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

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

"Penelitian ini bertujuan untuk mengetahui pengaruh latihan Chin Tuck Against Resistance (CTAR) dengan latihan Shaker terhadap peningkatan kekuatan kontraksi otot suprahyoid pada pasien karsinoma nasofaring dengan disfagia pasca kemoradiasi. Penelitian ini merupakan studi pendahuluan pada karsinoma nasofaring pasca kemoradiasi yang datang berobat ke Poliklinik Rehabilitasi Medik RSUPN Cipto Mangunkusumo. Pemeriksaan nilai kekuatan kontraksi otot suprahyoid dengan menggunakan alat Vitalstim. Data diambil pada baseline, minggu ke-2, dan minggu ke-4. Latihan dilakukan di rumah dan latihan biofeedback di Poliklinik Rehabilitasi Medik RSUPN Cipto Mangunkusumo 2 kali seminggu. Subjek penelitian terdiri dari 8 Latihan CTAR dan 6 latihan Shaker. Terdapat peningkatan kekuatan kontraksi otot suprahyoid pada Latihan CTAR pada minggu ke-2 dry swallowing : 93,5(51-118), p<0,05, isotonik : 114(48-140), p<0,05. Peningkatan kekuatan kontraksi otot suprahyoid Latihan Shaker terjadi pada minggu ke-4 dry swallowing :102,5(35-162), p<0,05, isometrik : 83(61-139), p<0,05, Isotonik : 121(73-151), p<0,05. Tidak didapatkan perbedaan yang signifikan jika dibandingkan antara Latihan CTAR dan Latihan Shaker. Kesimpulan penelitian ini adalah kedua kelompok menunjukkan peningkataan kekuatan kontraksi otot suprahyoid dari data baseline setelah 4 minggu latihan, namun perbandingan antar kedua kelompok tidak berbeda signifikan. Latihan CTAR memberikan perbaikan sejak minggu ke-2, sedangkan latihan Shaker pada minggu ke-4.

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This study aims to determine the effect of Chin Tuck Against Resistance (CTAR) exercise with Shaker exercise on increasing the strength of suprahyoid muscle contraction in nasopharyngeal carcinoma patients with post-chemoradiation dysphagia. This research is a preliminary study on nasopharyngeal carcinoma after chemoradiation who came to the Medical Rehabilitation Polyclinic of Cipto Mangunkusumo Hospital. Examination of the strength value of suprahyoid muscle contraction using the Vitalstim tool. Data were taken at baseline, week 2, and week 4. Exercises were performed at home and biofeedback exercises at the Medical Rehabilitation Polyclinic of Cipto Mangunkusumo Hospital twice a week. The study subjects consisted of 8 CTAR exercises and 6 Shaker exercises. There was an increase in suprahyoid muscle contraction strength in CTAR Exercise at week 2 of dry swallowing: 93.5 (51-118), p<0.05, isotonic: 114(48-140), p<0,05. Increased suprahyoid muscle contraction strength Shaker exercise occurred at week 4 dry swallowing: 102.5 (35-162), p<0.05, isometric: 83 (61-139), p<0.05, Isotonic: 121(73-151), p<0,05. There was no significant difference when compared between CTAR Exercise and Shaker Exercise. This study concludes that both groups showed increased suprahyoid muscle contraction strength from baseline data after 4 weeks of training. Still, the comparison between the two groups was not significantly different. CTAR exercise provides improvement since week 2, while the Shaker exercise in week 4. "

"Gangguan menelan atau disfagia sering dijumpai pada pasien stroke, kanker kepala dan leher, serta lansia. Disfagia dapat meningkatkan risiko malnutrisi, aspirasi, dan kematian. Pasien disfagia juga rentan mengalami ansietas atau depresi yang berdampak pada penurunan kualitas hidup. Dysphagia Handicap Index (DHI) merupakan instrumen swaisi yang dirancang khusus untuk menilai kualitas hidup pasien disfagia. Instrumen DHI terdiri dari 25 pertanyaan yang meliputi penilaian domain fisik, fungsional, dan emosional, serta telah diterjemahkan dan divalidasi dalam berbagai bahasa. Penelitian ini bertujuan untuk menguji validitas dan reliabilitas DHI versi Bahasa Indonesia. Kuesioner DHI diterjemahkan ke dalam Bahasa Indonesia melalui proses forward translation dan backward translation, serta cognitive debriefing. Hasil terjemahan balik juga didiskusikan dan disetujui oleh penulis utama DHI. Kuesioner DHI versi Bahasa Indonesia (DHI-INA) final kemudian diujikan kepada 46 subjek dengan berbagai etiologi disfagia. Sebanyak 20 subjek kemudian melakukan pengisian ulang satu minggu setelah pengisian pertama. DHI-INA menunjukkan korelasi yang kuat antara masing-masing domain dan skor total [fisik (r = 0,93); fungsional (r = 0,97); emosional (r = 0,93); dan keparahan (r = 0,84)]. Konsistensi internal DHI-INA juga menunjukkan nilai yang baik (Cronbach's = 0,87), begitu pula uji tes-retest untuk skor total (ICC = 0,94). Tingkat keterbacaan DHI-INA setara dengan kelas 7 berdasarkan formula grafik Fry. Kuesioner DHI-INA merupakan kuesioner yang valid dan reliabel untuk menilai kualitas hidup pasien disfagia.

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Swallowing problem or dysphagia often found in stroke patients, head and neck cancer, and elderly. Dysphagia increases the risk of malnutrition, aspiration, and death. Patient with dysphagia also prone to have anxiety or depression which has an impact on decreasing quality of life. The Dysphagia Handicap Index (DHI) is a self-administered instrument specially designed to assess the quality of life of dysphagic patients. The DHI instrument consists of 25 questions covering physical, functional, and emotional aspects and has been translated and validated into various languages. This study aims to test the validity and reliability of the Indonesian version of DHI. The DHI questionnaire was translated into Indonesian through a forward and backward translation process, and cognitive debriefing. The backward translation results were discussed and approved by the lead author of DHI. The final Indonesian version of the DHI Questionnaire (DHI-INA) was then tested on 46 subjects with various etiologies of dysphagia. A total of 20 subjects were then refilled one week after the first administration. DHI-INA showed strong correlation between each domain and total score [physical (r = 0.93); functional (r = 0.97); emotional (r = 0.93); and severity (r = 0.84)]. The internal consistency of DHI-INA was also good (Cronbach's a = 0.87), as well as test–retest reliability for the total scores (ICC = 0.94). The readability level of DHI-INA is 7th grade using the Fry graph formula. The DHI-INA questionnaire is a valid and reliable questionnaire to assess the quality of life of dysphagia patients."

"Kemampuan makan dan menelan pada anak bersifat dinamis sejalan dengan proses tumbuh kembang anak. Struktur anatomi mengalami pertumbuhan yang selanjutnya berdampak pada kematangan fungsi menelan. Gangguan pada proses menelan menyebabkan disfagia. Tesis ini membahas mengenai gambaran proses menelan pada anak dengan kecurigaan disfagia, dengan menggunakan pemeriksaan menelan dengan endoskopi serat optik lentur, serta menilai karakteristik percontoh berdasarkan usia, masa kehamilan, pengasuh, gejala, komplikasi serta kelainan medis. Penelitian ini adalah penelitian potong lintang dengan desain deskriptif pada 54 subyek yang diambil secara berurutan. Hasil dari penelitian ini didapatkan prevalensi disfagia pada anak dengan kecurigaan kesulitan makan sebesar 63 . Gejala disfagia pada anak le; 6 bulan yang paling sering adalah apnea saat menyusu 7/34 . Sedangkan pada anak > 6 bulan adalah postur tubuh terganggu 10/34 , mengeces berlebih 6/34 , dan batuk saat makan 8/34 . Kelainan medis yang mendasari adalah kelainan struktural 25/34 , kelainan jantung / paru / laring 24/34 , dan kelainan neurologis 23/34 . Komplikasi yang terjadi adalah PRGE 12/34 , gagal tumbuh 10/34 , dan pneumonia aspirasi 3/34 . Pada pemeriksaan FEES didapatkan standing secretion 22/34 dan pergerakan lidah terganggu 20/34 adalah tanda yang sering ditemukan pada anak disfagia; dan residu sering terjadi pada konsistensi tim kasar 44,7 , penetrasi pada konsistensi air 44,2 , serta aspirasi pada konsistensi susu 34,8 .Kata kunci: aspirasi, disfagia, pemeriksaan menelan dengan endoskopi serat optik lentur, penetrasi, residu, sekret yang terkumpul di hipofaring.

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Eating and swallowing ability in Children had dynamic characteristic and closely related with growth process in themselves. The anatomical structure underwent growth process, therefore had impact in the maturity of swallowing ability. Disruption of swallowing process may caused dysphagia. This study use Flexible Endoscopic Evaluation of Swallowing FEES and also assessed the characteristics of the subjects based on age, gestation age, caregivers, symptom, complication, and medical disorder. This study is a descriptive cross sectional design involving 54 subjects with consecutive sampling. The result of this study are prevalence of dysphagia is 63 in children with dysphagia suspicion. Dysphagia symptom in children 6 months, apnea while bottle breast feeding 7 34 . Meanwhile, in children 6 months, postural impairment 10 34 , drooling 6 34 , and cough while eating 8 34 . Underlying disease are structural anomaly 5 34 , cardiopulmonary larynx disorder 24 34 and neurological disorder 23 43 . The complication are GERD 12 34 , failure to thrive 10 34 , and aspiration pneumonia 3 34 . In FESS examination, standing secretion 22 34 and impaired tongue movement 20 34 are sign for dysphagia, and residue is more common in gastric rice consistency 44,7 while penetration in thin liquid 44,2 and aspirations is more common in thick liquid 34,8."

"Latar Belakang: Disfagia adalah gangguan fungsi menelan yang disebabkan oleh gangguan neurologik, non-neurologik, ataupun campuran. Disfagia dapat menyebabkan berbagai komplikasi yang membahayakan kehidupan jika tidak ditangani dengan baik. Profil pasien disfagia baik di Indonesia maupun di negeri lain tidak terdata dengan baik sehingga diperlukan lebih banyak penelitian dalam hal ini guna meningkatkan kualitas dan efisiensi rehabilitasi disfagia di masa yang mendatang. Metode: Penelitian deskriptif retrospektif ini dilakukan di RSCM dengan mendata profil 52 pasien disfagia yang datang ke poli rehabilitasi medik RSCM dari Januari sampai dengan Juni 2023 yang terpilih menggunakan teknik consecutive sampling. Usia, jenis kelamin, fase disfagia, etiologi disfagia, dan derajat disfagia dari subjek terpilih dikumpulkan melalui akses rekam medis masing-masing pasien. Hasil: Subjek berumur 58–67 tahun paling prevalen dengan perbandingan keseluruhan jenis kelamin subjek laki-laki terhadap perempuan sebesar 1.08:1. Seluruh subjek didiagnosis dysphagia orofaringeal dan 84,6% kasus disebabkan oleh etiologi neurologik. Derajat disfagia beragam di antara subjek dengan skor penetration-aspiration scale (PAS) 8 paling prevalen (32,7%). Kesimpulan: Penelitian ini telah mendata profil usia, jenis kelamin, fase disfagia, etiologi disfagia, dan derajat disfagia dari 52 pasien disfagia yang terpilih. Data yang telah terkumpul dan disajikan direkomendasikan untuk dipakai dan dianalisis lebih lanjut oleh penelitian lain di masa mendatang.

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Background: Dysphagia is defined as the dysfunction in swallowing which is caused by neurologic, non-neurologic, and other mixed etiologies. Dysphagia can lead to multiple life-threatening complications if proper intervention isn’t given. Profiles of patients with dysphagia aren’t well documented in Indonesia nor in other countries. This calls for more researches to study this topic to increase the quality and efficiency of dysphagia rehabilitation in the future. Methods: A retrospective descriptive study was done at RSCM by collecting the data of 52 patients with dysphagia that visited RSCM’s medical rehabilitation ward from January to June of 2023 chosen with the consecutive sampling technique. Age, gender, dysphagia phase, dysphagia etiology, and dysphagia degree of selected subjects was collected by accessing the their medical records. Results: Subjects aged 58–67 years old were the most prevalent with an overall comparable man to woman ratio of 1.08:1. All subjects were diagnosed with oropharyngeal dysphagia mostly caused by neurologic etiologies (84,6%). Dysphagia degree amongst subjects showed a considerable variety with a penetration-aspiration scale (PAS) score of 8 being the most prevalent (32.7%). Conclusion: This research has documented the age, gender, dysphagia phase, dysphagia etiology, and dysphagia degree profiles of 52 selected dysphagic patients. The data presented is recommended to be used and analysed further in future studies."

"Pasien dengan disfagia rentan mengalami komplikasi seperti pneumonia aspirasi hingga kematian. Oleh karena itu diperlukan alat skrining untuk mendiagnosis disfagia secara cepat. GUSS merupakan alat skrining dengan validitas dan reliabilitas yang baik dalam menilai disfagia, namun belum dilakukan uji diagnostik di Indonesia. Subjek penelitian terdiri dari pasien disfagia neurogenik yang kemudian menjalani pemeriksaan GUSS-INA dengan modifikasi bahan uji, dilanjutkan dengan pemeriksaan baku emas FEES. Selanjutnya, dilakukan uji diagnostik untuk melihat sensitivitas dan spesifisitas GUSS-INA sebagai metode skrining disfagia. Rerata pasien disfagia neurogenik di RSCM berusia 56 tahun dengan jumlah proporsi laki – laki lebih besar dengan penyebab tersering adalah stroke, dengan komorbid hipertensi (56.5%), dengan komplikasi pneumonia 21.7%. Sebagian besar mengalami disfagia kronik, seluruh pasien mengalami keluhan subjektif disfagia dengan 3 gejala tersering adalah batuk, tersedak, dan sulit menelan terutama konsistensi padat. Lebih dari separuh pasien membutuhkan selang makan. Rerata status gizi pasien menunjukan indeks masa tubuh 24.92, dengan rerata penurunan BB 2 kg. Berdasarkan pemeriksaan pencitraan pasien stroke, lokasi tersering berada supratentorial, dengan derajat stroke sedang. Rerata nilai GUSS 14 (disfagia sedang) pada seluruh subjek, 28.3% mengalami aspirasi. Hasil Uji diagnostik GUSS-INA sebagai alat skrining deteksi disfagia memiliki nilai Sensitivitas 84%, Spesifisitas 78%, NDP 94%, NDN 54% dan AUC 0.86. Modalitas GUSS-INA dapat dijadikan alat skrining disfagia yang cukup baik.

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Patient with dysphagia has the tendency to undergo serious complications such as aspiration pneumonia that can cause increased mortality. Screening tool to effectively diagnose dysphagia in patient with difficulty swallowing is needed. GUSS is a screening tool with good validity and reliability; however, no diagnostic test has been done in Indonesia. This study samples consisted of neurogenic dysphagia patients which underwent GUSS-INA with test material modification assessment followed by FEES as gold standard examination. Diagnostic test was then done to analyze sensitivity and specificity of GUSS-INA as dysphagia screening tool. The average age of neurologenic dysphagia patients in Cipto Mangunkusumo Hospital was 56 years with higher male proportion, most common etiology was stroke, with most common morbidity being hypertension (56,5%). History of pneumonia was found in 21.7% patients.Majority of patients have chronic dysphagia, all patients had subjective dysphagia complaint with three most common symptoms being cough, choking, and difficulty swallowing especially of solid texture. More than half of the patients needed feeding tube. The average of BMI was 24.93, with average weight loss of 2 kg. Based on radiology results on post-stroke cases, the most common lesion was supratentorial, with moderate stroke score. Average GUSS score is 14 (moderate dysphagia) from all subjects and in 18.3% patients aspiration in found. Diagnostic test result of GUSS-INA as screening tool for neurogenic dysphagia had 84% sensitivity, 78% specificity, 94% PPV, 54% NPV, and AUC of 0.86. GUSS-INA could be used as a screening tool for dysphagia."

"Disfagia adalah kondisi medis yang berkaitan dengan kesulitan menelan. Pasien dengan disfagia tidak bisa minum cairan normal dikarenakan cairan biasa dapat masuk ke paru paru dan menyebabkan pneumonia aspirasi. Penggunaan cairan kental adalah pengobatan yang paling umum. Di bawah pedoman Australia cairan kental dibagi menjadi tiga tingkatan tingkat 150 agak tebal tingkat 400 cukup tebal dan tingkat 900 sangat tebal. Cairan mengental tersedia dalam dua bentuk sias dikonsumsi pre thickened minuman atau sebagai bubuk pengental yang dapat ditambahkan ke dalam minuman apapun hand thickened. Masalah utama dengan cairan kental adalah inkonsistensi dalam viskositas mereka antara cairan dan jenis pengental yang berbeda Juga pedoman untuk pengukuran viskositas fluida menebal sangat subjektif. Oleh karena itu tujuan pengukuran rheologi dilakukan untuk menentukan viskositas air dan susu pre thickened air dan susu menebal menggunakan bubuk pengental membandingkan viskositas thickened water dan thickened milk baik dalam bentuk pre thickened dan hand thickened Selain itu perbandingan viskositas antara bentuk juga diselidiki. Reologi dari seluruh sampel dianalisis menggunakan Rheoscope. Ditemukan bahwa thickened milk memiliki viskositas lebih tinggi dari pada thickened water yang menunjukkan bahwa kandungan cairan memiliki efek pada viskositas. Selanjutnya cairan pre thickened ditemukan memiliki viskositas lebih tinggi dari hand thickened.

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Dysphagia is a medical condition related to difficulties with swallowing. Patients with dysphagia cannot drink normal fluids because thin fluids could enters their lungs and cause aspiration pneumonia. Use of thickened fluids are the most common treatment for dysphagia. Under Australian guidelines thickened fluids are divided into three levels level 150 mildly thick level 400 moderately thick and level 900 extremely thick. Thickened fluids are available in two forms ready to serve pre thickened drinks or as powder thickener that can be added into any drink hand thickened. The main issue with thickened fluids is the inconsistency in their viscosity between different fluids and type of thickener. Also the guidelines for measurement of thickened fluid viscosity is very subjective. Therefore objective rheological measurement is performed to determine the viscosity of pre thickened water and milk and water and milk thickened using powder thickener compare the viscosity of thickened water and thickened milk in both pre thickened and hand thickened forms Moreover the comparison of viscosity between forms was also investigated. Rheology of all samples were analysed using Rheoscope. It was found that thickened milk had a higher viscosity than thickened water which indicates that the content of a fluid have an effect on viscosity. Furthermore pre thickened fluids were found to have a higher viscosity than hand thickened fluids. "

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

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

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

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

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

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

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