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"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."

"Latar Belakang: Salah satu masalah dalam tatalaksana karsinoma nasofaring (KNF) adalah masih tingginya angka rekurensi pascaterapi. Hingga saat ini, biomarker yang digunakan di klinik untuk mengevaluasi hasil terapi definitif pada KNF adalah melalui CT scan nasofaring. Overekspresi Rad51 berhubungan dengan peningkatan resistensi sel tumor terhadap radiasi dan kemoterapi. Oleh karena rekurensi pascaterapi berhubungan dengan resistensi sel-sel tumornya, maka penelitian ini dilakukan dengan tujuan untuk menilai korelasi antara ekspresi Rad51 pada biopsi nasofaring sebelum terapi dengan penyusutan massa tumor pascaterapi yang diukur dengan metode unidimensional. Bahan dan Metode: Studi potong lintang dilakukan pada 15 kasus KNF. Ekspresi Rad51 dinilai dari biopsi nasofaring sebelum terapi. Evaluasi hasil terapi dilihat dari penyusutan massa tumor, berdasarkan CT scan nasofaring sebelum dan setelah terapi definitif. Cara yang digunakan untuk mengukur penyusutan massa tumor adalah dengan mengukur diameter terpanjang (unidimensional). Hasil: Ekspresi dari pewarnaan Rad51 yang dinilai berdasarkan skor-H menunjukkan hubungan bermakna dan korelasi yang kuat dengan penyusutan massa tumor. Diperoleh nilai p = 0,005 dan koefisien korelasi r = - 0,64. Kesimpulan: Ekspresi Rad51 memiliki korelasi negatif dengan penyusutan massa tumor karsinoma nasofaring.

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Background: The remain challenging problem in the management of nasopharyngeal carcinoma (NPC) is its higher rate of recurrency. Untill now, CT scan is the most common use biomarker to evaluate the treatment response after the definitive therapy. There’s a significance association between Rad51 overexpression and the increasing of resistancy to irradiation and chemotherapy in tumor cells and the resistancy of tumor cells correlates to its recurrency after therapy. Therefore, this study was conducted to evaluate the correlation between Rad51 expression level and the tumor’s shrinkage with unidimensional measurement. Material and

Methods: Fifteen cases of NPC were analyzed by a cross-sectional study. The expression of Rad51 were taken from the pretreatment of nasopharyngeal biopsy. The treatment response was evaluated from the nasopharyngeal CT scan, before and after definitive therapy, using the unidimensional measurement based on the change in sum longest diameter.

Result: The expression of Rad51 immunostaining assessed by the H-score were strongly correlate with the regression of the tumor mass which represent the treatment response. The p value is 0,005 and the correlation’s coefficient is -0,64.

Conclusion: There is significant correlation with negative magnitude between the expression of Rad51 with the shrinkage of tumor mass in nasopharyngeal carcinoma."

"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%)."

"AbstrakNasopharyngeal carcinoma (NPC) is the most frequent head and neck malignancy in Indonesia. Misdiagnosis of NPC is common because of unspecific symptoms as unilateral ear complaint. This case reminds doctors of the early symptoms of NPC and of other factors which lead to misdiagnosis and addresses also patients and their families. Reported is a 44 years old man with unilateral ear disorder that had been treated by otorhinolaryngologists, an ophthalmologist, a neurologist, and dentist first, but diagnosed with nasopharyngeal carcinoma stage IVA (T4N1M0) one year later. NPC has unspecific early symptoms such as unilateral ear disorder. Primarily doctors, but also patients and their families should be aware of unilateral ear complaint."

"Karsinoma nasofaring (KNF) merupakan penyakit endemis di Indonesia dengan tingkat mortalitas yang tinggi. Salah satu penyebab mortalitas adalah metastasis jauh. VEGF-A terbukti berperan pada kejadian metastasis jauh KNF, namun penelitian yang membahas hubungan langsung keduanya masih terbatas. Selain VEGF, terdapat jalur pensinyalan lain terkait VEGF yang mungkin berperan dalam kejadian metastasis jauh, yaitu jalur pensinyalan Hippo. Protein Yes-Associated Protein (YAP) adalah downstream efektor utama dari jalur pensinyalan ini. Dengan dilakukan pulasan YAP serta dievaluasi hubungan antara YAP dengan VEGF-A diharapkan hasilnya dapat memberikan informasi mengenai potensi biomarker sebagai indikator prognostik kejadian metastasis jauh KNF. Penelitian menggunakan metode analitik observasional dengan uji Chi-square dan korelasi koefisien kontingensi. Terdapat perbedaan ekspresi YAP yang bermakna pada kelompok KNF dengan dan tanpa metastasis jauh (p<0,001). Terdapat perbedaan bermakna ekspresi VEGF-A pada kelompok KNF dengan dan tanpa metastasis jauh (p<0,001). Ekspresi YAP yang tinggi berhubungan dengan peningkatan ekspresi VEGF-A (p=0,001). Terdapat korelasi signifikan antara peningkatan ekspresi YAP dan peningkatan ekspresi VEGF-A dengan kekuatan lemah (C=0,397, p=0,01). Terdapat perbedaan bermakna koekspresi YAP tinggi dan VEGF-A tinggi (double co-high-expression) antara kelompok KNF dengan dan tanpa metastasis jauh (p<0,001). Penelitian ini mendukung sifat onkogenik YAP. YAP dan VEGF-A dapat menjadi biomarker potensial untuk memprediksi kejadian metastasis jauh KNF.

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Nasopharyngeal carcinoma (NPC) is an endemic disease in Indonesia with a high mortality rate. Distant metastasis is one of the leading causes of death. Although VEGF-A has been found to play a role in distant NPC metastasis, research on the relationship between the two is still limited. Another VEGF-related pathway, the Hippo pathway, may be involved in distant metastasis. Yes-Associated Protein (YAP) is the main downstream effector of this signaling pathway. It is expected that performing YAP marker and studying the relationship between YAP and VEGF-A, would provide data on the possibility of biomarkers that may be used as a prognostic predictor of the occurrence of distant metastasis in NPC. An observational analytic study was conducted—statistical analysis using SPSS 25.0 with Chi-square and contingency coefficients test. There was a significant difference in YAP expression between NPC with and without distant metastasis (p<0.001). The expression of VEGF-A differed significantly between NPC with and without distant metastasis (p<0.001). There was a significant relationship between YAP and VEGF-A (p=0.001) and a weak correlation (C 0.397, p=0.01). There was a significant difference in the double co-high-expression group between the KNF with and without distant metastasis (p<0.001). This study highlights YAP's oncogenic role in NPC, suggesting that YAP and VEGF-A might be potential biomarkers to predict distant metastasis in NPC."

"Latar Belakang: Indonesia menduduki urutan kedua terbanyak kasus karsinoma nasofaring (KNF) di dunia. CT masih menjadi modalitas awal untuk mendeteksi KNF. Akan tetapi gambaran CT pada KNF kadang sulit untuk dibedakan dengan nasofaringitis kronis (NFK) terutama jika ukuran tumor masih kecil. Texture analysis (TA) merupakan suatu metode matematika yang digunakan untuk menganalisis distribusi dan hubungan pixel gray level suatu gambar. TA banyak diteliti di bidang onkologi kepala dan leher untuk membedakan karakteristik tumor, jinak atau ganas, menilai respon terapi serta memprediksi prognosis pasien.Metode: Studi komparatif dengan desain potong lintang. Terdapat 27 sampel KNF dan 18 sampel NFK yang dilakukan ROI pada regio tumor, kemudian dilakukan pengukuran nilai histogram yang terdiri dari mean, skewness, kurtosis dan nilai grey level co-occurencce matrix (GLCM) terdiri dari homogeinity, energy, contrast, correlation, entropy. Nilai yang diperoleh dari kedua kelompok kemudian dibandingkan dengan menggunakan T-test atau Mann-Whitney U Test.Hasil: Tidak didapatkan perbedaan signifikan secara statistik untuk mean (P = 0,098), kurtosis (P = 0,914), skewness (P = 0,775), Homogeinity (P = 0,943), Energy (P = 0,745), Contrast (P = 0,891), Correlation (P = 0,517), Entropy (P = 0,286) antara kelompok KNF dan NFKKesimpulan: Tidak terdapat perbedaan signifikan dari nilai histogram (mean, skewness, kurtosis) dan nilai GLCM (homogeinity, energy, contrast, correlation, entropy) antara kelompok KNF dan NFK.

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Background: : Indonesia is the second country with most nasopharyngeal carcinoma (NPC) cases in the world. CT is still the initial modality for detecting NPC. However, CT imaging of NPC are sometimes difficult to distinguish from chronic nasopharyngitis (CNP), especially with small tumor size. Texture analysis (TA) is a mathematical method used to analyze the distribution and relationship of gray level pixels of an image. TA is widely studied in head and neck oncology to distinguish the characteristics of tumors, benign or malignant, assess response to therapy and predict patient prognosis.

Methods: This is a cross-sectional comparative study. There were 27 NPC samples and 18 CNP samples with ROI performed on the tumor region, then measured the histogram value consisting of mean, skewness, kurtosis and the gray level co-occurrence matrix (GLCM) consisting of homogeinity, energy, contrast, correlation, entropy. The values between two groups were then compared using the T-test or the Mann-Whitney U Test.

Results: There were no statistically significant differences for mean (P = 0.098), kurtosis (P = 0.914), skewness (P = 0.775), Homogeinity (P = 0.943), Energy (P = 0.745), Contrast (P = 0.891), Correlation (P = 0.517), Entropy (P = 0.286) between NPC and CNP group.

Conclusion: There were no significant difference for histogram values (mean, skewness, kurtosis) and GLCM values (homogeinity, energy, contrast, correlation, entropy) between the NPC and NFK groups."

"Penelitian ini bertujuan untuk memverifikasi dosis radiasi radioterapi pada kasus kanker payudara dan kanker nasofaring (KNF). Percobaan dilakukan dengan menggunakan Linac Varian Trilogy radiasi foton berenergi 6 MV. Detektor yang digunakan dalam penelitian ini adalah film gafchromic, MatriXX 2D array, TLD, dan EPID. Film gafchromic dan TLD ditempatkan dalam phantom rando untuk mengevaluasi distribusi dosis pada volume target, sedangkan untuk mendapatkan hasil registrasi film gafchromic dan MatriXX 2D array ditempatkan dalam Multi Cube, dan dilakukan juga penyinaran pada EPID. Hasil perbedaan distribusi dosis teknik IMRT dan VMAT antara film dengan dosis preskripsi TPS pada KNF PTV70 adalah 6,87% dan 8,55%, pada KNF PTV50 adalah 14,43% dan 4,65%, sedangkan pada kanker payudara 11,98% dan 12,10%. Perbedaan nilai dosis antara TLD dengan dosis preskripsi TPS teknik IMRT dan VMAT pada KNF PTV50 sebesar 1,76% dan 1,60%, dan pada kanker payudara sebesar 7,06% dan 3,36%. Selisih perbedaan nilai gamma indeks teknik IMRT dan VMAT pada KNF sebesar -0,09% dan -1,65% antara film dan MatriXX, dan 5,13% dan 1,43% antara film dengan EPID. Pada kanker payudara selisih perbedaan nilai gamma indeks teknik IMRT dan VMAT sebesar 0,51% dan 0,19% antara film dengan MatriXX, dan 2,28% dan 4,38% antara film dengan EPID. Verifikasi dosis radioterapi dan registrasi citra pada kasus kanker payudara dan KNF dapat dilakukan menggunakan film gafchromic, TLD, MatriXX 2D array, dan EPID.

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This study was aimed to verify the radiation dose in the case of breast cancer and nasopharyngeal carcinoma (NPC). The experiments were performed using a Varian Trilogy Linac at 6 MV photon radiation and gafchromic films, Matrixx 2D Array, TLD, and EPID detectors. Gafchromic films and TLD were inserted into rando phantom to measures the dose on target volume and organ at risk. In order to evaluated the gamma index, gafchromic films and Matrixx 2D array were placed in the Multi Cube, and was irradiated with EPID in position. Results of the dose distribution differences on IMRT and VMAT between film and TPS on NPC PTV70 was 6.87% and 8.55%, the NPC PTV50 was 14.43% and 4.65%, and for breast cancer was 11,98% and 12,10%. The dose differences between TLD and TPS on IMRT and VMAT for NPC PTV50 was 1.76% and 1.60%, and the breast cancer was 7.06% and 3.36%. Gamma index differences on IMRT and VMAT technique on NPC was -0.09% and -1.65% between film and MatriXX, and 5.13% and 1.43% between films and EPID. In breast cancer the gamma index differences on IMRT and VMAT was 0.51% and 0.19% between films and MatriXX, and 2.28% and 4.38% between films and EPID. Radiotherapy dose verification and image registration for breast cancer and NPC was done using gafchromic film, TLD, MatriXX 2D array, and EPID."

"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<0,001 dan r=0,9, dengan formula regresi volume tumor primer = - 11,38 + (1,97 x ukuran bidimensional). Kesimpulan: Terdapat korelasi positif sangat kuat antara ukuran bidimensional dengan volume KNF.

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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<0.001 and strength of correlation (r) = 0.9, with regression formula of the primary tumour volume = - 11.38 + (1.97 x bidimensional measurement).

Conclusion: There is a very strong positive correlation between bidimensional and volume measurement of NPC. "

"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"