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Abstrak :
[ABSTRAK
Pendahuluan : Glioma adalah jenis tumor yang paling umum dari neoplasma intraserebral primer. Tumor ganas primer sistem saraf pusat (SSP) mencapai sekitar 2% dari semua kanker dan high grade glioma adalah jenis yang paling banyak ditemukan. High grade glioma menyebabkan tingkat morbiditas dan mortalitas yang tinggi. Saat ini belum ada data yang menggambarkan profil pasien glioma yang menjalani radioterapi di Indonesia. Metode penelitian : Penelitian ini merupakan penelitian retrospektif deskriptif analitik terhadap 121 pasien glioma yang mendapat radiasi di departemen Radioterapi RSUPN Dr. Cipto mangunkusumo dari Januari 2009 sampai Januari 2014. Data diperoleh dari catatan medisdan hasil penelusuran melalui telepon terhadap pasien atau keluarganya. Respon tumor dianalisa terhadap 22 pasien yang mempunyai CT scan atau MRI pre dan post radiasi dengan menggunakan kriteria RECIST. Hasil : Sebagian besar pasien adalah laki-laki (53,7%), dengan usia rata-rata 45 tahun. Histopatologi yang paling banyak ditemukan adalah astrositoma. Prosedur bedah yang paling banyak ditemukan pada penelitian ini adalah craniotomi removal tumor (70%). Teknik 3D CRT paling banyak digunakan yaitu pada 77,7% pasien. Nimotuzumab sebagai antibodi monoklonal digunakan pada 9% pasien. Respon parsial ditemukan 59,1%. Analisis kesintasan hidup tiga tahun dari seratus sebelas pasien yang memenuhi kriteria didapatkan angka kesintasan yaitu 46,15%. Analisis kaplan meyer menunjukkan overall treatment time merupakan faktor prognostik untuk kesintasan hidup (p = 0,016). Kesimpulan : Teknik operasi terbanyak pada pasien glioma yang menjalani radiasi di departemen radioterapi RSUPN DR. Cipto Mangunkusumo adalah kraniotomi removal tumor (70,9%). Teknik 3D CRT adalah teknik radiasi yang paling banyak digunakan. Respon parsial ditemukan 59,1%. Kesintasan hidup tiga tahun pasien glioma yaitu 46,2% dan overall treatment time merupakan faktor prognostik yang bermakna untuk kesintasan hidup

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ABSTRACT
Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis., Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis.]

Abstrak :
Tujuan dan latar belakang : High grade glioma mecakup hanya 2% dari seluruh kanker, namun memiliki morbiditas dan mortalitas yang tinggi walaupun dengan menggunakan pendekatan terapi multimodal menggunakan kombinasi modalitas operasi, radiasi, kemoterapi dan targetd therapy. Penelitian ini bertujuan untuk mengetahui korelasi kadar MGMT, sebuah protein repair, yang diperiksa menggunakan teknik ELISA dengan respon tumor terhadap radiasi pada High Grade Glioma sehingga diharapkan dapat menambah pemahaman mengenai sifat biomolekuler dari High grade Glioma. Metode : Studi ini merupakan sebuah studi restrospektif yang melibatkan 14 pasien yang telah didiagnosa sebagai High Grade Glioma berdasarkan histopatologi dan telah mendapatkan radiasi postoperasi dengan dan/atau tanpa chemosensitizer temozolomide di Departemen Radioterapi RSUPN Cipto Mangunkusumo dari tahun 2004-2015. MGMT diperiksa dengan teknik ELISA dari jaringan tumor yang sudah diparafinisasi. Respon tumor dihitung berdasarkan perubahan volume tumor pada imaging CT/MRI pre dan pasca radiasi. Hasil: Rerata kada MGMT adalah 184 (160-206) pg/mL. Rerata penyusutan tumor adalah 10,64% (-75.64-80.20%). Tidak didapatkan korelasi antara kadar MGMT dengan respon tumor, dengan r= 0.065 (p=0.825). Pada kelompok yang hanya mendapat radiasi didapatkan r= 0.199 (p=0.607) dan pada kelompok yang mendapat kemoradiasi dengan TMZ didapatkan korelasi negatif dengan r= -0,447 (p=0.45). Kesimpulan : Tidak ada korelasi antara kadar MGMT dengan respon radiasi. Baik pada kelompok yang mendapatkan radiasi saja ataupun pada kelompok yang mendapatkan kemoradiasi dengan TMZ. ...... Purpose and background : High Grade Glioma comprises just 2% of all cancer, but it disproportionally has the 6th lowest survival of all cancer found. Despite combined multimodality approach that has been used by clinician which can be the combination of two or more modalities of such : surgery, radiation, chemotherapy and targeted therapy, the mortality and morbidity of HGG remains high. This study aims to know the correlation between MGMT protein expression, a repair protein well known in glioma, with the radiation response, in order to gain more knowledge of the bio molecular behavior of HGG. Material and Methods : This study is a retrospective study that involves 14 patients which were diagnosed as HGG based on histopathological findings and received postoperative radiation with or without concurrent Temozolomide (TMZ) at the Radiotherapy Department of Cipto Mangunkusumo Hospital from 2004-2015. Tumor MGMT concentration was quantified by Enzyme-Linked Immunosorbent Assay from Formalin-Fixed Paraffin-Embedded (FFPE) tissue. Tumor response was evaluated by comparing pre and post radiation tumor volume by CT and MRI. Result: MGMT concentration was 184 (160-206) pg/mL. Mean tumor volume shrinkage was 10,64% (-75.64-80.20%). There were no correlation between MGMT concentration and tumor response (r= 0.065, p=0.825). The sample was split according to use of TMZ. In the group that had radiation only, the correlation between MGMT concentration and tumor response was not significant (r= 0.199, p=0.607). In the chemoradiation group there was a moderate negative correlation, but was not significant (r= -0,447, p=0.45). Conclusion: MGMT protein expression was not correlated with the tumor radiation response. There was a negative moderate correlation between MGMT concentrasion and tumor response in patients who underwent chemoradiation with TMZ, but this correlation was not statistically significant.

Abstrak :
[ABSTRAK
Glioma adalah tumor otak primer yang sampai saat ini sering timbul resistensi terapi. Sel punca glioma diduga berperan penting dalam resistensi dan rekurensi sel tumor. Sel punca glioma memiliki penanda permukaan CD133 dan mampu berpluripotensi dengan mengekspresikan Oct4. Kondisi hipoksia tumor juga berperan dalam self renewal sel punca glioma. Tujuan dari penelitian ini adalah untuk mengetahui hubungan keberadaan sel punca glioma dengan keganasan, pluripotensi dan kondisi hipoksia. Cross sectional digunakan sebagai desain penelitian dengan jumlah sampel sebanyak 35 jaringan, terdiri atas 15 glioma derajat keganasan tinggi dan 20 glioma derajat keganasan rendah. Pengukuran ekspresi relatif mRNA CD133, Oct4 dan HIF-1α menggunakan metode qRTPCR. Protein HIF-1α dilihat ekspresinya melalui teknik imunohistokimia. Ekspresi relatif mRNA CD133 dan Oct4 lebih tinggi bermakna (p < 0.05, Mann- Whitney) pada glioma derajat keganasan tinggi dibanding glioma derajat keganasan rendah. Protein HIF-1α lebih tinggi bermakna (p < 0,01, Mann- Whitney) pada glioma derajat keganasan tinggi dibanding glioma derajat keganasan rendah. Terdapat hubungan ekspresi sel punca glioma CD133 dengan pluripotensi serta kondisi hipoksia (r = 0,518, r = 0,339; Spearman?s rho) serta pluripotensi dengan kondisi hipoksia pada derajat keganasan tinggi (r = 0,749; Spearman?s rho). Ekspresi relatif mRNA CD133, Oct4 dan HIF-1α meningkat seiring dengan peningkatan derajat keganasan. Terdapat hubungan yang bermakna antara keberadaan penanda sel punca glioma CD133 dengan pluripotensi dan kondisi hipoksia pada glioma derajat keganasan tinggi.

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ABSTRACT
Glioma is primary brain tumor with frequent therapeutic resistance. Glioma cancer stem cells were considered to play a role in resistance and recurrence of tumor cells. Glioma cancer stem cells expressed CD133 on their surface and capable of pluripotency as expressed by Oct4 positive. Tumor hypoxic condition also play a role in glioma cancer stem cells self renewal. Aim of this study is to investigate correlation between glioma cancer stem cells, degree of malignancy, pluripotency and hypoxia. Design of this study is cross sectional with 35 glioma samples comprises of 20 low grade malignant glioma and 15 high grade malignant glioma. Expression of mRNA CD133, Oct4 and HIF-1α were measured using qRT-PCR. HIF-1α protein expression was detected by immunohistochemistry from glioma sample. mRNA CD133 and Oct4 expression significantly higher (p < 0.05, Mann-Whitney) in high grade malignant glioma compared to low grade malignant glioma. HIF-1α tissue expression significantly higher (p < 0,01, Mann- Whitney) in high grade malignant glioma compared to low grade malignant glioma. There was correlation between expression of CD133 glioma cancer stem cells marker with pluripotency and hypoxia (r = 0,518, r = 0,543; Spearman?s rho) and pluripotency with hypoxia in high grade malignant glioma (r = 0,749; Spearman?s rho). mRNA CD133, Oct4 and HIF-1α expression increased with high grade malignant glioma. There was significant correlation between CD133 glioma cancer stem cell marker with pluripotency and hypoxia in high grade malignant glioma, Glioma is primary brain tumor with frequent therapeutic resistance. Glioma cancer stem cells were considered to play a role in resistance and recurrence of tumor cells. Glioma cancer stem cells expressed CD133 on their surface and capable of pluripotency as expressed by Oct4 positive. Tumor hypoxic condition also play a role in glioma cancer stem cells self renewal. Aim of this study is to investigate correlation between glioma cancer stem cells, degree of malignancy, pluripotency and hypoxia. Design of this study is cross sectional with 35 glioma samples comprises of 20 low grade malignant glioma and 15 high grade malignant glioma. Expression of mRNA CD133, Oct4 and HIF-1α were measured using qRT-PCR. HIF-1α protein expression was detected by immunohistochemistry from glioma sample. mRNA CD133 and Oct4 expression significantly higher (p < 0.05, Mann-Whitney) in high grade malignant glioma compared to low grade malignant glioma. HIF-1α tissue expression significantly higher (p < 0,01, Mann- Whitney) in high grade malignant glioma compared to low grade malignant glioma. There was correlation between expression of CD133 glioma cancer stem cells marker with pluripotency and hypoxia (r = 0,518, r = 0,543; Spearman’s rho) and pluripotency with hypoxia in high grade malignant glioma (r = 0,749; Spearman’s rho). mRNA CD133, Oct4 and HIF-1α expression increased with high grade malignant glioma. There was significant correlation between CD133 glioma cancer stem cell marker with pluripotency and hypoxia in high grade malignant glioma]