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Abstrak :
Tujuan penelitian ini adalah untuk mengetahui korelasi antara penilaian risiko malnutrisi menggunakan skor PG-SGA dengan kadar CRP serum sehingga dapat digunakan untuk memprediksi tingkat inflamasi pada pasien kanker kepala dan leher stadium I_IV guna mencegah terjadinya kaheksia. Malnutrisi hingga kaheksia pada kanker terjadi karena interaksi faktor tumor, faktor pejamu dan faktor-faktor lainnya. Faktor tumor berupa sitokin pro-inflamasi akan memicu respons pejamu untuk memproduksi protein fase akut seperti CRP. Protein fase akut memerlukan sejumlah substrat yaitu asam amino yang berasal dari otot rangka. Otot rangka akan mengalami degradasi sehingga menyebabkan wasting otot rangka. Oleh karena itu, CRP selain dapat digunakan sebagai marker inflamasi sistemik juga dapat digunakan sebagai salah satu indikator faktor risiko yang berperan dalam terjadinya malnutrisi dan kaheksia. Efek wasting otot rangka yang ditimbulkan secara tidak langsung oleh CRP dapat dinilai dengan terdapatnya penurunan BB maupun berkurangnya massa otot yang juga merupakan komponen dalam penilaian PG-SGA. Penelitian ini merupakan studi potong lintang dengan menggunakan consecutive sampling yang melibatkan 51 subjek kanker kepala dan leher stadium I_IV yang belum mendapatkan terapi. Hasil penelitian didapatkan rerata usia 46,6 13,9 tahun, sebanyak 76,5 berjenis kelamin laki-laki. Kanker nasofaring merupakan kanker terbanyak 80,4 , dan stadium terbanyak yaitu stadium IVA. Rerata indeks massa tubuh IMT yaitu 20,6 4,0 kg/m2, dan sebanyak 37,3 subjek berada pada IMT normal. Berdasarkan skor PG-SGA sebanyak 64,7 subjek berisiko tinggi malnutrisi dengan rerata skor PG-SGA 11,7 6,2. Nilai median CRP yaitu 6,4 0,4_170,4 . Penelitian ini memperoleh korelasi positif yang signifikan antara skor PG-SGA dengan kadar CRP serum dengan kekuatan korelasi lemah r = 0,372; p = 0,007. ......The purpose of this study was to determine the correlation between the malnutrition risk assessment using PG SGA score with serum CRP levels so that it can be used to predict the levels of inflammation in head and neck cancer patients stage I IV to prevent cachexia. Malnutrition and cancer cachexia occurs due to the interaction of tumor factors, host factors and other factors. Tumor factors such as pro inflammatory cytokines will trigger a response of the host to produce acute phase proteins such as CRP. Acute phase protein which require a number of amino acids derived from skeletal muscle. Skeletal muscles will be degraded, causing skeletal muscle wasting. Therefore, CRP can be used as a marker of systemic inflammation and can be used as one indicator of the risk factors also that contribute to malnutrition and cachexia. Effect of skeletal muscle wasting which caused indirectly by the CRP can be assessed by the weight loss and reduced muscle mass which is a component in the assessment of PG SGA also. This study is a cross sectional study using consecutive sampling, 51 subjects head and neck cancer stage I IV who had not received treatment participated in this study. Data showed the mean age of subjects was 46.6 13,9 years, and 76 were male. Most cancer sites were as nasopharyngeal 80,4, and mostly in stage IVA. The mean body mass index BMI is 20,6 40 kg m2, with most of the BMI is normal 37,3. Based on PG SGA score 64,7 of the subjects at high risk of malnutrition, and the PG SGA mean score is 11,7 6,2. The median value of CRP is 6,4 0,4 170,4. The result of this study showed a significant positive correlation between PG SGA score with serum CRP levels with the strength of correlation is weak r 0,372 p 0,007.

Abstrak :
Latar belakang: Risiko kaheksia pada pasien kanker kepala dan leher KKL meningkat akibat tumor itu sendiri, letak tumor, dan pemberian terapi medis. Penurunan berat badan akibat efek samping radioterapi atau kemoradioterapi dapat menurunkan angka kesintasan dan kualitas hidup, serta meningkatkan angka morbiditas dan mortalitas. Terapi medik gizi klinik bertujuan mencegah malnutrisi bertambah berat, memperbaiki kualitas hidup, dan mendukung outcome terapi yang baik. Terapi medik gizi klinik berupa konsultasi individu, meliputi pemberian nutrisi adekuat sesuai kebutuhan energi, makronutrien, mikronutrien, dan nutrien spesifik, serta terapi medikamentosa dan edukasi. Metode: Pasien pada serial kasus ini berjumlah empat orang, berusia 32 ndash;53 tahun. Satu orang pasien dengan diagnosis karsinoma lidah dan 3 orang dengan kanker nasofaring. Dua dari 4 pasien menjalani kemoradioterapi. Semua terdiagnosis kaheksia pada awal pemeriksaan. Kebutuhan energi total dihitung menggunakan persamaan Harris-Benedict untuk kebutuhan basal dikalikan faktor stres 1,5. Pemantauan meliputi keluhan subjektif dan pemeriksaan objektif tanda vital, kondisi klinis, antropometrik, massa otot, massa lemak, kekuatan genggam tangan, Karnofsky Performance Status, analisis asupan, dan laboratorium . Pemantauan dilakukan secara berkala setiap minggu untuk menilai pencapaian target pemberian nutrisi. Hasil: Terapi medik gizi klinik pada keempat pasien meningkatkan asupan energi, protein, dan nutrien spesifik asam amino rantai cabang dan eicosapentaenoic acid . Penurunan BB, massa otot, dan kapasitas fungsional yang terjadi pada pasien hanya minimal. Kesimpulan: Terapi medik gizi klinik pada pasien KKL dengan kaheksia dalam radioterapi atau kemoradioterapi dapat meningkatkan asupan nutrisi dan meminimalkan penurunan status gizi pasien lebih lanjut.

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Introduction: The risk of cachexia of head and neck cancer HNC is increased because of the tumor itself, site of the tumor, and side effects of cancer treatment. Weight loss during radiotherapy or chemoradiotherapy will decrease the survival rates and quality of life, and increase morbidity and mortality rates. The purpose of medical therapy in clinical nutrition is to prevent further malnutrition during therapy, improve quality of life, and support the good outcome of cancer treatment. Individual medical therapy in clinical nutrition include adequate energy, macro and micronutrient, and specific nutrients requirements, pharmacotherapy and education. Methods: Four HNC patients in this case series aged between 32 and 53. One patient diagnosed squamous cell carcinoma of the tongue and 3 patients with nasopharyngeal cancer. Two of four patients received chemoradiotherapy. Total energy requirement was calculated using Harris Benedict equation for basal energy need multipled by stress factor of 1,5. Monitoring include subjective complaints and objective examination vital sign, physical examination, anthropometric, muscle mass, fat mass, handgrip strength, Karnofsky Performance Status, dietary analysis, and laboratory. Monitoring was performed routinely every week to assess achievement of the nutrition therapy target. Results: Medical therapy in clinical nutrition to four patients can increase the intake of energy, protein, and specific nutrients branched chain amino acid and eicosapentaenoic acid. The decreased of weight, muscle mass, and functional capacity during radiotherapy or chemoradiotherapy were only minimal. Conclusion: Medical therapy in clinical nutrition for HNC patients with cachexia on radiotherapy or chemoradiotherapy can increase nutrition intake and minimalized further malnutrition.

Abstrak :
Latar Belakang: Kanker kepala dan leher terdapat 10 dari keseluruhan kasus kanker di seluruh tubuh. Efek samping akibat terapi kanker berdampak signifikan pada kualitas hidup pasien. Instrumen yang sering digunakan untuk menilai kualitas hidup pasien kanker kepala dan leher salah satunya adalah University of Washington Quality of Life UW-QOL. Hingga saat ini belum pernah dilakukan adaptasi kuesioner UW-QOL ke bahasa Indonesia. Tujuan: Penelitian ini bertujuan mendapatkan instrumen UW-QOL adaptasi bahasa Indonesia yang valid dan reliabel untuk menilai kualitas hidup pasien kanker kepala dan leher. Metodologi: Penelitian ini berdesain potong lintang, dilakukan di poliklinik THT FKUI/RSCM dr. Cipto Mangunkusumo terhadap pasien kanker kepala dan leher usia dewasa. Hasil: Uji validitas menggunakan uji korelasi Spearman dengan korelasi bermakna pada seluruh butir pertanyaan di tingkat signifikansi p ......Background: Head and neck cancer accounts for 10 of all cancer cases throughout the body.. Side effects due to cancer therapy have a significant impact on patient quality of life. The University of Washington Quality of Life UW QOL is the most frequent intruments used to assess the quality of life of head and neck cancer patients. At present, the Indonesian version of UW QOL questionnaire is not available. Objective: This study aims to obtain a valid and reliable Indonesian adaptation of UW QOL to assess the quality of life of head and neck cancer patients. Method: Cross sectional study was conducted in ORL HNS Department outpatient clinic dr. Cipto Mangunkusumo hospital towards 41 adult patients with head and neck cancer. Result: The validity test using Spearman correlation test with significant correlation in all questions items at the level of significance p

Abstrak :
Pasien kanker kepala leher rentan mengalami malnutrisi akibat penurunan sensitivitas indera pengecap yang sudah terjadi sejak awal diagnosis dan akan diperberat oleh terapi. Seng merupakan salah satu zat gizi yang berperan dalam proses metabolisme utama seperti regulasi siklus sel dan pembelahan sel, sintesis protein dan penyembuhan luka termasuk di antaranya sel-sel taste bud pada indera pengecap. Penelitian ini bertujuan untuk melihat hubungan antara asupan seng dengan kepekaan indera pengecap pada pasien kanker kepala leher sebelum menjalani kemoradiasi. Penelitian menggunakan desain potong lintang pada subyek dewasa dengan kanker kepala leher sebelum kemoradiasi di RSCM. Asupan seng dinilai menggunakan FFQ semi kuantitatif. Kepekaan indera pengecap dinilai dengan menggunakan 3-stimulus drop technique yang dikembangkan oleh Mossman dan Henkin untuk 4 kualitas rasa (asin, manis, asam, dan pahit). Sebanyak 85 subyek penelitian dengan median usia 54 tahun, mayoritas laki-laki, terdiagnosis kanker nasofaring dengan jenis karsinoma sel skuamosa dan stadium IV. Rerata subyek memiliki status gizi normal, dengan median asupan energi 28 (15-58) kkal/kgBB dan protein 1 (0-3) g/kgBB. Median asupan seng pada subyek sebesar 8 (3-24) gram dengan FFQ semi kuantitatif. Kepekaan indera pengecap subyek didapatkan paling tinggi berturut-turut adalah untuk rasa asam, pahit, asin, dan manis. Dilakukan uji korelasi antara asupan seng dengan kepekaan indera pengecap. Tidak ditemukan adanya korelasi bermakna antara asupan seng dengan kepekaan indera pengecap pada pasien kanker kepala leher praradiasi baik rasa manis (r= -0,170, p= 0,120), asin (r= -0,085, p= 0,442), asam (r= 0,080, p= 0,467), ataupun pahit (r= -0,131, p= 0,233). ......Head and neck cancer patients are susceptible to malnutrition due to decreased taste sensitivity that has occurred since first diagnosed and worsened by therapy. Zinc is a nutrient that plays a role in major metabolic processes such as regulation of the cell cycle dan cell proliferation, protein synthesis and wound healing, including taste bud cells. This study aims to examine the relationship between zinc intake and taste sensitivity in head and neck cancer patients before undergoing chemoradiation. The study used a cross-sectional design on adult head and neck cancer subjects who have not been undergone chemoradiation at RSCM. Zinc intake was assessed using a semi-quantitative food frequency questionnaire. Taste sensitivity was assessed using the 3-stimulus drop technique developed by Mossman and Henkin for 4 taste qualities (salty, sweet, sour, and bitter). A total of 85 subjects with a median age of 54 years, most of them are male, diagnosed with nasopharyngeal cancer and already at stage IV. On average, the subjects had normal nutritional status, median energy intake was 28 (15-58) kcal/kgBW and protein 1 (0-3) g/kgBW. The median zinc intake in subjects was 8 (3-24) grams assessed with a semi-quantitative FFQ. The highest taste sensitivity of the subjects was sour, bitter, salty, and sweet, respectively. A correlation test was conducted between zinc intake and taste sensitivity. There was no significant correlation between zinc intake and taste sensitivity in head and neck cancer patients before chemoradiation, either sweet (r= -0.170, p= 0.120), salty (r= -0.085, p= 0.442), sour (r= 0.080), p= 0.467), or bitter (r= -0.131, p= 0.233).

Abstrak :
Radiotherapy is one of treatment's modalities for head and neck malignancies. Its successful rate in curing cancer is undeniable. However, the patient will suffer several side effects or oral complications due to the treatment. If this condition is not properly managed, it can lead to the decline of patient's quality of life. There are 4 aspects that can be used as indicators of quality of life for the case of head and neck that must be aware of which are: (1) disturbing pain, (2) problem in chewing and swallowing, (3) problem in oral communication, (4) patient's emotion. In order to maintain patient's quality of life, patients must have the willingness to recover and follow all instructions suggested by the medical staffs in charge and receive full support of the family and health personnel which include oncology radiotherapist, dentists, and all the paramedics involved.

Abstrak :
[ABSTRAK
Latar belakang dan tujuan: efek samping radioterapi pada kulit, yang disebut dengan radiodermatitis, merupakan masalah bagi pasien keganasan kepala dan leher yang menjalani radioterapi. Efek samping yang terjadi dapat menurunkan kepatuhan pasien berobat, sehingga dapat meningkatkan angka putus terapi. Dua studi pendahulu telah mempelajari light emitting diode (LED) untuk mengurangi kejadian radiodermatitis dengan hasil yang berlawanan. Penelitian ini ingin mempelajari lebih lanjut mengenai efektivitas LED untuk menurunkan kejadian radiodermatitis. Metode: pada kelompok perlakuan, subjek penelitian (SP) mendapat tambahan fototerapi LED segera setelah radioterapi selesai. Fototerapi LED diberikan selama radioterapi berlangsung. Penilaian derajat radiodermatitis dilakukan oleh peneliti setiap lima kali radioterapi dijalani, menggunakan kriteria menurut Common Terminology Criteria for Adverse Event (CTCAE) yang dimodifikasi. Hasil: kejadian radiodermatitis antara kelompok kontrol dan perlakuan hampir sama dan tidak berbeda bermakna secara statistik. Berdasarkan analisis kecenderungan, terlihat bahwa terjadi peningkatan persentase jumlah SP dengan radiodermatitis pada kelompok kontrol sebesar dua kali lipat saat rerata dosis radiasi kumulatif 34 Gy, sedangkan pada kelompok perlakuan baru meningkat saat rerata dosis radiasi kumulatif 44 Gy. Rasa gatal, lesi eritematosa, dan hiperpigmentasi lebih dahulu dialami oleh kelompok kontrol. Pada pemantauan 2 minggu pasca radioterapi terlihat bahwa persentase SP dengan radiodermatitis menurun lebih cepat pada kelompok perlakuan. Kesimpulan: fototerapi LED tidak dapat menurunkan kejadian radiodermatitis pada pasien keganasan kepala dan leher, namun mempunyai kecenderungan untuk menurunkan kejadian radiodermatitis saat rerata dosis radiasi kumulatif 34 Gy hingga mencapai dosis 44 Gy. Fototerapi LED juga dapat menunda terjadinya rasa gatal, lesi eritematosa, dan hiperpigmentasi, serta mempercepat penyembuhan radiodermatitis. Diperlukan studi lebih lanjut untuk membuktikan hipotesis ini dengan memperhitungkan saran dari peneliti.

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ABSTRACT
Background and objectives: radiation dermatitis remains a common problem in patients with head and neck cancer. This side effect causes discomfort, pain, and may lead to treatment delay. Two previous studies using light emitting diode (LED) phototherapy to prevent radiation dermatitis have been reported, with a completely different result. This study sought to further evaluate the effectiveness of LED phototherapy in lessening radiation dermatitis. Method: in the LED treatment group, all subjects with head and neck cancer received LED phototherapy after each radiation treatment. Reactions were evaluated every five treatments by the author, using the modified Common Terminology Criteria for Adverse Event (CTCAE) criteria. Results: instances of radiodermatitis amongst the control and the treated group has no clinical or statistical differences. Based on trend analysis, the fourth week of the study (mean cumulative radiation dose 34 Gy) shows a two-fold increase in the number of subject developing radiodermatitis in the control group. On the other hand, the treated group experiences an increase in the number of subject developing radiodermatitis on the fifth week (mean cumulative radiation dose 44 Gy). The control group experiences itching sensation, erythematous and hyperpigmented lesion sooner than the treated group. Two weeks after radiation therapy, the percentage of subject experiencing radiodermatitis decreases faster. Conclusions: LED phototherapy did not reduce the incidence of radiation dermatitis, but there is a patterned trend which show LED phototherapy may reduce radiation dermatitis when the mean cumulative radiation dose 34 Gy until it reaches 44 Gy. LED phototherapy tend to delay development of itching sensation, erythematous and hyperpigmented lesion, also accelerate radiodermatitis healing process. Further study needed to prove this hypothesis.;Background and objectives: radiation dermatitis remains a common problem in patients with head and neck cancer. This side effect causes discomfort, pain, and may lead to treatment delay. Two previous studies using light emitting diode (LED) phototherapy to prevent radiation dermatitis have been reported, with a completely different result. This study sought to further evaluate the effectiveness of LED phototherapy in lessening radiation dermatitis. Method: in the LED treatment group, all subjects with head and neck cancer received LED phototherapy after each radiation treatment. Reactions were evaluated every five treatments by the author, using the modified Common Terminology Criteria for Adverse Event (CTCAE) criteria. Results: instances of radiodermatitis amongst the control and the treated group has no clinical or statistical differences. Based on trend analysis, the fourth week of the study (mean cumulative radiation dose 34 Gy) shows a two-fold increase in the number of subject developing radiodermatitis in the control group. On the other hand, the treated group experiences an increase in the number of subject developing radiodermatitis on the fifth week (mean cumulative radiation dose 44 Gy). The control group experiences itching sensation, erythematous and hyperpigmented lesion sooner than the treated group. Two weeks after radiation therapy, the percentage of subject experiencing radiodermatitis decreases faster. Conclusions: LED phototherapy did not reduce the incidence of radiation dermatitis, but there is a patterned trend which show LED phototherapy may reduce radiation dermatitis when the mean cumulative radiation dose 34 Gy until it reaches 44 Gy. LED phototherapy tend to delay development of itching sensation, erythematous and hyperpigmented lesion, also accelerate radiodermatitis healing process. Further study needed to prove this hypothesis., Background and objectives: radiation dermatitis remains a common problem in patients with head and neck cancer. This side effect causes discomfort, pain, and may lead to treatment delay. Two previous studies using light emitting diode (LED) phototherapy to prevent radiation dermatitis have been reported, with a completely different result. This study sought to further evaluate the effectiveness of LED phototherapy in lessening radiation dermatitis. Method: in the LED treatment group, all subjects with head and neck cancer received LED phototherapy after each radiation treatment. Reactions were evaluated every five treatments by the author, using the modified Common Terminology Criteria for Adverse Event (CTCAE) criteria. Results: instances of radiodermatitis amongst the control and the treated group has no clinical or statistical differences. Based on trend analysis, the fourth week of the study (mean cumulative radiation dose 34 Gy) shows a two-fold increase in the number of subject developing radiodermatitis in the control group. On the other hand, the treated group experiences an increase in the number of subject developing radiodermatitis on the fifth week (mean cumulative radiation dose 44 Gy). The control group experiences itching sensation, erythematous and hyperpigmented lesion sooner than the treated group. Two weeks after radiation therapy, the percentage of subject experiencing radiodermatitis decreases faster. Conclusions: LED phototherapy did not reduce the incidence of radiation dermatitis, but there is a patterned trend which show LED phototherapy may reduce radiation dermatitis when the mean cumulative radiation dose 34 Gy until it reaches 44 Gy. LED phototherapy tend to delay development of itching sensation, erythematous and hyperpigmented lesion, also accelerate radiodermatitis healing process. Further study needed to prove this hypothesis.]

Abstrak :
Proses inflamasi pada kanker kepala dan leher menyebabkan peningkatan sitokin proinflamasi dan sintesis protein fase akut c-reactive protein, CRP yang kemudian menyebabkan perubahan metabolisme dan anoreksia pada penderitanya. Seng merupakan zat gizi yang memiliki peran penting dalam menekan inflamasi, namun dilaporkan sekitar 65 pasien kanker kepala dan leher mengalami kekurangan seng. Penelitian potong lintang ini bertujuan mengetahui korelasi antara asupan seng dan kadar seng serum dengan kadar c-reactive protein CRP sebagai upaya menekan inflamasi sehingga dapat mengurangi morbiditas dan mortalitas pasien kanker kepala leher. Dari 49 subyek yang dikumpulkan secara konsekutif di Poliklinik Onkologi RS Kanker Dharmais, 67,3 adalah laki-laki, rentang usia subyek 46 ndash;65 tahun. Frekuensi terbanyak 65,3 adalah kanker nasofaring dan 69,4 berada pada stadium IV. Seratus persen subyek memiliki asupan seng dibawah nilai angka kecukupan gizi. Rerata kadar seng serum subyek adalah 9,83 2,62 mol/L. Sebanyak 51 subyek memiliki kadar CRP yang meningkat. Terdapat korelasi negatif yang lemah antara kadar seng dengan kadar CRP subyek r =-0,292, p =0,042, namun tidak terdapat korelasi antara asupan seng dengan kadar CRP subyek p =0,86. ......The inflammatory process of head and neck cancer leads to increase the proinflammatory cytokines and the synthesis of c reactive protein CRP , which then causes metabolic alteration and anorexia in the patients. Zinc is one of nutrient that has an important role in suppressing inflammation. It is reported that about 65 of head and neck cancer patients have zinc deficiency. The aim of this cross sectional study is to determine the correlation between zinc intake and serum zinc levels with CRP level as an effort to reduce inflammation to reduce the morbidity and mortality of head and neck cancer patients. Subjects were collected by consecutive sampling in the Oncology Polyclinic Dharmais Cancer Hospital, from 49 subjects 67,3 were men, most subjects were in the age range between 46 ndash 65 years. The highest frequency 65,3 is nasopharyngeal cancer and 69,4 are already in stage IV. All subjects in this study have a zinc intake below the recommended dietary allowance RDA in Indonesia. The mean serum zinc level of the subjects was 9.83 2.62 mol L. Most subjects have elevated CRP levels. There was a weak significant negative correlation between zinc concentration and CRP levels of subjects r 0.292, p 0.042, but there was no correlation between zinc intake and CRP levels of subjects p 0.86.

Abstrak :
Latar Belakang: Gen Interleukin-1 Receptor Antagonist IL-1RN merupakan gen yang mengkodekan protein IL-1RN dan polimorfisme VNTR 86bp gen tersebut telah dihubungkan dengan terjadinya berbagai kanker, termasuk kanker kepala dan leher KKL. Penelitian ini bertujuan untuk mendeskripsikan polimorfisme gen IL-1RN pada penderita KKL di Indonesia. Metode: Analisis Polymerase Chain Reaction PCR digunakan pada sampel DNA tersimpan dari 50 subyek kontrol dan 50 subyek penderita KKL untuk melihat polimorfisme gen IL-1RN VNTR. Hasil: Persentase genotip pembawa alel A2 alel mutan adalah 18 pada sampel kontrol dan 32 pada sampel penderita KKL. Nilai p>0,05 untuk distribusi genotip dan alel pada sampel kontrol dan penderita KKL. Kesimpulan: Ditemukan polimorfisme gen IL-1RN VNTR pada penderita KKL dan tidak terdapat perbedaan bermakna pada distribusi polimorfisme gen IL-1RN VNTR antara penderita KKL dan individu sehat di Indonesia.

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Background: Interleukin 1 Receptor Antagonist IL-1RN gene encodes IL-1RN protein and its 86bp variable number of tandem repeat VNTR polymorphism within intron 2 has been associated with the development of several cancers, including head and neck cancer HNC. This study aimed to describe the IL-1RN polymorphism of HNC patients in Indonesia. Methods: The polymerase chain reaction PCR analysis was conducted on stored blood derived DNA samples from 50 control subjects and 50 HNC subjects for IL-1RN VNTR polymorphism. Results: The percentage of A2 carrier genotype is 18 in control samples and 32 in HNC samples. The p value is 0,05 in the frequencies of genotypes or alleles in both control and cancer groups. Conclusion: There is IL-1RN VNTR gene polymorphism in HNC patients and there is no significant association of IL 1RN VNTR polymorphism between HNC patients and healthy individuals in the studied Indonesian population.

Abstrak :
Kanker kepala dan leher merupakan kanker yang menggambarkan berbagai tumor ganas yang berasal dari saluran aerodigestif atas, yang meliputi kanker pada mata, telinga, rongga hidung, sinus paranasal, nasofaring, orofaring, hipofaring, laring, kelenjar saliva, dan kelenjar tiroid. Penelitian ini bertujuan untuk mengetahui pengaruh terapi akupunktur manual terhadap kadar MDA dan skor NAS dibandingkan dengan akupunktur manual sham pada penderita kanker kepala dan leher pasca terapi radiasi. Uji klinis acak tersamar tunggal dengan kontrol dilakukan terhadap 30 pasien kanker kepala dan leher yang dibagi secara acak menjadi kelompok akupunktur manual n=15 dan kelompok akupunktur manual sham n=15. Pemeriksaan kadar MDA dilakukan sebelum perlakuan dan setelah sesi ke-12. Penilaian skor NAS dilakukan pada saat sebelum perlakuan, setelah sesi ke-6, dan setelah sesi ke-12. Hasil penelitian menunjukkan tidak terdapat perbedaan bermakna antara kelompok akupunktur manual dengan kelompok akupunktur manual sham terhadap penurunan kadar MDA sebelum dan sesudah perlakuan p=0,787. Terdapat perbedaan bermakna antara kelompok manual dengan akupunktur manual sham terhadap penurunan skor NAS sebelum dan sesudah perlakuan yang diukur pada sesi ke-6 p=0,001 dan sesi ke-12 p=0,003. Kesimpulan penelitian ini terapi akupunktur manual efektif untuk menurunkan skor NAS, namun kurang efektif untuk menurunkan kadar MDA pada penderita kanker kepala dan leher pasca terapi radiasi.

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Head and neck cancer encompasses a wide range of malignant tumours arising from the upper aerodigestive tract, includes eyes, ears, nasal cavities, paranasal sinuses, nasopharynx, oropharynx, hypopharynx, larynx, salivary glands, and thyroid gland. This study aims to determine the effect of manual acupuncture therapy on MDA levels and NAS scores compared with manual sham acupuncture in patients with head and neck cancer post radiation therapy. Single blinded randomized clinical trials with control were performed on 30 head and neck cancer patients divided randomly into manual acupuncture groups n = 15 and the sham manual acupuncture group n = 15. The examination of MDA levels is performed before treatment and after the 12th session. Assessment of NAS scores is performed before the treatment, after the 6th session, and after the 12th session. The result showed no significant difference between manual acupuncture group and sham manual acupuncture group to decrease MDA level before and after treatment p = 0,787. There was a significant difference between manual group and sham manual acupuncture on NAS score decrease before and after treatment measured at 6th session p = 0,001 and 12th session p = 0,003. The conclusion: manual acupuncture therapy effectively decrease NAS scores, but statistically less effective to reduce levels of MDA in patients with head and neck cancer after radiotherapy.

Abstrak :
Latar Belakang: Hitung limfosit total berhubungan dengan prognosis serta harapan hidup pasien kanker kepala leher. Regulasi limfosit dipengaruhi berbagai hal termasuk nutrisi. Salah satu zat gizi yang berperan dalam proliferasi limfosit adalah asam amino rantai cabang. Penelitian ini bertujuan untuk melihat korelasi antara asupan asam amino rantai cabang dengan hitung limfosit total pada pasien kanker kepala dan leher. Metode: Studi potong lintang ini dilakukan pada subjek dewasa dengan kanker kepala leher yang belum menjalani terapi di poliklinik radioterapi dan hematologi onkologi medik RSCM. Asupan asam amino rantai cabang dinilai dengan 3 x 24-h food recall dan FFQ semi kuantitatif. Hitung limfosit total diukur dengan differential blood cell counter. Hasil: Sebanyak 85 subjek penelitian dengan rerata usia 53 tahun, dengan sebagian besar laki-laki, terdiagnosis kanker nasofaring dengan jenis karsinoma sel skuamosa dan stadium IV. Rerata subjek memiliki status gizi normal, dengan rerata asupan energi 29,99 ± 0,95 kkal/kgBB dan protein 1,39 ± 0,05 g/kgBB dengan penilaian FFQ semi kuantitatif. Rerata asupan AARC pada subjek sebesar 10,92 ± 0,48 gram dengan FFQ semi kuantitatif. Sebagian besar subyek memiliki hitung limfosit total pada rentang normal. Terdapat sebanyak 17.6% subyek dengan hitung limfosit total yang rendah. Terdapat korelasi lemah antara asupan asam amino rantai cabang dengan hitung limfosit total (r=0,230, p=0,029). Kesimpulan: Terdapat korelasi bermakna yang lemah antara asupan AARC dengan hitung limfosit total pada subjek kanker kepala leher yang belum menjalani kemoradioterapi. ......Background: Total lymphocyte count is related with prognosis and survival rate of head and neck cancer patients. Lymphocyte regulation is affected by multiple factors, including nutrition. One of the nutrients that plays role in lymphocyte proliferation is branched-chain amino acids. This study aims to investigate the correlation between branched-chain amino acid and total lymphocyte count in head and cancer patients. Method: This cross-sectional study was conducted on adults with head and neck cancer who had not undergone therapy at the radiotherapy and medical hematology oncology clinic at RSCM. Branched-chain amino acid intake was assessed using 3x24-h food recall and semi quantitative FFQ. Total lymphocyte count was measured with differential blood cell counter. Results: Eighty-five subjects with a mean age of 53 years, mostly are male, diagnosed with nasopharyngeal cancer, with histopathology appearance of squamous cell carcinoma, and stage IV cancer. The average subject had normal nutritional status, with an average intake of 29.99 ± 0.95 kcal/kgBW of energy and 1.39 ± 0.05 g/kgBW of protein with a semi quantitative FFQ assessment. The average branched-chain amino acid intake in subjects was 10,92 ± 0,48 gram with semi quantitative FFQ. There were 17.6% subjects with low total lymphocyte count. There was a low correlation between intake of branched-chain amino acids and total lymphocyte count (r=0,230, p=0,029). Conclusion: There was a significant low correlation between branched-chain amino acids intake with total lymphocyte count in head and neck cancer subjects who had not undergone chemoradiotherapy.