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"Pendahuluan: Saat ini belum ada publikasi tentang hasil radioterapi eksterna (RT) pada kanker prostat lokal atau lokal-lanjut di Indonesia.Metode: Studi retrospektif ini meneliti 96 pasien dengan kanker prostat lokal atau lokal-lanjut yang mendapat terapi radiasi dari tahun 1995-2009, di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais, Indonesia. Jenis / dosis kumulatif radiasi prostat dan pelvis pada 84,4% pasien sebesar <70Gy dengan RT konvensional, dan pada 15,6% pasien diberikan dosis ≥70Gy dengan three dimensional-conformal RT atau intensity modulated RT. Sintasan Overall survival (OS) dan biochemical progression-free survival (BFS) diestimasi dengan Kaplan-Meier. Faktor-faktor prediksi dari OS dan biochemical recurrence dianalisis dengan Multivariate Cox regressions. Hasil: Median durasi follow-up adalah 61 bulan (rentang, 24-169 bulan). Diantara seluruh kasus kanker prostat, terdapat 3,1% risiko rendah, 26% risiko sedang, dan 70,8% risiko tinggi. Lebih dari separuh pasien (52,1%) memiliki nilai Prostatespecific antigen (PSA) sebelum terapi >20 ng/ml. Angka sintasan 5 tahun pada pasien-pasien dengan risiko rendah, sedang, dan tinggi, secara berurutan adalah: OS, 100%, 94,7%, 67,9% (P=0,297); dan BFS, 100%, 94,1%, 57,1% (P=0,016). Pada kelompok risiko tinggi, didapatkan OS 5 tahun 88,3% pada pasien yang mendapatkan terapi adjuvan hormonal androgen deprivation therapy (HT), dibandingkan dengan 53% pada pasien yang mendapat terapi radiasi saja, P =0,08. Faktor prediksi yang signifikan pada OS meliputi kelompok risiko tinggi (hazard ratio [HR], 9,35; confidence interval [CI] 95%, 1,52-57,6; P=0,016), terapi adjuvan (HR, 0,175; 95% CI, 0,05-0,58; P=0,005), deteksi dengan transurethral resection of the prostate (TUR-P) (HR, 6,81; 95% CI, 2,28-20,33; P=0,001), dan nilai PSA sebelum terapi (HR, 1,003; 95% CI, 1,00-1,005; P=0,039). Satu-satunya faktor prediksi biochemical failure adalah PSA sebelum terapi (P=0,04), dengan odds ratio 4,52 (95% CI, 1,61-12,65) untuk PSA > 20 ng/ml. Kesimpulan: RT merupakan modalitas yang efektif untuk terapi kanker prostat lokal atau lokal-lanjut di Indonesia, dengan hasil dan faktor prediksi yang konsisten dengan publikasi di tempat lain. Faktor prediksi dari hasil yang lebih buruk meliputi kelompok risiko tinggi, PSA sebelum terapi yang lebih tinggi, temuan insidental pada TUR-P, dan tidak diberikannya terapi adjuvan HT. Terapi adjuvan hormonal secara signifikan meningkatkan sintasan pada pasien dengan risiko tingggi.

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Introduction: Presently there is no published data on the outcomes of localized or locally-advanced prostate cancer (PCa) treated by external-beam radiotherapy (RT) in Indonesia.

Methods: This study retrospectively analyzed 96 patients with localized or locally-advanced PCa treated by RT from year 1995 to 2009, at the national referral hospital and the national cancer hospital of Indonesia. Cumulative prostate and pelvic radiation dose/ type was <70 Gy conventional RT in 84.4% patients, and ≥70 Gy Three dimensional-conformal or intensity modulated RT in 15.6% patients. Overall survival (OS) and biochemical progression-free survival (BFS) were estimated by Kaplan-Meier. Predictors of OS and biochemical recurrence were analyzed by multivariate Cox regressions.

Results: The median follow-up was 61 months (range, 24 to 169 months). There were 3.1% low-risk, 26% intermediate-risk, and 70.8% high-risk cases. More than half of the patients (52.1%) had pretreatment prostate specific antigen (PSA) >20 ng/mL. The 5-year survival outcome of low-risk, intermediate-risk, and high-risk patients were: OS, 100%, 94.7%, and 67.9% (P=0.297); and BFS, 100%, 94.1%, and 57.1% (P=0.016), respectively. In the high-risk group, the 5-year OS was 88.3% in patients who received adjuvant hormonal androgen deprivation therapy (HT), compared to 53% in RT only, P=0.08. Significant predictors of OS include high-risk group (hazard Ratio [HR], 9.35; 95% confidence interval [CI], 1.52 to 57.6; P=0.016), adjuvant therapy (HR, 0.175; 95% CI, 0.05 to 0.58; P=0.005), detection by transurethral resection of the prostate (TUR-P) (HR, 6.81; 95% CI, 2.28 to 20.33; P=0.001), and pretreatment PSA (HR, 1.003; 95% CI, 1.00 to 1.005; P=0.039). The sole predictor of biochemical failure was pretreatment PSA (P=0.04), with odds ratio of 4.52 (95% CI, 1.61 to 12.65) for PSA >20 ng/mL.

Conclusions: RT is an effective treatment modality for localized or locally advanced PCa in Indonesian patients, with outcomes and predictors consistent to that reported elsewhere. Predictors of poorer outcomes include high-risk group, higher pretreatment PSA, incidental detection by TUR-P, and lack of adjuvant HT. Adjuvant hormonal therapy significantly improve the survival of high risk patients."

"Tujuan: Mengevaluasi tren tatalaksana kanker prostat stage T3 berdasarkan faktor faktor yang mempengaruhi. Material dan Metode: Studi retrospektif tatalaksana kanker prostat stage T3 di Rumah Sakit Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais periode 1995 2013. Data tren pemilihan terapi antara radioterapi atau terapi hormonal dianalisis berdasarkan kelompok tahun terapi kadar PSA grade tumor dan kelompok usia. Hasil: Dari 50 subjek 25 50 23 46 and 2 4 subjek mendapatkan tatalaksana radioterapi terapi hormonal dan prostatektomi radikal secara berturutan. Perubahan tren pemilihan terapi berdasarkan tahun terapi secara statistik signifikan p 0 012 dengan mengeksklusikan kelompok periode terapi 1995 1999. Terapi hormonal lebih menjadi pilihan untuk kelompok tumor high grade 53 8 dan lebih sering dipilih seiring bertambahnya usia pasien Kadar PSA tidak mempengaruhi tren pemilihan terapi. Kesimpulan: Terdapat perubahan yang bermakna dalam pemilihan terapi kanker prostat stage T3 berdasarkan tahun terapi Terapi hormonal lebih menjadi pilihan pada kasus dengan tumor high grade dan kelompok usia yang semakin tua.

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Objective: To evaluate treatment trend of stage T3 prostate cancer based on several factors.

Materials and Methods: A retrospective study was done on stage T3 prostate cancer patients from year 1995 2013 at two national referral hospitals in Indonesia. Treatment trends between hormonal therapy and radiotherapy based on year of treatment PSA level tumor grade and age groups were evaluated.

Results: On 50 patients subjects 25 50 23 46 and 2 4 subjects were treated by radiotherapy hormonal therapy and radical prostatectomy respectively. Year of treatment were significantly associated with treatment selection p 0 012 after excluding year of treatment 1995 1999 group. Hormonal therapy was preferred on high grade tumor group 53 8 and more applied for older patients. Treatment trend was not affected by PSA level.

Conclusion: Year of treatment were significantly associated with treatment selection of stage T3 prostate cancer Hormonal therapy was preferred on high grade tumor group and older age groups."

"Tujuan: Membandingkan distribusi dosis respon akhir RE dan efek samping akut RE teknik konvensional dan teknik konformal pada kasus kanker serviks lokal lanjut Metode Dilakukan studi kohort retrospektif terhadap pasien kanker serviks II B dan III B yang mendapat RE pra brakiterapi di Dept Radioterapi RSCM. Hasil: Didapat 51 pasien menjalani RE teknik konvensional 25 dengan Cobalt 60 26 dengan Linac dan 29 pasien menjalani teknik konformal Sesuai ketentuan ICRU 50 dan 62 prescribed dose dan cakupan volume target teknik konvensional Cobalt lebih kecil p 0 001 dan 1 kasus dari 25 pasien mendapatkan PTV 95 Prescribed dose dan cakupan volume target teknik konvensional Linac lebih besar p 0 001 dibanding teknik konformal Rerata conformity index teknik konvensional sebesar 2 dan teknik konformal 1 02 p 0 001 Dosis dan volume pada buli rektosigmoid dan bowel teknik konvensional lebih besar p 0 001 Respon komplit akhir RE teknik konvensional adalah 42 dan teknik konformal adalah 58 p 0 001 Faktor independen respon akhir RE yaitu stadium FIGO dini dan ukuran tumor sebelum RE kecil le 4cm Pada semua kasus tidak didapatkan efek samping akut lokal yang berat RTOG grade 3 4 Proporsi efek samping ringan RTOG grade 1 2 pada gastrointestinal vesikourinaria dan kulit lebih banyak pada teknik konvensional secara berurutan 72 Vs 28 p 0 002 78 Vs 22 p 0 003 dan 78 Vs 22 p 0 01. Kesimpulan: RE teknik konformal lebih unggul dibanding teknik konvensional dalam distribusi prescribed dose dan cakupan volume target atau organ kritis yang berdampak pada respon tumor akhir RE dan efek samping.

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Purpose: To compare the dose distribution acute tumor response and acute side effects between conventional and conformal techniques EBRT in locally advanced uterine cervical cancerMethods and materials Retrospective cohort study was done in stage II B and III B uterine cervical cancer underwent EBRT before brachytherapy in Dept Radioterapi RSUPN Cipto Mangunkusumo.

Results: Fifety one patients underwent conventional technique EBRT and 29 patients of conformal technique EBRT The average of target prescribed dose and volume coverage of 2 techniques EBRTwas in accordance with criteria of ICRU 50 and 62 smaller p 0 001 only 1 case of Cobalt conventional technique EBRT showed PTV 95 Conformity index of conventional technique EBRT was 2 and conformal technique EBRT was 1 02 p 0 001 Dose and volume of vesicourinary rectosigmoid and distal large bowel of conventional technique EBRT was greater p 0 001 Complete response of conventional technique was 42 and conformal technique was 58 p 0 001 Independent factors were early FIGO stage and tumor size before EBRT le 4cm There were no severe acute side effects RTOG grade 3 4 in both groups Acute side effects RTOG grade 1 2 of conventional techniques was more than conformal gastrointestinal vesikourinaria and skin respectively 72 vs 28 p 0 002 78 vs 22 p 0 003 and 78 vs 22 p 0 01.

Conclusion: Conformal technique EBRT was superior to conventional technique EBRT in prescribed dose distribution target volume coverage and organ at risk dose that impact on acute tumor response and side effects "

"Tujuan: Mengetahui kesintasan hidup, respon pengobatan dan faktor yang mungkin mempengaruhi dalam penanganan karsinoma nasofaring stadium lokal lanjut. Metode: Dilakukan penelitian retrospektif deskriptif analitik terhadap 391 pasien karsinoma nasofaring stadium lokal lanjut yang berobat di Departemen Radioterapi RSCM periode Januari 2007-Desember 2011, dilihat karakteristik pasien maupun tumor. Analisis kesintasan dihitung dengan kurva Kaplan Meier dan respon radiasi dianalisa menggunakan uji korelasi Spearman pada pasien yang memenuhi kriteria inklusi. Hasil: Didapatkan 70.6% pasien adalah laki laki, median usia 45 (9-86) tahun. Sebagian besar stadium IVB (32,7%) dengan tipe histopatologis WHO III paling dominan (82,4%) Kesintasan hidup 3 dan 5 tahun untuk masing-masing stadium IIB, III, IVA, IVB berturut-turut adalah 64,9%, 57,6%, 47,4%, 48,0% dan 64,9%, 43,2%, 34,3%, 26,6%. Sedangkan respon komplit untuk masing-masing stadium IIB, III, IVA, IVB berturut-turut 83,3%, 73,3%, 52,6%, 45,8%. Terdapat korelasi bermakna antara respon radiasi dengan stadium (r=0,242;p=0,038) dan antara respon radiasi dan kesintasan hidup (r=-0,251;p=0,031).

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Purpose: To show the overall survival rate, radiation response and factors influenced on locally advanced nasopahryngeal cancer.

Method: Retrospective analytic descriptive study of 391 newly diagnosed locally advanced nasopharyngeal cancer patients from January 2007 till December 2011, to show their characteristics. Overall survival rate were analyzed by Kaplan Meier Survival curve and the radiation response correlation with other factors were analyzed by Spearman correlation test.

Result: Most of the subjects are male (70.6%), with median age 45 (9-86) years old. Mainly on stage IVB (32,79%) with the most hystopalogic was type III WHO (82,4%). All of the subjects were analyzed for 3 and 5 years overall survival, resulted for stage IIB, III, IVA, IVB were 64,9%, 57,6%, 47,4%, 48,0% dan 64,9%, 43,2%, 34,3%, 26,6% respectively. Complete respons for stage IIB, III, IVA, IVB were 83,3%, 73,3%, 52,6%, 45,8%, respectively. There were significant correlation between radiation response and cancer stadium (r=0,242;p=0,038) and between radiation response with overall survival rate (r=-0,251;p=0,031)."

"Latar Belakang: Skrining awal dengan pemeriksaan viral load EBV plasma belum menjadi pemeriksaan rutin pada kanker nasofaring. Penelitian ini dikhususkan meneliti peran viral load EBV plasma pada pasien kanker nasofaring. Penelitian ini akan menjadi studi pilot di bidang viral load EBV plasma pada kanker nasofaring, khususnya di Indonesia. Metode: Desain penelitian ini adalah Study Ekploratif, mengeksplorasi hubungan antara viral load EBV plasma dengan viral load EBV jaringan pada kanker nasofaring stadium lokal lanjut dan stadium lanjut. Besar sample diambil berdasarkan rule of thumb, diperkirakan 15 sampel memberikan gambaran yang cukup memadai, mempertimbangkan biaya dan waktu penelitian. Untuk pemeriksaan viral load EBV plasma maupun jaringan tumor dilakukan dengan metode Real Time PCR dengan Kit dan alat PCR milik perusahaan QIAGEN®. Hasil: Ditemukan korelasi lemah-sedang (R= 48,3%) antara viral load EBV plasma dengan viral load EBV jaringan, dengan nilai p = 0,003 yang menyatakan bahwa korelasi ini dapat dipercaya. Tidak ada korelasi antara konsentrasi PD-L1 ELISA, IFN gamma, Limfosit, Neutrofil, maupun Leukosit dengan viral load EBV plasma. Kesimpulan: Semakin tinggi konsentrasi DNA EBV jaringan, semakin tinggi pula konsentrasi viral load EBV plasma, walaupun korelasi lemah-sedang, namun signifikan. Sampel yang sedikit menjadi kelemahan dalam penelitian ini, karena biaya dan waktu yang terbatas.

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Background: Initial screening with plasma EBV viral load has not become a routine examination of nasopharyngeal cancer. This research will be a pilot study in the field of plasma EBV viral load in nasopharyngeal cancer, especially in Indonesia.

Method: The design of this study was an Explorative Study. This study explores the relationship between plasma and tissue EBV viral load in locally advanced and advanced stage nasopharyngeal cancer. Large samples are taken based on the rule of thumb, it was estimated that 15 samples would provide an adequate picture. Plasma and tissue DNA EBV PCR examinations were carried out using the Real Time PCR method with the company's QIAGEN® Kit and PCR tool.

Results: There is a weak-moderate correlation (R = 48,3%) between plasma EBV viral load and tissue EBV viral load, with a value of p = 0.003 which indicates that this correlation can be trusted. There is no correlation between the concentration of PD-L1 ELISA, IFN gamma, Lymphocytes, Neutrophils, or Leukocytes with plasma EBV viral load. Conclusion: The higher the tissue EBV viral load concentration, the higher the plasma EBV viral load concentration, although this correlation was weak - moderate, but significant."

"Pendahuluan: Kanker payudara lokal lanjut merupakan skenario klinis yang amat sering dijumpai di negara berkembang, dimana rekurensi masih menjadi permasalahan. Mastektomi merupakan salah satu terapi utama. Usia, stadium klinis, keterlibatan kelenjar getah bening, tipe histopatologis, grade histopatologis, subtipe tumor merupakan faktor-faktor klinikohistopatologis yang mempengaruhi rekurensi. Tujuan penelitian ini adalah untuk mengetahui pengaruh faktor-faktor tersebut terhadap rekurensi kanker payudara lokal lanjut pasca mastektomi. Metode: Desain penelitian bersifat analitik potong lintang. Pengumpulan data dilakukan pada semua pasien kanker payudara lokal lanjut yang telah dilakukan mastektomi serta terapi definitif sesuai stadium tumor dan terdapat disease free interval serta dapat diikuti minimal 24 bulan pada periode Januari 2011 - Desember 2012 di RS Dr.Cipto Mangunkusumo. Hasil: Didapatkan 39 pasien dengan kanker payudara lokal lanjut yang telah dilakukan mastektomi serta terapi definitif dan terdapat disease free interval dengan median follow up 30 bulan. Jumlah rekurensi adalah 7,6%. Pada analisis bivariat ditemukan hubungan bermakna antara jenis histopatologi (p 0,008) dan keterlibatan kelenjar getah bening (p 0,026) dengan rekurensi. Pada analisis multivariat didapati faktor yang paling berpengaruh terhadap rekurensi adalah keterlibatan kelenjar getah bening (p 0,002). Konklusi: Faktor yang paling berpengaruh terhadap terjadinya rekurensi kanker payudara lokal lanjut pasca mastektomi adalah kelenjar getah bening positif tumor dengan jumlah lebih dari tiga.

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Introduction: Locally advanced breast cancer is clinical scenario that is very common in developing countries where recurrence is still a problem. Mastectomy is one of the primary teraphy. Age, clinical stage, lymph nodes involvement, histopathlogic type, histopatologic grades, tumor subtypes are clinicohystopatoligic factors affecting recurrence. The purpose of this study was to determine the influence of these factors on the recurrence of locally advanced breast cancer after mastectomy.

Methodology: The study design was analytical cross-sectional. Data collection was performed in all patients with locally advanced breast cancer who had performed mastectomy and appropriate definitive therapy according to tumor stage, had disease free interval and can be followed at least 24 month in the period January 2011 - December 2012 at the Hospital Dr. Cipto Mangunkusumo.

Result: There were 39 patient with locally advanced breast cancer patient who had performed mastectomy as well as definitive therapy, had disease free interval with a median follow-up interval of 30 months. The number of recurrences was 7,6%. In the bivariate analysis found a significant relationship between the hystopathology type (p 0,008), lymph node involvement (p 0,026) with recurrence. In multivariate analysis found that the most influential factor to reccurrence was lymph node involvement (p 0,002).

Conclusion: The most influential factor on the occurrence of locally advanced breast cancer recurrence after mastectomy is tumor positive lymph nodes in an amount greater than three."

"Latar belakang: Kanker kepala dan leher merupakan salah satu kanker yang berisiko tinggi malnutrisi. Pada kanker kepala dan leher stadium lanjut lokal, radioterapi dengan atau tanpa kemoterapi merupakan terapi pilihan dan berkaitan dengan berbagai efek samping yang berperan dalam penurunan asupan makan dan berefek negatif pada status nutrisi. Tata laksana nutrisi bertujuan untuk mengurangi risiko malnutrisi, mendukung keberhasilan terapi kanker, meningkatkan kualitas hidup, serta menurunkan angka morbiditas dan mortalitas. Pemberian terapi nutrisi berupa konsultasi individu yang meliputi perhitungan kebutuhan energi, makronutrien, mikronutrien, dan nutrien spesifik, serta pemberian medikamentosa bila diperlukan. Metode: Pasien pada serial kasus ini berjumlah empat orang dengan rentang usia 3055 tahun. Dua dari empat pasien mendapat kombinasi kemoterapi. Hasil skrining keempat pasien dengan malnutrition screening tools (MST) didapatkan skor ≥2. Kebutuhan energi total dihitung menggunakan persamaan Harris-Benedict yang dikalikan dengan faktor stres sebesar 1,4. Pemantauan yang dilakukan berupa anamnesis keluhan subyektif dan analisis asupan, pemeriksaan fisik, antropometri, massa otot skelet, massa lemak, kekuatan genggam tangan, dan hasil laboratorium. Pemantauan dilakukan secara rutin dengan frekuensi satu kali per minggu untuk menilai pencapaian target nutrisi. Hasil: Terapi nutrisi dapat meningkatkan asupan protein dan nutrien spesifik, namun tidak dapat mencegah penurunan BB, massa otot skelet, dan kekuatan genggam tangan pada pasien kanker kepala dan leher stadium lanjut lokal yang menjalani terapi radiasi dengan atau tanpa kemoterapi. Kesimpulan: Tata laksana nutrisi pada pasien kanker kepala dan leher stadium lanjut lokal yang menjalani terapi kanker dapat memberikan efek positif pada asupan nutrien pasien.

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Introduction: Head and neck cancer is one of malignancy with higher risk of malnutrition. Treatment of choice for locally advanced head and neck cancer is radiotherapy with or without chemotherapy and is associated with various side effects that may decrease food intake and negatively affect nutritional status. The aim of nutrition management is to reduce the risk of malnutrition, to support the success of cancer therapy, to enhance the quality of life, and to reduce morbidity and mortality. Nutrition therapy in the form of consultation includes calculation of energy needs, macronutrient, micronutrient, and specific nutrients, as well as drug therapy when needed.

Methods: This case series consist of four patients between 3055 years old. Half of the patients received combination with chemotherapy. All patients had screening score with malnutrition screening tools (MST) ≥2. The total energy requirement was calculated using Harris-Benedict equation then multiplied with stress factor 1.4. Monitoring was done by anamnesis of subjective complaints and food intake, physical examination, anthropometric, muscle mass, fat mass, hand grip strength, and laboratory results. Monitoring was performed frequently once a week to assess the accomplishment of nutritional target.

Results: Nutrition therapy could improve intake of protein and specific nutrients, but couldn't prevent weight loss, a decrease in muscle mass and hand grip strength in locally advanced head and neck cancer patients receiving radiation therapy with or without chemotherapy.

Conclusion: Nutrition management in locally advanced head and neck cancer patients receiving anticancer therapy positively affect patient's nutrient intake."

"[ABSTRAKTelah dilakukan verifikasi dosis organ target dan jaringan sehat di sekitar target dengan menempatkan TLD Rod LiF100 dan film Gafchromic EBT2 di lubang slab bagian pelvis dari phantom Rando Alderson untuk simulasi kanker prostat. TLD dievaluasi menggunakan TLD Reader Harshaw, sementara Film Gafchromic EBT2 dipindai menggunakan scanner Epson Perfection V700 dengan mode transmisi, red channel dan resolusi 72 dpi. Pengukuran dosis titik dilakukan dengan membandingkan antara dosis yang direncanakan TPS Eclipse ver. 11 dan dosis yang diukur pada target organ target dan organ beresiko menggunakan teknik IMRT dan VMAT. Hasilnya adalah deviasi dosis pada organ target menggunakan teknik IMRT dan VMAT adalah kurang dari 5%. Demikian pula, deviasi dosis pada bladder dan rectum untuk kedua teknik juga kurang dari 5% karena posisinya sangat dekat dengan target volume. Di sisi lain, deviasi dosis di femoral head lebih dari 5% untuk kedua teknik karena lokasinya pada gradien dosis rendah. Selanjutnya, deviasi dosis organ target untuk teknik IMRT cenderung lebih kecil dari teknik VMAT baik untuk TLD dan Film. Perbedaan dosis pada dosis titik organ target antara IMRT dan VMAT kurang dari 1% tetapi terjadi pada dosis yang random untuk organ beresiko. Adapun dosis permukaan pada teknik IMRT cenderung lebih kecil dari teknik VMAT jika kita menggunakan TLD, tetapi dosis pada film EBT2 cenderung sama antara teknik IMRT dan VMAT.

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ABSTRACTHave been done the dose verification of the target and healthy tissues around by placing the TLD Rod LiF100 and EBT2 Gafchromic film at slab hole of pelvic part of the Alderson Rando phantom for prostate cancer simulation. The Exposed TLDs was evaluated using the TLD Reader Harshaw, while Gafchromic Film EBT2 was scanned using Epson Perfection V700 scanner with transmission mode, red channel and resolution 72 dpi. The point dose measurements were compared between planned dose TPS Eclipse ver. 11 and measured dose at target volume organ and organ at risk for IMRT and VMAT techniques. The result is the dose difference at target volume for IMRT and VMAT are less than 5%. Similarly, the dose difference at Bladder and Rectum for both techniques are also less than 5% due to the position of OAR is very close to target volume. On the other hand, the dose difference at Femoral head are more than 5% for both techniques because the location of OAR already in low gradient dose. Furthermore, the difference dose of the target volume for IMRT technique is tends to be smaller than VMAT either for TLD and film detectors. The dose difference at point dose of target volume between IMRT and VMAT techniqe are less than 1% but it occur in random number for organ at risk. More over, the surface dose of IMRT tend to be smaller than VMAT dose if we are using TLDs, but the dose of EBT2 films tend to be similar between IMRT and VMAT techniques, Have been done the dose verification of the target and healthy tissues around by placing the TLD Rod LiF100 and EBT2 Gafchromic film at slab hole of pelvic part of the Alderson Rando phantom for prostate cancer simulation. The Exposed TLDs was evaluated using the TLD Reader Harshaw, while Gafchromic Film EBT2 was scanned using Epson Perfection V700 scanner with transmission mode, red channel and resolution 72 dpi. The point dose measurements were compared between planned dose TPS Eclipse ver. 11 and measured dose at target volume organ and organ at risk for IMRT and VMAT techniques. The result is the dose difference at target volume for IMRT and VMAT are less than 5%. Similarly, the dose difference at Bladder and Rectum for both techniques are also less than 5% due to the position of OAR is very close to target volume. On the other hand, the dose difference at Femoral head are more than 5% for both techniques because the location of OAR already in low gradient dose. Furthermore, the difference dose of the target volume for IMRT technique is tends to be smaller than VMAT either for TLD and film detectors. The dose difference at point dose of target volume between IMRT and VMAT techniqe are less than 1% but it occur in random number for organ at risk. More over, the surface dose of IMRT tend to be smaller than VMAT dose if we are using TLDs, but the dose of EBT2 films tend to be similar between IMRT and VMAT techniques]"

"ABSTRAK Tujuan penelitian ini adalah untuk melihat perbandingan terapi,toksisitas dan kesintasanhidup. Pasien predominan usia antara 40-60 tahun (81,7%),Karsinoma sel skuamosa (78,8%),diffrensiasis sedang (63,5%), stadium III B (68,3%), dan ukuran tumor > 4 cm (62,5%)Kemoradiasi merupakan terapi yang umumnya dilakukan. Karbogen ( karbon dioksida 2%dan oksigen 98%) + Nikotinamid meningkatkan oksigenisasi tumorABSTRACT The purpose of this study was to compare the therapies, toxicity and survival oflife. Patients are predominantly aged between 40-60 years (81.7%), squamouscell carcinoma (78.8%), diffrensiasis moderate (63.5%), stage III B (68.3%), andtumor size> 4 cm (62.5%) Chemoradiation is a therapy that is generally done.Karbogen (2% carbon dioxide and 98% oxygen) + Nicotinamide improve tumoroxygenation;The purpose of this study was to compare the therapies, toxicity and survival oflife. Patients are predominantly aged between 40-60 years (81.7%), squamouscell carcinoma (78.8%), diffrensiasis moderate (63.5%), stage III B (68.3%), andtumor size> 4 cm (62.5%) Chemoradiation is a therapy that is generally done.Karbogen (2% carbon dioxide and 98% oxygen) + Nicotinamide improve tumoroxygenation;The purpose of this study was to compare the therapies, toxicity and survival oflife. Patients are predominantly aged between 40-60 years (81.7%), squamouscell carcinoma (78.8%), diffrensiasis moderate (63.5%), stage III B (68.3%), andtumor size> 4 cm (62.5%) Chemoradiation is a therapy that is generally done.Karbogen (2% carbon dioxide and 98% oxygen) + Nicotinamide improve tumoroxygenation;The purpose of this study was to compare the therapies, toxicity and survival oflife. Patients are predominantly aged between 40-60 years (81.7%), squamouscell carcinoma (78.8%), diffrensiasis moderate (63.5%), stage III B (68.3%), andtumor size> 4 cm (62.5%) Chemoradiation is a therapy that is generally done.Karbogen (2% carbon dioxide and 98% oxygen) + Nicotinamide improve tumoroxygenation"

"ABSTRACTNilai indeks gamma yang dihasilkan antara satu perencanaan dengan perencanaan lainnya berbeda. Perbedaan ini mungkin dipengaruhi oleh banyak hal seperti detektor yang digunakan, kasus kanker yang berbeda, dll. Akan tetapi, terdapat passing criteria yang direkomendasikan oleh AAPM TG 119, sehingga seharusnya nilai indeks gamma tidak akan bernilai jauh dari passing criteria yang telah direkomendasikan. Oleh karena itu, pada penelitian ini akan dilakukan evaluasi konsistensi verifikasi yang dilakukan di RS MRCCC Siloam Hospital Semanggi dengan cara melihat perbedaan nilai rata-rata indeks gamma setiap tahunnya selama 8 tahun sejak tahun 2011-2018. Uji statistika juga dilakukan untuk menganalisis perbedaan dan pengaruh antara detektor yang berbeda, kasus kanker yang berbeda, serta teknik penyinaran yang berbeda terhadap nilai indeks gamma yang dihasilkan. Peralatan yang digunakan dalam penelitian ini adalah Pesawat LINAC Varian Clinac iX dengan TPS Eclipse versi 8.6-13, detektor 2D array bilik ionisasi MatriXXEvolution , EPID serta software Portal Dosimetry, Omni Pro I rsquo;mRT dan SPSS. Secara umum, metode penelitian dibagi menjadi beberapa tahap yaitu : pencatatan data pasien, verifikasi perencanaan, evaluasi indeks gamma, uji statistika dan analisis. Uji statistika yang digunakan merupakan uji Kruskal-Wallis, Mann-Whitney dan Wilcoxon. Uji Kruskal Wallis digunakan untuk melihat perbedaan rata-rata nilai indeks gamma setiap tahunnya. Uji Mann Whitney digunakan untuk melihat perbedaan rata-rata nilai indeks gamma antara kanker otak dan kanker prostat serta melihat perbedaan rata-rata nilai indeks gamma yang dihasilkan antara teknik IMRT dan VMAT. Uji Wilcoxon digunakan untuk melihat perbedaan rata-rata nilai indeks gamma detektor MatriXX dan EPID. Hasil penelitian menunjukkan perbedaan yang signifikan secara statistika pada nilai rata-rata indeks gamma antara dua detektor, dua teknik IMRT dan VMAT, serta antara dua kasus kanker yang berbeda, sedangkan nilai rata-rata indeks gamma per tahun tidak signifikan secara statistika. Secara keseluruhan, nilai rata-rata indeks gamma setiap tahunnya konsisten. Oleh karena itu, disimpulkan bahwa verifikasi yang dilakukan di RS MRCCC Siloam selama 8 tahun konsisten secara statistika.

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ABSTRACTThe gamma index value generated between one plan and another is normally different. This can be affected by many factors such as the usage of different detectors, different type of cancer cases, etc. However, there is certain passing criteria recommended by AAPM TG 119, thus the gamma index value ideally should not be much far from the recommended passing criteria. Therefore, this study will evaluate the verification consistency conducted at MRCCC Siloam Hospital Semanggi by looking at the difference between the mean value of gamma index every year for 8 years since 2011 2018. Statistical tests were also performed to analyze differences and effects between different detectors, different cancer cases, and different irradiation techniques on the resulting gamma index values. The equipment used in this research was LINAC Varian Clinac iX with TPS Eclipse version 8.6 13, 2D detector MatrixEvolution ionization array, EPID and Dosimetry Portal software, Omni Pro I 39 mRT and SPSS. In general, the study method is divided into several stages patient data recording, planning verification, gamma index evaluation, statistical test run, and analysis. The statistical test used is Kruskal Wallis, Mann Whitney and Wilcoxon test. The Kruskal Wallis test was used to see the average difference in the gamma index value annually. In addition, Mann Whitney test was used to see the difference in gamma index mean values between brain cancer and prostate cancer and to see the difference in gamma index mean values generated between IMRT and VMAT techniques. Furthermore, Wilcoxon test was used to see the difference in gamma index mean values of MatriXX and EPID detectors. The results showed statistically significant differences on the gamma index mean values between two detectors, two IMRT and VMAT techniques, and between two different cancer cases, while the difference between gamma index mean value per year was not statistically significant. Overall, the average value of the gamma index each year is consistent. Therefore, the verification performed at MRCCC Siloam Hospital for over 8 years is consistent statistically."