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"Latar Belakang. Kesintasan 3 tahun pasien KNF stadium lokal lanjut di Indonesia lebih rendah dibandingkan luar negeri. Prediktor alternatif dari rasio hemoglobin-trombosit (RHT) lebih sederhana, murah, dan stabil nilainya dibanding rasio dari komponen sel leukosit, namun belum ada studi yang meneliti perannya dalam memrediksi mortalitas tiga tahun pasien KNF stadium ini.Tujuan. Mengetahui peran RHT sebelum terapi dalam memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.Metode. Studi kohort retrospektif yang meneliti 289 pasien KNF stadium lokal lanjut yang diterapi di Rumah Sakit Cipto Mangunkusumo (RSCM) dalam rentang waktu Januari 2012 - Oktober 2016. Nilai RHT optimal didapatkan menggunakan receiver operating curve (ROC). Subjek penelitian dibagi menjadi 2 kelompok, di bawah dan di atas titik potong. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia > 60 tahun, stadium, jenis kelamin, dan indeks massa tubuh) untuk mendapatkan nilai adjusted hazard ratio (HR).Hasil. Nilai titik potong RHT optimal adalah 0,362 (AUC 0,6228, interval kepercayaan (IK) 95% : 0,56-0,69, sensitivitas 61,27%, spesifisitas 60,34%). 48,44% pasien memiliki nilai RHT <0,362 dan memiliki mortalitas tiga tahun lebih besar dibandingkan kelompok lainnya (50%vs31,54%). RHT < 0,362 secara signifikan memrediksi kesintasan tiga tahun (p = 0,003; HR 1,75; IK 95% 1,2-2,55). Pada analisis multivariat, RHT < 0,362 sebelum terapi merupakan faktor independen dalam memrediksi kesintasan tiga tahun pada pasien KNF stadium lokal lanjut (adjusted HR 1,82; IK 95% 1,25-2,65).Simpulan. RHT < 0,362 sebelum terapi dapat memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut

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Background. The 3-year survival of locally advanced nasopharyngeal cancer (NPC) patients in Indonesia is lower than in foreign countries. Alternative predictors from the hemoglobin-platelet ratio (HPR) are easier, cheaper, and stable in value than the ratio of leukocyte cell components, but there are no study conducted to know its potential in predicting three-year survival in locally advanced

nasopharyngeal cancer.

Objective. To determine the role of pre-treatment hemoglobin to platelet ratio in predicting three-year survival of locally advanced nasopharyngeal cancer patients.

Method. Retrospective cohort study that examined 289 locally advanced NPC patients who underwent therapy at the National Government General Hospital-Cipto Mangunkusumo from January 2012 to October 2016. HPR cut-off was determined using ROC, and then subjects were divided into two groups according to its HPR value. The Kaplan-Meier curve was used to determine the three-year survival of the patients and cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Results. The optimal cut-off for HPR was 0,362 (AUC 0,6228, 95% CI: 0,56-0,69, sensitivity 61,27%, specificity 60,34%). Patients with HPR < 0,362 occurred in 48, 44% and had higher three-year mortality (50% vs. 31, 54%). HPR <0.362 significantly predicted the three years of survival (p = 0,003; HR 1, 75; IK 95% 1, 2-2, 55). In multivariate analysis,

it was concluded that pre-treatment HPR < 0,362 was an independent factor in predicting three-year

survival in locally advanced NPC patients (adjusted HR 1, 82; IK 95% 1, 25-2, 65).

Conclusion. Pre-treatment HPR < 0, 362 could predict the three-year survival of locally advanced nasopharyngeal cancer patients."

"Latar belakang: Pengukuran tumor primer karsinoma nasofaring KNF belum rutin dikerjakan karena bentuknya yang ireguler dengan infiltrasi yang ekstensif pada jaringan sekitarnya Pengukuran volume memiliki akurasi tinggi namun sulit dilakukan dan memerlukan waktu lama Lebih lanjut belum ada penelitian yang membandingkan antara teknik pengukuran bidimensional dengan volume tumor primer KNF di Indonesia Tujuan: Mendapatkan nilai korelasi ukuran bidimensional terhadap volume tumor primer KNF pada pemeriksaan Computed Tomography CT scan. Metode: Penelitian ini menggunakan desain potong lintang dengan metode simple random sampling Subjek penelitian berjumlah 50 pasien KNF yang menjalani pemeriksaan CT scan nasofaring di Departemen Radiologi FKUI RSUPN CM Penelitian dilakukan sejak Juni hingga September 2015 Pengukuran volume tumor primer nasofaring pada PACS INFINITT dilanjutkan dengan pengukuran bidimensional satu minggu kemudian Hasil: Uji korelasi Spearman antara ukuran bidimensional dengan volume KNF memperlihatkan nilai p

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Background: Primary tumour measurement of the nasopharyngeal carcinoma NPC has not been routinely performed because of its irregular shape and extensive infiltration to adjacent structures Measuring the volume is highly accurate yet highly difficult and time consuming Moreover there has not been comparison study between the bidimensional and volume measurement of the primary tumour of NPC done in Indonesia before

Purpose: To obtain the correlation value of the bidimensional measurement to the volume of the primary tumour of NPC using the CT scan

Method: This study used a cross sectional design Fifty subjects were chosen using simple random sampling from NPC patients that underwent nasopharyngeal CT scan at the Radiology Department of the Indonesia University's Faculty of Medicine Cipto Mangunkusumo Hospital This study was done from June until September 2015 NPC volume measurement was performed using PACS INFINITT followed by the bidimensional measurement one week after

Results: Spearman correlation test between bidimensional and volume measurement of NPC shows p value"

"Latar belakang. Karsinoma nasofaring merupakan penyakit yang masih menempati urutan tertinggi di negara berkembang seperti Indonesia. Kasus baru karsinoma nasofaring di poli Onkologi THT RSUPN Cipto Mangunkusumo pada tahun 2014 sebanyak 164 kasus, dan pada tahun 2015 sekitar 142 kasus, namun sayangnya hampir seluruh kasus sudah datang pada stadium lanjut. Keberhasilan terapi karsinoma nasofaring sangat ditentukan oleh stadium saat pasien terdiagnosis, sehingga sangat penting mendiagnosis KNF sedini mungkin. Narrrow band imaging merupakan alat endoskopi dengan sistem pencahayan yang dapat meningkatkan visualisasi pembuluh darah tumor ganas yang mengenai epitel mukosa. Tujuan. NBI diharapkan dapat membantu para klinisi untuk menilai lesi ganas atau tidak sehingga perlu diketahui nilai sensitifitas dan spesifisitas NBI. Metode. Penelitian ini merupakan penelitian potong lintang berupa uji diagnostik yang dilakukan di Unit Rawat Jalan Terpadu THT-KL RSUPN Cipto Mangunkusumo Januari-Juni 2016 dengan melibatkan 56 subjek. Subjek dengan kecurigaan karsinoma nasofaring dan ditemukan massa nasofaring berdasarkan pemeriksaan fisik atau pencitraan akan dimasukkan sebagai subjek dan dilakukan pemeriksaan NBI dan dilakukan biopsi lokal. Hasil. Berdasarkan penelitian ini dapat dibuat kesimpulan bahwa NBI dapat digunakan sebagai alat penapisan karsinoma nasofaring dengan nilai sensitifitas yang tinggi (100%) walaupun nilai spesifisitasnya rendah (6,7%).

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Background. Nasopharyngeal carcinoma is a disease with the highest rank in developing countries like Indonesia. New cases of nasopharyngeal carcinoma in ENT Oncology outpatient clinic Cipto Mangunkusumo hospital in 2014 was 164 cases, and in 2015 around 142 cases, but unfortunately almost all cases has come at an advanced stage. The success of nasopharyngeal carcinoma treatment is largely determined by the stage when patients are diagnosed, it is important to diagnose NPC as early as possible. Narrow band imaging (NBI) is an endoscopic instrument with a light system that can improve the visualization of blood vessels on the mucosal epithelium malignant tumors.

Aim. NBI is expected to help clinicians to assess whether a lesion is malignant or not, it is important to know the value of sensitivity and specificity.

Methode. This study is a cross-sectional form of a diagnostic test which was performed in the Outpatient Clinic ENT-Head and Neck Surgery Department Cipto Mangunkusumo Hospital from January to June 2016, where 56 subjects were involved. Subjects with nasopharyngeal mass discovered by physical examination or imaging and suspected nasopharyngeal carcinoma will be included as a subject and NBI examination and biopsy was performed locally.

Result. Based on this research, NBI could be used as a screening tool for nasopharyngeal carcinoma with high sensitivity (100%) though with low specificity result (6,7%)."

"Tujuan : Mengetahui kepatuhan panduan terapi terhadap angka keberhasilan terapi kanker nasofaring. Metode : Penelitian kohort retrospektif terhadap 269 pasien kanker nasofaring yang berobat di RSCM periode Januari 2017-Juli 2018. Analisis bivariate, log regression dan kesintasan hidup Kaplan Meier dilakukan pada 140 pasien yang memenuhi kriteria inklusi. Hasil : Didapatkan 67,1% pasien lelaki, median usia 48 (18-73) tahun, rujukan internal RSCM 52,9% dengan 57,1% dari Departemen THT-KL. Sekitar 49,3% pasien datang dengan stadium IV A (49,3%), tipe histopatologi WHO III (90%), dan mendapatkan kemoradiasi (60,7%). Angka kepatuhan terhadap PPK dari interna dan RSCM adalah 21,6% dan 6,1%. Ketidakpatuhan penggunaan modalitas terapi dan penegakkan diagnosis kerja internal dan eksternal RSCM adalah 6,8%-4,06% dan 13,6%-31,8%. Ketidakpatuhan pemberian jumlah siklus kemoterapi neoajuvan dan ajuvan sebesar 29,27% dan jumlah siklus pada kemoterapi konkuren sebesar 70,71%. Sekitar 2,14% pasien mendapatkan dosis radiasi <70Gy. Durasi waktu dimulainya terapi adalah 92,5 (14-830) hari, dimulainya kemoradiasi paska kemoterapi neoajuvan adalah 146 (SB 10,04) hari, dimulainya kemoterapi ajuvan paska kemoradiasi adalah 121,88 (SB 18,35) hari. Durasi radiasi / kemoradiasi adalah 48 (39-77) hari. Kesintasan hidup satu dan dua tahun pada masing-masing stadium I, II, III, IV A, dan IV B secara berurutan adalah 100%, 85%, 85%, 84%, 87% dan 100%, 85%, 77%, 69%, 46%. Dosis radiasi dan kemoterapi neoajuvan berpengaruh terhadap angka kesintasan hidup pasien (P < 0,01 dan P < 0,03). Kepatuhan terhadap modalitas dan durasi waktu terapi secara statistik tidak bermakna namun memiliki trend perbedaan dalam memperngaruhi kesintasan. Kesintasan hidup satu dan dua tahun pada kelompok yang patuh PPK adalah 94,1% dan 80,5%. Pada kelompok yang tidak patuh PPK, didapatkan 82,6% dan 64,2% (P <0,19)

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Objective: The purpose of this study was to determine adherence to therapeutic guidelines and their effects on the success rates of nasopharyngeal cancer therapy. Methods: A retrospective cohort study was performed to 269 nasopharyngeal cancer patients treated at Dr. Cipto Mangunkusumo General Hospital (RSCM) from January 2017 to July 2018. Bivariate analysis, logistic regression and Kaplan-Meier survival analyses were conducted to assess the 140 patients who met the inclusion criteria. Results: In our cohort, approximately 67.1% of male patients, median age was 48 years (18-73 years old ), and RSCM internal referrals were 52.9% with 57.1% from the ENT Department. The majority of patients came with stage IV A (49.3%) with WHO III (90%) histopathological type and chemoradiation was the main modality used (60.7%). The compliance rate for PPK from the RSCM internally was 21.6% and the RSCM external was 6.1%. Non-compliance of the usage of therapeutic modalities and the diagnosis from internal and external referrals of the RSCM is 6.8%-4.06% and 13.6%-31.8%. Non-compliance with the number of cycles of neoadjuvant and adjuvant chemotherapy was 29.27% ​​and the number of cycles in concurrent chemotherapy was 70.71%. About 2.14% of patients get a radiation dose under 70 Gy. Duration of commencement therapy was 92.5 (14-830) days, the commencement of chemoradiation after neoadjuvant chemotherapy was 146 (SD 10.04) days, the commencement of adjuvant chemotherapy after chemoradiation was 121.88 (SD 18.35) days. Radiation / chemoradiation duration is 48 (39-77) days. The survival of one and two years for each stage I, II, III, IV A and IV B sequentially was 100%, 85%, 85%, 84%, 87% and 100%, 85% , 77%, 69%, 46%. In general, radiation doses and neodjuvant chemotherapy affect the survival of patients (P<0,01 and P<0,03). Compliance with modalities and duration of therapy is not statistically significant but has a trend of difference in influencing survival in groups that are obedient and not obedient to PPK. The survival of one and two years in the PPK-compliant group was 94.1% and 80.5%. In the PPK non-adherent group, 82.6% and 64.2% were found (P<0.19)"

"Latar belakang: Pada kanker nasofaring, tingginya angka kegagalan metastasis jauh paska terapi masih menimbulkan masalah. Sehingga, penelitian mengenai penggunaan terapi sistemik novel pada kanker nasofaring seperti imunoterapi perlu dilakukan. Terdapat beberapa biomarker yang dapat diperiksa untuk dapat memprediksi respon dari pemberian imunoterapi, salah satunya adalah microsatellite instability (MSI). Mikrosatelit merupakan area pada DNA yang memiliki banyak pengulangan kodon, sehingga rentan terjadi gangguan coding dan mengakibatkan akumulasi mutasi. Pada keadaan normal, kerusakan ini akan diperbaiki dengan sistem mismatch repair. Namun, jika terdapat gangguan atau mutasi terkait sistem ini, atau yang disebut dengan deficient mismatch repair (dMMR), akan menghasilkan fenotipe MSI. Pada kanker kolorektal dan endometrium. Namun sampai saat ini, hanya terdapat 3 penelitian yang melakukan pemeriksaan status MSI pada kanker nasofaring. Penelitian ini bertujuan untuk melihat gambara status MSI pada pasien kanker nasofaring pada pasien di RSCM, Indonesia.Metode: Penelitian ini merupakan penelitian eksploratif dengan 36 subjek penelitian. Dilakukan pemeriksaan status instabilitas mikrosatelit menggunakan pemeriksaan berbasis polymerase chain reaction (PCR) Idylla MSI. Dilakukan pula pemeriksaan MMR menggunakan pemeriksaan berbasis imunohistokimia (IHK) menggunakan 4 antibodi untuk mendapatkan keselerasan antara pemeriksaan MSI dan MMR pada pasien kanker nasofaring di RSCM.Hasil : Menggunakan pemeriksaan Idylla MSI, ditemukan MSI pada 2 dari 36 pasien (5,6%) dan dMMR menggunakan pemeriksaan IHK pada 3 dari 36 pasien (8,34%). Hasil yang konsisten ditemukan pada 2 metode pemeriksaan sebesar 96,97%.Kesimpulan: Pada kanker nasofaring ditemukan frekuensi MSI yang rendah baik menggunakan pemeriksaan IHK dan Idylla MSI. Ditemukan keselerasan yang tinggi antara pemeriksaan berbasis IHK dan pemeriksaan berbasis PCR Idylla MSI.

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Background: Despite high probability of local control after treatment, high rate of distant metastases-failure still pose as problem in the management of locally advanced nasopharyngeal carcinoma. Thus, research for novel systemic therapies for nasopharyngeal cancer, such as immunotherapy, needs to be done. There are several biomarkers that may predict the response to immunotherapy, one of which is microsatellite instability (MSI) phenotype. Microsatellites defined by areas in DNA that are prone to mutations due to repetition of 1-3 nitrogen base. However, under normal circumstances, there are repair systems that can identify and correctly repairs DNA mutations in microsatellite area, a system called mismatch repair (MMR) system. Microsatellite instability is a condition of accumulating mutations in microsatellite area due to defect in MMR system. In colorectal and endometrial cancer, MSI are known as one of prognostic and predictive markers, especially with the usage of immunotherapy immune checkpoint blockade PD-1/PD-L1. To this date, only 3 studies are available in exploring the role of MSI in nasopharyngeal cancer, and no study was done in Indonesia. We conduct this study to assess the MSI status of Indonesia's nasopharyngeal cancer patients in Ciptomangunkusumo Hospital.

Methods: This is the first explorative study in exploring the role of MSI in Indonesia's nasopharyngeal cancer patients. A total of 36 subjects were recruited, and both MSI assessment using immunohistochemistry (IHC) and polymerase chain reaction (PCR) Idylla MSI was done on all study subjects.

Results: MSI was found in 2 patients (5,6%) using PCR based Idylla MSI, and dMMR was found in 3 patients (8,34%). Consistent results between IHC and PCR based MSI assessment was found in 32 patients (96,97%).

Conclusion: MSI was a rare event in Indonesia's nasopharyngeal cancer patients. High concordance was found between IHC and PCR MSI assessment in nasopharyngeal cancer."

"ABSTRAKLatar Belakang: Disfagia fase faring ditemukan pada sebagian besar pasien karsinoma nasofaring (KNF) pasca-kemoradiasi. Manuver Mendelsohn bertujuan untuk meningkatkan durasi elevasi kompleks hyolaringeal, telah digunakan dalam penatalaksanaan disfagia dengan berbagai penyebab. Penelitian ini menilai pengaruh latihan manuver Mendelsohn pada penderita KNF pasca-kemoradiasi dengan disfagia fase faring.Metode: Desain kuasi eksperimen dengan penilaian sebelum dan sesudah latihan menelan dengan manuver Mendelsoh selama 6 minggu. Penelitian dilakukan pada 20 pasien KNF yang memenuhi kriteria penelitian. Sampel didapat secara konsekutif. Penilaian dilakukan dengan flexible endoscopic swallowing study (FEES) terhadap standing secretion, residu, penetrasi, dan aspirasi menggunakan konsistensi pure, thick liquid dan thin liquid.Hasil: Terdapat perbedaan bermakan pada penilaian standing secretion (p=0,034). Penilaian terhadap residu mendapatkan perbedaan bermakna pada pemberian pure dan thick liquid (p=0,021 dan p=0,008), sedangkan pada pemberian thin liquid tidak didapatkan perbedaan bermakna (p=0,129). Penilaian terhadap penetrasi mendapatkan perbedaan bermakna pada pemberian pure dan thick liquid (p=0,034 dan p=0,008), pada pemberian thin liquid tidak didapatkan perbedaan bermakna (p=0,059). Penilaian terhadap aspirasi tidak mendapatkan perbedaan bermakna pada pemberian ketiga konsistensi (p=>0,05).Kesimpulan: Latihan menelan dengan manuver Mendelsohn selama 6 minggu memeperbaiki standing secretion, residu pada pemberian pure dan thick liquid, penetrasi pada pemberian pure dan thick liquid. Latihan ini tidak memperbaiki aspirasi secara bermakna pada pemberian ketiga konsistensi.

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ABSTRACTBackground: Dysphagia is commonly seen in patients with nasopharingeal carcinoma (NPC) post chemoradiation. The Mendelsohn maneuver which promotes a prolonged voluntary of hyolaryngeal elevation at the peak of swallowing process has been used to treat various causes of pharyngeal dysphagia. The aim of the study was to see of the influence of swallowing exercise with Mendelsohn manuever in post-chemoradiation NPC patients with pharyngeal phase dysphagia.Methods: A quasi experimental with pre and post-test assessment at before and after six weeks exercise of Mendelsohn manuever. The study was conducted on 20 NPC patients who met the study criteria. Flexible endoscopic of swallowing study (FEES) was used to asess standing secretion, residue, penetration, and aspiration by giving 3 consistency of food/fluid (pure, thick liquid and thin liquid).Results: There was a significant difference in standing secretion assesment (p=0,034). Significant differences were found in residue assesment of pure and thick liquid, although no significant difference was found in thin liquid (p=0,129). There were also significant differences in penetration assesment of pure and thick liquid (p=0.034 and p = 0.008), but no significant difference in thin liquid ( p = 0.059 ). The study did not find significant differences in assesment of aspiration in all kind of consistencies (p > 0.05). Conclusion: Six weeks swallowing exercise with Mendelsohn manuever can reduce severity of standing secretion, residue and penetration of pure and thick liquid. However the exercise improve aspiration status but did not reach significant difference at all consistencies. ;Background: Dysphagia is commonly seen in patients with nasopharingeal carcinoma (NPC) post chemoradiation. The Mendelsohn maneuver which promotes a prolonged voluntary of hyolaryngeal elevation at the peak of swallowing process has been used to treat various causes of pharyngeal dysphagia. The aim of the study was to see of the influence of swallowing exercise with Mendelsohn manuever in post-chemoradiation NPC patients with pharyngeal phase dysphagia.Methods: A quasi experimental with pre and post-test assessment at before and after six weeks exercise of Mendelsohn manuever. The study was conducted on 20 NPC patients who met the study criteria. Flexible endoscopic of swallowing study (FEES) was used to asess standing secretion, residue, penetration, and aspiration by giving 3 consistency of food/fluid (pure, thick liquid and thin liquid).Results: There was a significant difference in standing secretion assesment (p=0,034). Significant differences were found in residue assesment of pure and thick liquid, although no significant difference was found in thin liquid (p=0,129). There were also significant differences in penetration assesment of pure and thick liquid (p=0.034 and p = 0.008), but no significant difference in thin liquid ( p = 0.059 ). The study did not find significant differences in assesment of aspiration in all kind of consistencies (p > 0.05). Conclusion: Six weeks swallowing exercise with Mendelsohn manuever can reduce severity of standing secretion, residue and penetration of pure and thick liquid. However the exercise improve aspiration status but did not reach significant difference at all consistencies. "

"Latar Belakang. Kesintasan 3 tahun pasien KNF stadium lokal lanjut di Indonesia lebih rendah dibandingkan luar negeri. Prediktor alternatif dari rasio hemoglobin-trombosit (RHT) lebih sederhana, murah, dan stabil nilainya dibanding rasio dari komponen sel leukosit, namun belum ada studi yang meneliti perannya dalam memrediksi mortalitas tiga tahun pasien KNF stadium ini. Tujuan. Mengetahui peran RHT sebelum terapi dalam memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.Metode. Studi kohort retrospektif yang meneliti 289 pasien KNF stadium lokal lanjut yang diterapi di Rumah Sakit Cipto Mangunkusumo (RSCM) dalam rentang waktu Januari 2012 - Oktober 2016. Nilai RHT optimal didapatkan menggunakan receiver operating curve (ROC). Subjek penelitian dibagi menjadi 2 kelompok, di bawah dan di atas titik potong. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia > 60 tahun, stadium, jenis kelamin, dan indeks massa tubuh) untuk mendapatkan nilai adjusted hazard ratio (HR). Hasil. Nilai titik potong RHT optimal adalah 0,362 (AUC 0,6228, interval kepercayaan (IK) 95% : 0,56-0,69, sensitivitas 61,27%, spesifisitas 60,34%). 48,44% pasien memiliki nilai RHT <0,362 dan memiliki mortalitas tiga tahun lebih besar dibandingkan kelompok lainnya (50%vs31,54%). RHT < 0,362 secara signifikan memrediksi kesintasan tiga tahun (p = 0,003; HR 1,75; IK 95% 1,2-2,55). Pada analisis multivariat, RHT < 0,362 sebelum terapi merupakan faktor independen dalam memrediksi kesintasan tiga tahun pada pasien KNF stadium lokal lanjut (adjusted HR 1,82; IK 95% 1,25-2,65). Simpulan. RHT < 0,362 sebelum terapi dapat memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.

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Background. The 3-year survival of locally advanced nasopharyngeal cancer (NPC) patients in Indonesia is lower than in foreign countries. Alternative predictors from the hemoglobin-platelet ratio (HPR) as single variable are easier, cheaper, and stable in value than the ratio of leukocyte cell components, but there are no study conducted to know its potential in predicting three-year survival in locally advanced nasopharyngeal cancer.

Objective. To determine the role of pre-treatment hemoglobin to platelet ratio in predicting three-year survival of locally advanced nasopharyngeal cancer patients.

Method. Retrospective cohort study that examined 289 locally advanced NPC patients who underwent therapy at the National Government General Hospital-Cipto Mangunkusumo from January 2012 to October 2016. HPR cut-off was determined using ROC, and then subjects were divided into two groups according to its HPR value. The Kaplan-Meier curve was used to determine the three-year survival of the patients and cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Results. The optimal cut-off for HPR was 0,362 (AUC 0,6228, 95% CI: 0,56-0,69, sensitivity 61,27%, specificity 60,34%). Patients with HPR < 0,362 occurred in 48, 44% and had higher three-year mortality (50% vs. 31, 54%). HPR <0.362 significantly predicted the three years of survival (p = 0,003; HR 1, 75; CI 95% 1, 2-2, 55). In multivariate analysis, it was concluded that pre-treatment HPR < 0,362 was an independent factor in predicting three-year survival in locally advanced NPC patients (adjusted HR 1, 82; CI 95% 1, 25-2, 65).

Conclusion. Pre-treatment HPR < 0, 362 could predict the three-year survival of locally advanced nasopharyngeal cancer patients."

"Latar Belakang. Coronavirus Disease-19 (COVID-19) sampai sekarang masih menjadi ancaman kesehatan global. Baku emas diagnosis COVID-19 adalah pemeriksaan RT-PCR dari sampel usap nasofaring. Pengambilan sampel dengan cara ini memiliki kekurangan seperti rasa tidak nyaman pada pasien, risiko perdarahan, dan risiko paparan pada tenaga medis. Saliva merupakan salah satu alternatif sampel yang bisa digunakan untuk tujuan ini. Tujuan. Mengetahui sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, dan akurasi RTPCR saliva. Metode. Penelitian potong lintang pasien dewasa suspek COVID-19 pada April-Juni 2021 di instalasi gawat darurat rumah sakit Siloam Lippo Village. Pasien yang memenuhi syarat dan menyatakan setuju dilakukan pemeriksaan RT-PCR dari sampel usap nasofaring dan saliva. RTPCR dikerjakan dengan menilai gen N dan gen ORF1AB menggunakan alat Rotorgen QPlex-5Plus dengan batas positif CT Value < 40. Hasil. Sebanyak 126 pasien suspek COVID-19 yang eligible ikut penelitian selama periode studi. Enam pasien menolak mengikuti penelitian. Analisis akhir dikerjakan pada 120 pasien dengan proporsi laki-laki 42,5% dan median usia 50 tahun. Hasil RT-PCR positif ditemukan pada 69 (57,5%) sampel saliva dan 75 (62,5%) sampel usap nasofaring. Sensitivitas uji RT-PCR COVID19 dari sampel saliva adalah 86,67% (95% CI 76,84- 93,42), spesifisitasnya 91,11% (95% CI 78,78- 97,52). Nilai NDP yang didapat adalah 94,20% (95% CI 86,39-97,65) dan nilai NDN yang didapat 80,39% (95% CI 69,57-88,03). Akurasi yang didapat adalah 88,33% (95% CI 81,2093,47). Rerata CT value RT-PCR dari sampel saliva lebih tinggi dibandingkan sampel nasofaring, baik pada gen N (mean saliva 26,22 vs nasofaring 22,18; p= 0,01) maupun ORF1AB (mean saliva 26,39 vs nasofaring 23,24; p= 0,01). Simpulan. Saliva yang diambil dengan metode drooling merupakan sampel yang akurat untuk pemeriksaan RT-PCR COVID-19.

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Background. Coronavirus Disease-19 (COVID-19) is still a global health problem. Diagnostic gold standard for COVID-19 is RT-PCR of the nasopharyngeal swab specimen. However, this method has several issues such as patient’s discomfort, risk of bleeding, and risk of exposure to examiner. Saliva is a viable alternative sample for this examination. Aim. To find out the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of saliva RT-PCR. Method. Crossectional study in adult patient with suspect ofCOVID-19 during April-June 2021 in emergency unit Lippo Village Hospital. Eligible and agreed patient are examined with RT-PCR from nasopharyngeal swab and saliva. RT-PCR was done by targeting gene N and ORF1AB using Rotorgen QPlex-5-Plus with CT value cut off 40. Result. A total of 126 suspected COVID-19 cases were admitted to ER during study period. Six patients were disagree to join. Final analysis was carried out on 120 patients (42.5% male, media age 60). Positive RT-PCR was found in 69 (57.5%) saliva specimens and 75 (62.5%) nasopharyngeal specimens. Sensitivity of saliva specimens was 86.67% (95% CI 76.84- 93.42), with specificity of 91.11% (95% CI 78.78-97.52). NDP of saliva was 94.20% (95% CI 86.39-97.65) with NDN of 80.39% (95% CI 69.57-88.03). Saliva’s accuracy was 88.33% (95% CI 81.20-93.47). Mean CT value of saliva specimens was higher than nasopharyngeal specimens in both gene N (mean saliva 26.22 vs nasopharyngeal 22.18; p= 0.01) and ORF1AB (mean saliva 26.39 vs nasopharyngeal 23.24; p= 0.01). Conclusion. Saliva collected with drooling method is an accurate sample for COVID-19 RT-PCR."

"ABSTRAKKasus kanker nasofaring memiliki banyak organ at risk diantaranya adalah parotid kanan, parotid kiri, mata kanan, mata kiri dan trakea.Teknik penyinaran yang dapat menekan dosis yang diterima organ at risk adalah volumetric modulation arc therapy VMAT . Dalam penelitian ini bertujuan untuk melakukan verifikasi dosis organ at risk pada kasus kanker nasofaring KNF menggunakan planning VMAT dengan teknik single arc dan double arc berdasarkan data klinis. Verifikasi ini dilakukan dengan menggunakan TLD rod dan film gafchromic EBT3 yang diletakkan pada pasien sesuai dengan letak organ at risk yang akan dievaluasi. Terdapat 5 organ at risk yang dievaluasi pada kasus kanker nasofaring diantaranya parotid kanan, parotid kiri, mata kanan, mata kiri dan trakea.Evaluasi yang dilakukan diantaranya perbandingan dosis antar teknik, deviasi pengukuran dosis menggunakan TLD rod dan film gafchromic EBT3 dengan TPS Treatment Planning System . Perbandingan pengukuran dosis rata-rata menggunakan film gafchromic, TLD rod dan TPS dapat dilihat bahwa nilai yang mendekati TPS adalah film gafchromic dengan nilai diferensiasi adalah 0,171 . Hasil pengukuran dosis menggunakan film gafchromic berdasarkan data CT rando dapat disimpulkan bahwa teknik VMAT double arc dengan kolimator dapat membuat organ at risk menjadi lebih aman karena dengan penggunaan kolimator dapat meminimalisasi kebocoran efek tongue and groove. Hasil statistik menggunakan perangkat lunak SPSS 16.0 didapat bahwa nilai uji korelasi antara 3 teknik double arc DA , double arc dengan kolimator DAC dan single arc SA menunjukkan korelasi kuat dan signifikan pada keseluruhan organ at risk kecuali parotis kiri pada teknik DA-DAC sedangkan pada teknik DAC-SA menunjukkan korelasi kuat dan tidak signifikan untuk keseluruhan organ at risk. Untuk uji hipotesa dapat disimpulkan bahwa perbedaan rata-rata distribusi dosis antara 3 teknik yang berbeda pada stadium 4 pada film gafchromic adalah signifikan.

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ABSTRACTThe cases of nasopharyngeal cancer have many organs at risk including right parotid, left parotid, right eye, left eye and trachea. The irradiation technique that can suppress the dose received by the organ at risk is volumetric modulation arc therapy VMAT . This research aims to verify dose in the organs at risk in cases of nasopharyngeal cancer NPC using VMAT planning with single arc and double arc techniques based on clinical data. The verification is performed by using TLD rod and gafchromic EBT3 films placed on the patient according to the location of the organs at risk which will be evaluated. There are 5 organs at risk evaluated in the cases of nasopharyngeal cancer such as right parotid, left parotid, right eye, left eye and trachea. The evaluation includes the ratio of dose between techniques, deviation of dose measurement using TLD rod and gafchromic EBT3 films with TPS Treatment Planning System . The measurement ratio of mean dose using gafchromic film, TLD rod and TPS shows that the values close to TPS is gafchromic film detector which its differentiation value is 0.171 . The result of dose measurement using gafchromic film based on the data of CT rando can be concluded that double arc VMAT technique with collimator can reduce the dose in the organ at risk. The statistical result using SPSS 16.0 shows that the correlation test value between 3 techniques such as double arc DA , double arc with collimator DAC and single arc SA shows strong and significant correlation in the whole organ at rialexcept left parotid in the DA DAC technique while in the DAC SA technique shows strong and insignificant correlation in the whole organ at risk. For hypothesis test, it can be concluded that the difference in themean dose distribution between 3 different techniques at stage 4 in gafchromic film is significant."

"Kanker masih menjadi penyakit yang menakutkan bagi masyarakat. Kanker merupakan penyebab ke dua kematian utama setelah penyakit jantung di dunia. Salah satu kanker ganas karsinoma nasofaring KNF merupakan jenis kanker ke empat terbanyak di Indonesia. Massa yang mendesak jaringan sekitar akan menyebabkan rasa nyeri bagi pasien yang mengalami penyakit kanker. Karya ilmiah akhir ini bertujuan menganalisis praktik asuhan keperawatan pada anak dengan KNF yang mengalami nyeri kronik. Evaluasi hasil intervensi yang dilakukan didapatkan data bahwa masalah nyeri kronik, kekurangan nutrisi kurang dari kebutuhan tubuh, resiko perdarahan teratasi sebagian. Tindakan teknik distraksi berupa permainan games dan penatalaksaan nyeri menggunakan farmakologi mampu mengurangi skala Children rsquo;s Hospital of Eastern Ontario Pain Scale CHEOPS dengan KNF.

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Cancer is still a frightening disease for people. Cancer is the second leading cause of death after heart disease in the world. One of the most severe cancers of nasopharyngeal carcinoma KNF is the fourth most common cancer in Indonesia. The urgent mass of surrounding tissue will cause pain for patients with cancer. This final paper aims to analyze the practice of nursing care in children with KNF who experience chronic pain. Evaluation of intervention result done got data that problem of chronic pain, lack of nutrition less than requirement of body, risk of bleeding partially resolved. The technique of distraction such as playing games and pain management using pharmacology can reduce the scale Children rsquo s Hospital of Eastern Ontario Pain Scale CHEOPS with KNF. "