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"Pendahuluan: Malnutrisi dan hipoksia merupakan faktor yang mempengaruhi kegagalan terapi pada KNF stadium lokal lanjut. Kadar albumin merupakan salah satu pemeriksaan status nutrisi. Hipoksia menyebabkan radioresistensi terhadap radiasi.Tujuan dari penelitian ini adalah mengetahui korelasi antara kadar albumin praradiasi, hipoksia terhadap respon radiasi. Metode penelitian: Penelitian ini merupakan studi kohort retrospektif menggunakan data sekunder terhadap 40 pasien kanker nasofaring stadium lokal lanjut yang memenuhi kriteria inklusi di Departemen Radioterapi dan Departemen Patologi Anatomi RSUP Dr Cipto Mangunkusumo dari Desember 2012 sampai Agustus 2013. Dilakukan pencatatan kadar albumin praradiasi, berat badan serta CT scan sebelum dan sesudah radiasi. Kemudian dilakukan analisa HIF1α dengan pulasan imunohistokimia. Sel yang positif hipoksia dihitung per 10 lapang pandang besar. Setelah itu, dilakukan penilaian respon radiasi berdasarkan kriteria Recist. Hasil: Rerata kadar albumin praradiasi sebesar 3,9 +/- 0,5 g/dL, dan median persentase hipoksia sel yaitu 24,7(1-100)%. Tidak terdapat hubungan yang bermakna antara kadar albumin praradiasi terhadap respon radiasi (p≥0,05). Terdapat hubungan yang bermakna anatara hipoksia terhadap respon radiasi (p<0,05). Korelasi antara kadar albumin praradiasi dan hipoksia menunujukkan korelasi yang lemah dan tidak bermakna (r=-0,24, p=0,324). Kesimpulan: Hasil penelitian ini memperlihatkan bahwa albumin praradiasi tidak berhubungan dengan respon radiasi pada KNF stadium lokal lanjut. Terbukti bahwa hipoksia meningkatkan radioresistensi dan menurunkan respon radiasi. Tidak terdapat korelasi antara albumin praradiasi dan hipoksia.

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Introduction: Malnutrion and hypoxia had been shown to cause irradiation failure. Albumin is one of the nutritional status examination. Hypoxia caused radioresistance to irradiation. The purpose of this study was to evaluate the correlation of albumin, hypoxia towards radiation response in locally advanced nasopharyngeal carcinoma.

Methods: This is a retrospective cohort study using secondary data from Departement of Radiotheraphy and Departement of Pathology Cipto Mangunkusomo hospital of 40 patients locally advanced nasopharyngeal cancer who meet the inclusion criteria from December 2012 to August 2013. Albumin preirradiation, body weight and CT scan before and after radiation were recorded. We examined the expression of HIF1 α by immunohistochemistry staining. Hypoxia cell was asessed by cell counting. Radiation response was determined by Recist criteria.

Results: The mean of serum albumin is 3.9 + / - 0.5 g /dL, and the median percentage of hypoxia was 24,7(1-100)%. There was no statistically significant relationship between albumin and radiation response (p≥0.05). There was a statistically significant relationship between hypoxia and radiation response (p<0,05). There were no correlation between albumin and hypoxia (r=-0,24, p=0,324).

Conclusion: This study showed that there was no correlation between albumin preirradiation and response in locally advanced nasopharyngeal cancer. It was proven that hypoxia increased radioresistance in locally advanced nasopharyngeal cancer. There was no correlation between albumin preirradiation and hypoxia."

"Kanker merupakan salah satu beban bagi pemerintah dari segi pelayanan dan pembiayaan kesehatan. Berbeda dengan Indonesia, di beberapa negara, informasi tentang kanker dijalankan melalui program yang bernama National Program of Cancer Registries (NPCR) yang dikelola oleh Centers for Disease Control and Prevention (CDC). Penelitian ini dilakukan untuk melaporkan tentang profil kanker wilayah Jakarta Barat tahun 2008-2012, karena belum adanya data yang tepat dari pemerintah. Penelitian ini merupakan studi deskriptif dengan desain studi cross sectional terhadap seluruh pasien kanker yang berdomisili di Jakarta Barat berdasarkan data yang tercatat di RS Cipto Mangunkusumo, sebagai pusat pengendali registrasi kanker DKI Jakarta. Sebagai hasil didapatkan kasus kanker berjumlah 4057 kasus, dan jenis lima kasus kanker terbanyak. Lima kasus kanker paling banyak berlokasi di payudara (22,5%), serviks uteri (10,3%), paru dan bronkus 7,5%), nasofaring (5,3%), sistem hematopoietik dan retikuloendotelial (5,3%). Sebagian besar kasus ditemukan pada stadium lanjut (III dan IV), dan dominan pada jenis kelamin wanita dengan usia antara 45-54 tahun. Karsinoma intraduktal merupakan tipe morfologi terbanyak pada kasus kanker payudara.

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Cancer is one of the government burdens in terms of health service and financing. Different from Indonesia, in several countries, the data about cancer profile were collected by National Program of Cancer Registries (NPCR) and administered by the Centers for Disease Control and Prevention (CDC) . The main objective of this study is to describe the cancer profile in the West Jakarta region, from the year of 2008 to 2012, since there was no proper data about cancer profile provided by government. By using descriptive study with a cross sectional study design, the data from all cancer patients living in the region of West Jakarta who were registered in Cipto Mangunkusumo Hospital, a cancer control and registration center in the region of DKI Jakarta, were collected. As a result, from a total number of 4057 cancer patients found in the area, there were five most common locations recorded. Those five most common locations affected by cancer were breast (22.5%), cervical (10.3%), lung and bronchus (7.5%), nasopharynx (5.3%), hematopoietic and reticuloendothelial systems (5.3%). Unfortunately, most of those cases were found at latter stages (III and IV), and were between 45-54 years old with female predominant. Breast Carcinoma was the most common among all with Intra Ductal Carcinoma as its most common morphology type. "

"Latar Belakang: Kanker Nasofaring (KNF) merupakan keganasan yang sering di Indonesia. Molekul terkait imun yang banyak diteliti adalah Programmed Death-1 (PD-1)/Programmed Death-Ligand 1 (PD-L1). Penelitian ini bertujuan untuk mengetahui profil PD-L1 dari spesimen KNF di Indonesia. Metode: Spesimen biopsi massa nasofaring diambil untuk pemeriksaan konsentrasi protein PD-L1 dengan metode Enzyme-Linked Immunosorbent Assay (ELISA). Pada spesimen yang terbukti secara histologis KNF dilakukan pemeriksaan Imunohistokimia (IHK) untuk mengetahui ekspresi PD-L1. Hasil: Lima puluh empat spesimen biopsi nasofaring diperoleh. Tiga puluh lima dari 54 spesimen dikonfirmasi secara histologis KNF yang tidak berdiferensiasi dengan usia rerata 51 tahun. Selebihnya, 19 spesimen lainnya secara histologis bukan KNF dengan usia rerata 37 tahun. Pada pemeriksaan ELISA, median konsentrasi PD-L1 dari spesimen KNF adalah 2100,73 ± 3689,52 pg/mg protein, dan spesimen bukan KNF adalah 1010,88 ± 1082,37 pg/mg protein. Pada pemeriksaan IHK 30 sampel KNF untuk pemeriksaan ekspresi PD-L1, semuanya mengekspresikan PD-L1 positif, dengan rincian; skor 1 sebanyak 7%, skor 2 sebanyak 30%, dan skor 3 sebanyak 63%. Kesimpulan: Protein PD-L1 dari spesimen KNF dengan pemeriksaan ELISA signifikan meningkat dibandingkan dengan bukan KNF. Semua spesimen KNF dengan pemeriksaan IHK mengeskspresikan PD-L1 positif dengan mayoritas skor 3.

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Background: Nasopharyngeal Carcinoma (NPC) is a common malignancy in Indonesia. Immune-related molecules that have been studied are Programmed Death-1 (PD-1)/Programmed Death-Ligand 1 (PD-L1). This study aims to determine the profile of PD-L1 from NPC specimens in Indonesia.

Method: A nasopharyngeal biopsy specimen was taken to examine the concentration of PD-L1 protein by the Enzyme-Linked Immunosorbent Assay (ELISA). Immunohistochemistry (IHC) examinations were conducted to determine the PD-L1 expression.

Results: Fifty-four nasopharyngeal biopsy specimens were obtained. Thirty-five of 54 specimens were confirmed histologically for undifferentiated NPC with an average age of 51 years. The rest, 19 other specimens are histologically non NPC with an average age of 37 years. On ELISA examination, the median PD-L1 concentration of the NPC specimen was 2100.73 ± 3689.52 pg/mg protein, and the non-KNF specimen was 1010.88 ± 1082.37 pg/mg protein. At the IHC examination of 30 NPC samples for PD-L1 expression examination, all of them expressed PD-L1 positive, with details; score 1 is 7%, score 2 is 30%, and score 3 is 63%.

Conclusion: PD-L1 protein from NPC specimens by ELISA examination was significantly increased compared to non-NPC. All NPC specimens with IHC examination expressed PD-L1 positive with a majority score of 3."

"Tujuan : Pembangunan pusat pelayanan radioterapi sampai saat ini belum menjadi prioritas utama khususnya di negara berkembang. Tingginya biaya yang dihabiskan untuk pusat pelayanan merupakan salah satu alasannya. Biaya terkait sumber daya manusia (SDM) berhubungan erat dengan biaya operasional yang dikeluarkan. Pengetahuan terkait produktivitas yang mencakup beban SDM dan penggunaan pesawat radiasi merupakan dasar untuk terciptanya pelayanan radioterapi dengan biaya efektif. Oleh karena itu, digagaslah penelitian tentang produktivitas SDM dan penggunaan pesawat radiasi di pusat pelayanan Onkologi Radiasi di Indonesia sebagai bagian dari penelitian terkait biaya radioterapi. Metode : studi deskriptif cross sectional. Subjek penelitian merupakan seluruh pusat pelayanan Onkologi Radiasi di Indonesia yang telah melakukan pelayanan selama setahun. Subjek diberikan kuesioner secara digital yang berisikan pertanyaan terkait ketersediaan SDM dan pesawat radiasi. Data yang didapat kemudian dimasukkan ke dalam Radiotherapy Resources and Cost Calculator (RRCC) v.20 serta dilakukan penghitungan dengan asumsi aktual sesuai kondisi di Indonesia. Hasil : beban kerja Dokter Spesialis, Fisika Medis, dan RTT di Indonesia bervariasi dengan rerata beban kerja secara berurutan sebesar 92,5% (asumsi aktual), 97,7%, 107,6%, dan 80,8%. Beban kerja SDM secara statistik lebih tinggi pada pusat pelayanan dengan brakhiterapi dan pusat pelayanan dengan jumlah pasien yang tinggi. Rerata penggunaan pesawat radiasi sebesar 104,1% dan 138% secara statistik signifikan lebih tinggi pada rumah sakit pemerintah dan jumlah pasien tinggi. Jumlah pasien memiliki korelasi kuat dengan jumlah kebutuhan dokter spesialis (r=0,927), fisika medis (r=0,838) dan RTT (r=0,886). Jumlah pasien dapat menjadi prediktor untuk menentukan kebutuhan Dokter Spesialis dengan adjusted R2 = 72,1% dan 80%, kebutuhan fisika medis adjusted R2 = 69,3%, dan kebutuhan RTT dengan adjusted R2 = 83,3%.Kesimpulan : produktivitas SDM dan penggunaan pesawat radiasi pada pusat pelayanan Onkologi Radiasi di Indonesia bervariasi. Penghitungan produktivitas dengan RRCC v.20 dapat diaplikasikan pada pusat pelayanan Onkologi Radiasi di Indonesia.

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Objective: The development of a radiotherapy center has not been a top priority, especially in developing countries. The high cost spent on service centers is one of the reasons. Human resource costs are inextricably linked to operational expenses. Knowledge related to productivity, which includes the workload of human resources and the use of radiation equipment, is the basis for creating cost-effective services. Therefore, research was initiated on human resource productivity and the use of radiation equipment at radiotherapy centers in Indonesia as part of research related to radiotherapy costs. Method: descriptive cross-sectional study. The research subjects were all radiotherapy centers in Indonesia that had been running for a year. Subjects were given a digital questionnaire containing questions related to the availability of human resources and radiation equipment. The data obtained is then entered into the Radiotherapy Resources and Cost Calculator (RRCC) v.20, and calculations are carried out with actual assumptions according to conditions in Indonesia. Results: The workload of specialists, medical physicists, and RTTs in Indonesia varies, with an average workload of 92.5% (actual assumption), 97.7%, 107.6%, and 80.8%, respectively. HR workload is statistically higher in centers with brachytherapy and in centers with a high number of patients. The mean use of radiation equipment was 104.1% and 138%, respectively, statistically significantly higher in government hospitals, and centers with a high number of patients. The number of patients has a strong correlation with the number of specialists (r = 0.927), medical physics (r = 0.838), and RTT (r = 0.886). The number of patients can be a predictor for determining the need for specialist doctors with adjusted R2 values of 72.1% and 80%, medical physics needs with adjusted R2 values of 69.3%, and RTT needs with adjusted R2 values of 83.3%. Conclusion: HR productivity and the use of radiation equipment at radiation oncology service centers in Indonesia vary. The calculation of productivity with RRCC v.20 can be applied to radiotherapy centers in Indonesia."

"ABSTRAK Peningkatan angka morbiditas dan mortalitas akibat penyakit kanker di Indonesia menunjukkan bahwa permasalahan kanker ini semakin besar dan kompleks Salah satunya adalah adanya keterlambatan pasien kanker untuk mendapatkan terapi definitif yang disebabkan oleh faktor faktor yang berasal dari pasien sendiri Penelitian ini merupakan studi analisis deskriptif menggunakan metode campuran kuantitatif dan kualitatif untuk mengetahui data insidens keterlambatan terapi karena keterlambatan pasien pada pasien kanker yang dirujuk ke Departemen Radioterapi RSUPN Dr Cipto Mangunkusmo pada bulan Mei Agustus 2015 serta mengevaluasi faktor faktor apa saja yang mempengaruhi keterlambatan pasien tersebut Terdapat 294 orang pasien yang diikutsertakan dalam penelitian ini setelah mendapatkan persetujuan tertulis Sebagian besar pasien 71 4 adalah perempuan dan 141 orang 48 bekerja sebagai ibu rumah tangga Rentang umur terbanyak adalah 36 50 tahun yaitu sebanyak 132 pasien 44 9 dan hampir seluruh pasien 91 8 telah menikah Keterlambatan terapi didapatkan pada 153 orang pasien 52 dan 67 orang di antaranya 43 8 memiliki riwayat pengobatan alternatif yang dilakukan dalam interval waktu setelah timbul keluhan pertama kali dan atau setelah pasien melakukan konsultasi medis pertama kali Analisis statistik menunjukkan adanya hubungan yang signifikan antara faktor usia p 0 047 pendidikan p 0 047 dan riwayat pengobatan alternatif p 0 0001 dengan keterlambatan terapi Adanya rasa takut untuk berobat secara medis atau menjalani tindakan medis menjadi alasan 51 orang pasien untuk memilih pengobatan alternatif Oleh karena itu diperlukan pengawasan dan evaluasi terhadap pengobatan alternatif terutama yang menyangkut kualitas efikasi dan keamanannya ABSTRACT Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety ;Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety ;Increased morbidity and mortality due to cancer in Indonesia showed that this problem has become more complex and significant One of the problems pointed out is regarding a delay in cancer patients to receive definitive therapy caused by factors derived from the patients themselves This study is a descriptive analysis using combination of quantitative and qualitative methods to determine the incidence of treatment delay due to patient delay in cancer patients who were referred to Radiotherapy Department Dr Cipto Mangunkusmo hospital during May August 2015 and to evaluate factors that influence the patient delay There are 294 patients enrolled in this study after obtaining a written consent Most of the patients 71 4 were women and 141 48 work as a housewife The largest age range was 36 50 years with 132 patients 44 9 and almost all patients 91 8 were married Delay in treatment obtained in 153 patients 52 and 67 of them 43 8 had a history of alternative medicine that is performed in a time interval after the patients experienced first complaints and or after patients had their first medical consultation Statistical analysis showed a significant relationship between age p 0 047 educational level p 0 047 and history of alternative medicine p 0 0001 with the treatment delay The fear of being treated medically or undergo a medical procedure has become the major reasons found in 51 patients to choose the alternative treatment Therefore it is necessary to conduct monitoring and evaluation of alternative medicine especially concerning the quality efficacy and its safety "