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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
Pendahuluan: Osteopontin merupakan salah satu penanda molekuler hipoksia endogen tumor. Hipoksia adalah salah satu faktor yang menentukan agresifitas penyakit. Kadar osteopontin tinggi pada berbagai keganasan termasuk glioma maligna. Peningkatan kadar osteopontin akan menyebabkan respon terapi berkurang. Penelitian ini bertujuan untuk mengetahui korelasi antara kadar osteopontin praradiasi dengan respon radiasi pada glioma maligna. Metode: Penelitian ini merupakan studi retrospektif kohort terhadap 15 pasien maligna glioma yang menjalani terapi radiasi dari juli 2004 sampai mei 2015 di RSUPN. DR. Cipto Mangunkusumo. Osteopontin diperiksa menggunakan metode ELISA dari sampel parafin blok. Volume tumor dihitung dari CT scan atau MRI berdasarkan pengukuran volume tiga dimensi. Respon tumor dinilai dengan membandingkan volume tumor sebelum dan sesudah radiasi dengan menggunakan CT dan MRI. Hasil: Didapatkan rerata kadar osteopontin sebesar 0,49 ± 0,45 ng/ml, rerata persentase perubahan volume tumor 8,59 ± 54,22 %. Volume tumor yang membesar 60%. Tumor yang progresif sebesar 26,7%. Secara keseluruhan terdapat korelasi negatif lemah yang tidak bermakna ( r -0,39 dan p 0,146 ) antara kadar osteopontin dengan respon radiasi. Terdapat korelasi positif kuat yang tidak bermakna ( r +0,68 dan p 0,219 ) antara kadar osteopontin dengan respon radiasi pada kelompok yang menggunakan kemosensitizer temozolamide. Kesimpulan: Terdapat korelasi negatif lemah yang tidak bermakna antara kadar osteopontin dengan respon radiasi. Terdapat korelasi positif kuat yang tidak bermakna antara kadar osteopontin dengan respon radiasi pada kelompok yang menggunakan kemosensitizer temozolamide.

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ABSTRACT
Introduction : Osteopontin is an endogenous molecular marker of tumor hypoxia, which is one of factors that determine the aggressiveness of the disease. Increased level of osteopontin will decrease therapeutic response which will eventually influence the success of therapy.The purpose of this study is to determine the correlation between osteopontin level and radiation response in malignant glioma. Method : This is a retrospective cohort study of 15 malignant glioma patients who underwent radiation from July 2004 to May 2015 at Cipto Mangunkusumo Hospital. Osteopontin level was measured with ELISA from paraffin embedded tissue. Tumor volume was calculated by measuring three dimensional volume of tumor imaging from CT or MRI. Tumor response was evaluated by comparing pre-irradiation with post-irradiation tumor volume seen in CT and MRI. Result : The mean osteopontin level was 0.49 ± 0.45 ng/ml and the mean percentage of change in tumor volume was 8.59 ± 54.22 %. Enlargement of tumor volume was 60 %. Progressive disease was found in 26.7 % of patients. Overall, there was an insignificant weak negative correlation (r -0.39 and p 0.146) between level of osteopontin and radiation response. There was an insignificant strong positive correlation (r +0.68 and p 0.219) between level of osteopontin and radiation response in the group that received radiation therapy concurrent with temozolamide. Conclusion : Overall, there was an insignificant weak negative correlation between level of osteopontin and radiation response. In the group that received radiation therapy concurrent with temozolamide, there was an insignificant strong positive correlation between level of osteopontin and radiation response, Introduction : Osteopontin is an endogenous molecular marker of tumor hypoxia, which is one of factors that determine the aggressiveness of the disease. Increased level of osteopontin will decrease therapeutic response which will eventually influence the success of therapy.The purpose of this study is to determine the correlation between osteopontin level and radiation response in malignant glioma. Method : This is a retrospective cohort study of 15 malignant glioma patients who underwent radiation from July 2004 to May 2015 at Cipto Mangunkusumo Hospital. Osteopontin level was measured with ELISA from paraffin embedded tissue. Tumor volume was calculated by measuring three dimensional volume of tumor imaging from CT or MRI. Tumor response was evaluated by comparing pre-irradiation with post-irradiation tumor volume seen in CT and MRI. Result : The mean osteopontin level was 0.49 ± 0.45 ng/ml and the mean percentage of change in tumor volume was 8.59 ± 54.22 %. Enlargement of tumor volume was 60 %. Progressive disease was found in 26.7 % of patients. Overall, there was an insignificant weak negative correlation (r -0.39 and p 0.146) between level of osteopontin and radiation response. There was an insignificant strong positive correlation (r +0.68 and p 0.219) between level of osteopontin and radiation response in the group that received radiation therapy concurrent with temozolamide. Conclusion : Overall, there was an insignificant weak negative correlation between level of osteopontin and radiation response. In the group that received radiation therapy concurrent with temozolamide, there was an insignificant strong positive correlation between level of osteopontin and radiation response]

Abstrak :
ABSTRAK
Latar Belakang: Insiden kanker serviks di RSCM masih tinggi, sebagian besar datang pada stadium lanjut, dan angka harapan hidup yang masih rendah. Jika respon radiasi komplit dan eradikasi tumor lokoregional dapat tercapai pada pasien kanker serviks, diperkirakan dapat meningkatkan kesintasan. Oleh karena itu, kami bermaksud mengadakan penelitian terhadap respon terapi radiasi dan karakteristik klinis serta patologi yang berhubungan pada pasien kanker serviks di RSCM.Metode: Penelitian kohort ini dilakukan dengan menggunakan data sekunder terhadap 123 pasien kanker serviks stadium IIA-IIIB yang menjalani radiasi kuratif definitif sesuai protokol standard bulan Januari 2014-Des 2015 di RSUPN CiptoMangunkusumo. Dilakukan pencatatan karakteristik klinis dan patologis sebelum radiasi, Dicatat juga efek samping akut gastrointestinal, traktus genitourinaria, dan hematologis selama menjalani protokol radiasi sampai 3 bulan pasca radiasi. Data respon tiga bulan pasca radiasi lengkap berdasarkan klinis dan pemeriksaan ultrasonografi transrektal/transvaginal dicatat dan diklasifikasikan sesuai Response Evaluation Criteria in Solid Tumors RECIST .Hasil: Dari 123 kasus, 84 kasus 68,29 diperoleh respon komplit, 30 kasus 24,39 respon parsial, 6 kasus 4,88 respon stabil, dan 3 kasus 2,44 respon progresif. Berdasarkan efek samping akut gastrointestinal, tidak didapatkan efek samping derajat 0 pada 99 kasus 80,49 , derajat 1 pada 20 kasus 16,26 , derajat 2 pada 4 kasus 3,25 , derajat 3 pada 0 kasus 0 . Berdasarkan efek samping akut genitourinaria, tidak didapatkan efek samping derajat 0 pada 105 kasus 85,37 , derajat 1 pada 17 kasus 13,82 , derajat 2 pada 1 kasus 0,81 , dan derajat 3 pada 0 kasus 0 . Berdasarkan efek samping akut hematologis, tidak didapatkan efek samping derajat 0 pada 108 kasus 87,80 , derajat 1 pada 15 kasus 12,20 , derajat 2 pada 0 kasus 0 , dan derajat 3 pada 0 kasus 0 . Dengan membandingkan kelompok respon komplit dan tidak respon parsial, stabil, progresif didapatkan faktor usia dengan p=0,266 RR 0,87;IK95 0,67-1,12 , klasifikasi tekanan darah dengan p=0,882 RR 0,98; IK95 0,76-1,27 , Indeks Masa Tubuh dengan p= 0,397 RR 1,06;IK95 0,83-1,34 , kadar hemoglobin dengan p= 0,193 RR 0,71;IK95 0,40-1,27 , jumlah leukosit darah dengan p=0,969 RR=1,00; IK95 0,78-1,29 , kadar albumin darah dengan p= 0,198 RR 0,73;IK95 0,44-1,20 , stadium FIGO dengan p=0,526 RR 1,08; IK95 0,85-1,38 , diameter tumor terbesar dengan p=0,034 RR 1,30; IK95 1,03-1,63 , jenis histopatologis dengan p=0,159 RR 1,18;IK95 0,90-1,55 , dan derajat diferensiasi dengan p=0,469. Pada analisa multivariat, didapatkan hubungan bermakna antara diameter tumor p=0,036;RR 2,64; IK95 1,07-6,56 dengan respon radiasi komplit.Kesimpulan: Gambaran respon radiasi kuratif definitif pada kanker serviks stadium IIA-IIIB di RSCM adalah 68,29 respon komplit, 24,39 respon parsial, 4,88 respon stabil, dan 2,44 progresif. Efek samping akut gastrointestinal, genitourinaria, dan hematologis pada umumnya tidak terjadi selama dan sampai 3 bulan pasca radiasi, yaitu 80,49 tidak mengalami efek samping akut gastrointestinal, 85,37 tidak mengalami efek samping akut genitourinaria, dan 87,80 tidak terjadi efek samping akut hematologi. Sebagian besar efek samping akut yang terjadi berderajat rendah yaitu grade 1 dan 2 traktus gastrointestinal, masing-masing 16,26 dan 3,25 , grade 1 dan 2 traktus genitourinaria, yaitu masing-masing 13,82 dan 0,81 , dan grade 1 hematologi, yaitu 12,20 . Terdapat hubungan bermakna antara diameter tumor terbesar dengan respon komplit radiasi. Tidak terdapat hubungan bermakna antara usia, Indeks Masa Tubuh, kadar hemoglobin, jumlah leukosit darah, kadar albumin serum, stadium FIGO, jenis histopatologis, dan derajat diferensiasi dengan respon terapi radiasi. "hr>" "b>ABSTRACT
" Background The incidence of cervical cancer was still high in RSCM, whom most of them was found in advanced stage. The issue that still become a problem related to radiotherapy on those patients was non satisfying local tumor control, which range 20 50 . If we can reach complete response and eradication of locoregional tumor on cervical cancer patients, it is estimated that the survival rate will increase. Therefore, we conducted a research to find out response of radiotherapy and related clinic pathologic characterictics on cervical cancer patients in our hospital.Methods This cohort study used secondary data on 123 patients of cervical cancer stage IIA IIIB who had undergone radiation therapy based on standard protocol in our hospital, during Januari 2014 to Dec 2015. The clinical factors of those patients, such as age, Body Mass Index, blood pressure, hemoglobin level, blood leucocyte count, serum albumin, largest tumor diameter FIGO staging and pathologic characteristic, i.e histopathology and grading were recorded. During radiation protocol until 3 months post radiation, we also noted any side effects of gastrointestinal tract, genitourinary tract, and hematologic. Evaluation of radiotherapy response was based on Response Evaluation Criteria in Solid Tumors RECIST .Results Among 123 cases, 84 cases or 68.29 was complete response, 30 cases or 24.39 was partial response, 6 cases or 4.88 was stabile response, and 3 cases or 2.44 was progressive. Based on gastrointestinal side effect, there was no side effect or grade 0 on 99 cases 80.49 , grade 1 on 20 cases 16.26 , grade 2 on 4 cases 3.25 , grade 3 on 0 case 0 . Based on side effect of genitourinary, there was no side effect or grade 0 on 105 cases 85,37 , grade 1 on 17 cases 13.82 , grade 2 on 1 case 0.81 , grade 3 on 0 case 0 . Based on hematologic side effects, there was no side effect on 108 cases 87.80 , grade 1 on 15 cases 12.20 , grade 2 on 0 case 0 , grade 3 on 0 case 0 . On bivariate analysis, p of each factors were age p 0.266 RR 0.87 0.67 1.12 , Body Mass Index p 0.397 , blood pressure classification p 0.658 RR 0.98 0.76 1.27 , largest tumor diameter p 0.034 RR 1.30 1.03 1.63 , haemoglobin level p 0.193 RR 0.98 0.76 1.27 , blood leucocyte count p 0.969 RR 1.00 0.78 1.29 , FIGO staging II vs III p 0.526 RR 1.08 0.85 1.38 , histopathology result squamous cell carcinoma vs nonsquamous cell carcinoma p 0.159 RR 1.18 0.90 1.55 , and grading p 0.469 . on multivariate analysis, tumor diameter was statistically significant, with p 0.036 RR 2.64 1.07 6.56 .Conclusion Most of definitive curative radiotherapy response on cervical cancer stage IIA IIIB was complete 68.29 . Partial response was 24.49 , stable response was 4.88 , and progressive was 2.44 . The Acute side effect of gastrointestinal tract, genitourinary tract, and hematologic were commonly can be tolerable during and 3 months post radiation therapy. Clinico pathologic characteristic that significantly related to complete response of radiotherapy were largest tumor diameter.

Abstrak :
Latar Belakang : Kanker serviks stadium awal dapat ditatalaksana dengan baik, namun pada stadium lanjut lokal memiliki prognosis yang buruk. Terapi standar yang tersedia masih kurang optimal dan memiliki efek samping yang mengganggu. Pada keadaan tertentu tumor dapat mengalami metastases atau progresif, salah satunya karena adanya ikatan PD-L1 dengan sel limfosit T sehingga kanker serviks terhindar dari respon imun. Pemberian anti PD-L1 menjadi bagian yang penting dalam pengobatan imunoterapi kanker. Di Indonesia belum tersedia data empirik profil karakteristik yang berkaitan dengan ekspresi PD-L1 serta respon tumor terhadap radiasi pada kanker serviks. Metode: Penelitian ini memeriksa ekspresi PD-L1 intratumoral pada jaringan biopsi karsinoma sel skuamosa serviks pre dan paska radiasi eksterna dengan menggunakan metode ELISA dan IHK, pemeriksaan IHK menggunakan antibodi clone 28-8 dari Abcam. Pemeriksaan CT scan evaluasi sebelum radiasi dan 2 bulan setelah radiasi dipakai sebagai alat untuk menilai respon terapi radiasi. Hasil : Dari 31 pasien yang ikut serta, terdapat 29 pasien yang telah dilakukan pemeriksaan ekspresi PD-L1 sebelum dan sesudah radiasi, selanjutnya hanya 22 pasien yang telah menjalani CT scan evaluasi. Ekspresi PD-L1 ELISA paska radiasi eksterna berbeda bermakna pada tumor berukuran ≥5cm (p=0,015) dan ekspresi PD-L1 IHK berbeda bermakna pada sel tumor berkeratin (p=0,023), pada pasien dengan grade IHK yang difus (+3) resiko relatif untuk respon komplit 0,5 kali dibandingkan dengan grade IHK yang  tidak difus. Uji korelasi perbedaan selisih ekspresi (delta) dan rasio PD-L1 ELISA menunjukkan tidak ada korelasi (R2= 0,217) dan (R2= 0,194) terhadap respons, begitu juga hasil pada hasil pemeriksaan ekspresi PD-L1 IHK tidak ada perbedaan bermakna pada kategori kenaikan, tetap dan penurunan, tetapi ketika kategori dirubah menjadi penurunan dan tidak ada penurunan didapatkan nilai p yang lebih baik (p=0,161 vs p=.0,613). Kesimpulan : Tidak terdapat perbedaan bermakna antara ekspresi PD-L1 pre dan paska radiasi terhadap respon, akan tetapi terdapat tren penurunan kadar PD-L1 IHK berkaitan dengan respon terapi. ......Correlation of Intratumoral PD-L1 Expression Before and After External Radiation to The Radiation Response in Locally Advanced Cervical Cancer. Background: Early-stage cervical cancer can be managed properly, but at a locally advanced stage it has a poor prognosis. The standard therapy available is still suboptimal and has disturbing side effects. In certain circumstances, tumors can undergo metastases or progressives, one of which is due to the binding of PD-L1 with T lymphocyte cells so that cervical cancer is protected from the immune response. In Indonesia, there is no available empirical data on the characteristic profiles related to PD-L1 expression and tumor response to radiation in cervical cancer. Method: This study examined intratumoral PD-L1 expression in biopsy tissue of squamous cell carcinoma of cervical cells pre and post external radiation using ELISA and IHC methods, IHC examination using antibody clone 28-8 from Abcam. CT scan evaluation before radiation and 2 months after radiation are used as a tool to assess the response of radiation therapy. Results: Of the 31 patients who participated, there were 29 patients who had examined the expression of PD-L1 before and after radiation, then only 22 patients who had undergone a CT scan evaluation. Expression of PD-L1 ELISA after external radiation was significantly different in tumors of ≥5cm (p=0.015) and expression of PD-L1 IHC was significantly different in keratinous tumor cells (p = 0.023), in patients with diffuse IHC grade (+3) relative risk to complete response of 0.5 times compared to the grade of IHC which is not diffuse. Correlation test difference in expression difference (delta) and PD-L1 ELISA ratio showed no correlation (R2=0.217) and (R2=0,194) to the response, as well as results on the examination results of PD-L1 IHC expression there was no significant difference in the increased category, constant and decrease, but when the category is changed to decrease and there is no decrease, a better p-value is obtained (p=0.161 vs p=0.613). Conclusion: There was no significant difference between the expression of PD-L1 pre and post-radiation to the response, but there was a trend of decreasing PD-L1 IHC levels concerning therapeutic response.

Abstrak :
Latar Belakang: Kanker serviks stadium awal dapat ditatalaksana dengan baik, namun pada stadium lanjut lokal memiliki prognosis yang buruk. Terapi standar yang tersedia masih kurang optimal dan memiliki efek samping yang mengganggu. Pada keadaan tertentu tumor dapat mengalami metastases atau progresif, salah satunya karena adanya ikatan PD-L1 dengan sel limfosit T sehingga kanker serviks terhindar dari respon imun. Pemberian anti PD-L1 menjadi bagian yang penting dalam pengobatan imunoterapi kanker. Di Indonesia belum tersedia data empirik profil karakteristik yang berkaitan dengan ekspresi PD-L1 serta respon tumor terhadap radiasi pada kanker serviks. Metode: Penelitian ini memeriksa ekspresi PD-L1 intratumoral pada jaringan biopsi karsinoma sel skuamosa serviks pre dan paska radiasi eksterna dengan menggunakan metode ELISA dan IHK, pemeriksaan IHK menggunakan antibodi clone 28-8 dari Abcam. Pemeriksaan CT scan evaluasi sebelum radiasi dan 2 bulan setelah radiasi dipakai sebagai alat untuk menilai respon terapi radiasi. Hasil: Dari 31 pasien yang ikut serta, terdapat 29 pasien yang telah dilakukan pemeriksaan ekspresi PD-L1 sebelum dan sesudah radiasi, selanjutnya hanya 22 pasien yang telah menjalani CT scan evaluasi. Ekspresi PD-L1 ELISA paska radiasi eksterna berbeda bermakna pada tumor berukuran ≥5cm (p=0,015) dan ekspresi PD-L1 IHK berbeda bermakna pada sel tumor berkeratin (p=0,023), pada pasien dengan grade IHK yang difus (+3) resiko relatif untuk respon komplit 0,5 kali dibandingkan dengan grade IHK yang  tidak difus.Uji korelasi perbedaan selisih ekspresi (delta) dan rasio PD-L1 ELISA menunjukkan tidak ada korelasi (R2 = 0,217) dan (R2 = 0,194) terhadap respons, begitu juga hasil pada hasil pemeriksaan ekspresi PD-L1 IHK tidak ada perbedaan bermakna pada kategori kenaikan, tetap dan penurunan, tetapi ketika kategori dirubah menjadi penurunan dan tidak ada penurunan didapatkan nilai p yang lebih baik (p=0,161 vs p=.0,613) Kesimpulan: Tidak terdapat perbedaan bermakna antara ekspresi PD-L1 pre dan paska radiasi terhadap respon, akan tetapi terdapat tren penurunan kadar PD-L1 IHK berkaitan dengan respon terapi. ......Background: Early-stage cervical cancer can be managed properly, but at a locally advanced stage it has a poor prognosis. The standard therapy available is still suboptimal and has disturbing side effects. In certain circumstances, tumors can undergo metastases or progressives, one of which is due to the binding of PD-L1 with T lymphocyte cells so that cervical cancer is protected from the immune response. In Indonesia, there is no available empirical data on the characteristic profiles related to PD-L1 expression and tumor response to radiation in cervical cancer. Method: This study examined intratumoral PD-L1 expression in biopsy tissue of squamous cell carcinoma of cervical cells pre and post external radiation using ELISA and IHC methods, IHC examination using antibody clone 28-8 from Abcam. CT scan evaluation before radiation and 2 months after radiation are used as a tool to assess the response of radiation therapy. Results: Of the 31 patients who participated, there were 29 patients who had examined the expression of PD-L1 before and after radiation, then only 22 patients who had undergone a CT scan evaluation. Expression of PD-L1 ELISA after external radiation was significantly different in tumors of ≥5cm (p=0.015) and expression of PD-L1 IHC was significantly different in keratinous tumor cells (p = 0.023), in patients with diffuse IHC grade (+3) relative risk to complete response of 0.5 times compared to the grade of IHC which is not diffuse. Correlation test difference in expression difference (delta) and PD-L1 ELISA ratio showed no correlation (R2 =0.217) and (R2=0,194) to the response, as well as results on the examination results of PD-L1 IHC expression there was no significant difference in the increased category, constant and decrease, but when the category is changed to decrease and there is no decrease, a better p-value is obtained (p=0.161 vs p=0.613) Conclusion: There was no significant difference between the expression of PD-L1 pre and post-radiation to the response, but there was a trend of decreasing PD-L1 IHC levels concerning therapeutic response.