was found that PD-L1 was expressed in almost all subjects (96.5%). The median PD-L1 concentration of ELISA PD-L1 preradiation was 409.19 pg / mg protein (59.80-3011.30), post-radiation 444.40 pg / mg protein (27.24-3217.85). No significant difference was found between the two groups (p = 0.804). In the ROC analysis it was found that ELISA values > 400 pg / mg protein were predictive to cause a decrease in postradiation ELISA levels. There is a conformality between the levels of PD-L1 ELISA method with the IHC method, where the ELISA value > 499 pg/mg of protein tends to show grade 3 values ​​on the IHC examination. Conclusion: PD-L1 was expressed positively in locally advanced cervical SCC. The effects of radiation in causing the ups and downs of the expression of PD-L1 is not very clear. ELISA examination has the potential to be considered as a representative to the results of the IHC examination, but stronger evidence is needed in the form of study with a larger number of samples."