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"Latar Belakang: Delineasi merupakan proses yang penting dalam radioterapi, namun dilaporkan adanya variabilitas dan inkonsistensi. Jenis modalitas dan kualitas pencitraan serta observer merupakan faktor yang mempengaruhi variabilitas delineasi. Variabilitas interobserver dapat digunakan untuk mengetahui adanya variasi delineasi. Saat ini delineasi kanker serviks menggunakan CT Scan. MRI lebih baik dalam memvisualisasikan jaringan lunak pada pelvis, namun belum digunakan rutin untuk delineasi kanker serviks.Tujuan: Membandingkan perbedaan variabilitas interobserver dalam mengidentiifkasi GTV pada kanker serviks.Metode: Sembilan pasien kanker serviks stadium lokal lanjut didelineasi oleh lima observer. Observer adalah peserta didik program studi onkologi radiasi tahap mandiri dengan kriteria tertentu. Modalitas pencitraan yang digunakan adalah CT Scan dan MRI. Struktur yang didelineasi adalah GTV, parametrium, uterus dan vagina. Hasil delineasi dibandingkan dengan menggunakan koefisien kesesuaian Dice Similarity Coefficient (DSC). Variabilitas delineasi akan dibandingkan antar kelompok modalitas menggunakan perbandingan dua rerata berpasangan menggunakan uji t berpasangan dan uji wilcoxon.Hasil: DSC delineasi GTV pada kelompok CT Scan adalah 0,74 (0,71-0,76 IK 95%). Sedangkan pada kelompok MRI adalah 0,79 (0,77-0,81 IK 95%). Rerata DSC didapatkan lebih tinggi pada kelompok MRI dibandingkan dengan kelompok CT Scan dan signifikan secara statisitik.Kesimpulan: Variabilitas interobserver delineasi GTV didapatkan baik menggunakan MRI maupun CT Scan dengan tingkat kesesuaian deliniasi baik (substantial agreement). Variabilitas interobserver delineasi GTV lebih kecil pada MRI dibandingkan CT Scan secara signifikan.

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Background: Delineation is an important process in radiotherapy, but variability and inconsistency have been reported in almost all tumor sites. The type of modality and quality of imaging as well as observers are factors that affect delineation variability. Interobserver variability can determine the variation of delineation. Currently delineation of cervical cancer using CT Scan. MRI is better at visualizing the soft tissues of the pelvis, but has not been used routinely for cervical cancer delineation.

Aim: Comparing interobserver differences in identifying GTV in cervical cancer.

Methods: Nine locally advanced cervical cancer patients were delineated by five observers. Observers were senior resident of the radiation oncology study program with certain criteria. The modalities used were CT Scan and MRI. The structures delineated were the GTV, parametrium, uterus and vagina. The results of the delineation were compared using the Dice Similarity Coefficient (DSC). Delineation variability will be compared between modality groups using a comparison of two paired means using paired tests and Wilcoxon's test.

Result: Mean DSC of GTV delineation in the CT scan group was 0.74 (0.71-0.76 95% CI). Meanwhile, the mean DSC in the MRI group was 0.79 (0.77-0.81 95% CI). The mean DSC was found to be higher in the MRI group. That the interobserver variability of GTV delineation using MRI is smaller than CT scan and statistically significant.

Conclusion: Interobserver variability of GTV delineation was obtained using either MRI or CT Scan with substantial agreement. Interobserver variability of delineation was significantly smaller on MRI than CT.

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"Tujuan: Mengetahui hubungan nilai DSC (Dice Similarity Coefficient) GTVMRI dan GTVCT dengan jarak waktu MRI sebelum radiasi dan CT Simulator dalam radiasi eksterna kanker serviks. Metode: Dilakukan studi potong lintang pada 25 pasien kanker serviks yang belum mendapatkan terapi definitif sebelumnya, dan sudah dilakukan MRI pelvis diagnostik dan CT Simulator pelvis pada periode Januari 2018 – Februari 2021. Dilakukan registrasi/fusi antara MRI dan CT, dilakukan delineasi GTV primer pada T2WI MRI dan CT Simulator. Dihitung nilai DSC dan dilakukan analisis korelasi antara nilai DSC dan jarak waktu. Batasan waktu dihitung menggunakan kurva ROC (Receiving Operator Characteristic). Hasil: Median jarak waktu MRI dan CT Simulator 24 (1-71) hari. Volume GTVMRI 104.35±66.23, GTVCT 167.79±97.15. Nilai DSC sebesar 0.53±0.16. Korelasi antara DSC dan jarak waktu r = -0.421, p = 0.036. Kurva ROC dengan sensitivitas 85.7%, spesifitas 54.5%, dengan indeks Youden yang paling optimal dan Area Under Curve (AUC) 0.682, 95% CI 0.461-0.902 didapatkan pada 10 hari. Kesimpulan: Semakin lama jarak waktu antara pemeriksaan MRI dan CT akan menurunkan nilai DSC. Diperlukan pertimbangan lebih jika akan dilakukan fusi antara MRI dan CT pada delineasi GTV primer kanker serviks dengan jarak waktu antara pemeriksaan lebih dari 10 hari.

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Objective: The aim of this study is to assess the correlation between DSC (Dice Similarity Coefficient) values of GTVMRI and GTVCT ​​with the MRI time interval before radiation and CT Simulator.

Method: A cross-sectional study was conducted on 25 cervical cancer patients who had not previously received definitive therapy, and already had a diagnostic pelvic MRI and pelvic CT simulator in periode January 2018 – February 2021. Rigid Body Registration/fusion between MRI and CT was carried out, primary GTV delineate on T2WI MRI and CT Simulator. The DSC value was calculated and a correlation analysis was performed between the DSC value and the interval time. The time limit was calculated using the ROC (Receiving Operator Characteristic) curve.

Result: Median time interval between MRI and CT Simulator was 24 (1-71) days. GTVMRI volume 104.35±66.23, GTVCT 167.79±97.15. Mean DSC value was 0.53±0.16. Correlation between DSC and time interval r = -0.421, p = 0.036. ROC curve with sensitivity 85.7%, specificity 54.5%, with the most optimal Youden index and Area Under Curve (AUC) 0.682, 95% CI 0.461-0.902 obtained at 10 days.

Conclusion: The longer the time interval between the MRI and CT planning, the lower the DSC value. Need to be more caution in doing the fusion if the time interval between MRI and CT is more than 10 days."

"Tujuan. Penelitian ini bertujuan untuk mengetahui profil Treg (ditunjukkan oleh Foxp3), CD4, dan CD8 pada kanker serviks stadium lanjut lokal dan dampaknya terhadap progresivitas tumor dan respons radiasi. Metode. Setelah disetujui oleh komite penelitian, kami mengumpulkan data pasien kanker serviks stadium lanjut lokal yang menjalani radioterapi, di RSCM, Jakarta, pada Januari 2018 – Desember 2020. Subjek penelitian harus memiliki pencitraan pra dan paska radiasi dan spesimen blok parafin untuk memenuhi syarat dalam penelitian ini. Profil Foxp, CD4, dan CD8, akan dianalisis dengan imunohistokimia dengan penghitungan jumlah sel. Respons radiasi akan dianalisa dengan kriteria RECIST 1.1. Semua informasi klinis pasien yang diperlukan akan dikumpulkan dari rekam medis elektronik. Hasil. Kami menemukan bahwa sebagian besar pasien memiliki karsinoma sel skuamosa (93%), stadium IIIC (48%), dan menjalani radiasi saja (72%). Evaluasi RECIST menunjukkan 62% pasien memiliki respons lengkap, 28% respons parsial, dan 10% respons buruk (penyakit stabil dan progresif). Kami dapatkan median jumlah sel CD4 =29 (7 – 154), CD8 = 30 (6 – 227), dan Foxp3 = 36 (2 – 156). Tidak ada hubungan bermakna antara jumlah sel limfosit CD4, CD8, dan Foxp3 dengan volume tumor, dengan p = 0.858; p = 0.975, dan p = 0.723 masing masing. Tidak ada hubungan bermakna dengan dimensi terbesar tumor dengan p = 0.481, p = 0.480, dan p = 0.792 masing masing. Tidak ada pula hubungan bermakna antara jumlah sel limfosit CD4, CD8, dan Foxp3 dengan respons radiasi dengan p = 0.964, p = 0.296, dan p = 0.787 masing masing. Namun kami mendapatkan korelasi positif yang kuat dan bermakna pada jumlah sel tumor pada stroma, CD 4 - CD8 (r = 0.580, p=0.001); CD4 - Foxp3 (r = 0.699, p < 0.001), dan CD8 - Foxp3 (r = 0.652, p < 0.001). Kesimpulan. Sebagian besar pasien kanker stadium lanjut lokal yang menjalani radiasi memiliki respons lengkap. Tidak didapatkan hubungan bermakna antara jumlah sel limfosit CD4, CD8, dan Foxp3 dengan volume tumor, dimensi terbesar tumor, dan respons radiasi. Terdapat korelasi yang kuat dan signifikan antar sel imun (CD4-CD8, CD4-Foxp3, dan CD8-Foxp3) pada lingkungan stroma.

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Aims: This study aims to determine profile of Treg (shown by Foxp3), CD4, and CD8 in locally advanced cervical cancer and the impact to tumor progressivity and radiation response.

Method. After been approved by the institution research committee, we collect data of locally advanced of cervical cancer patients who underwent radiotherapy, at RSCM, Jakarta, in January 2018 – December 2020. Studies subjects must have pre and post irradiation imaging and paraffin block specimen to be eligible in this study. Profile of Foxp, CD4, and CD8, will be analyzed by immunohistochemistry, by counting the number of cells, and radiation response will be analyzed by RECIST 1.1 criteria. All necessary patient’s clinical information will be collected from electronic medical record.

Result. We found that most of the patients had squamous cell carcinoma (93%), stage IIIC (48%), and underwent radiation alone (72%). RECIST evaluation showed 62% of patients had a complete response, 28% a partial response, and 10% had a poor response (stable and progressive disease). We found median CD4 cell counts = 29 (7 – 154), CD8 = 30 (6 – 227), and Foxp3 = 36 (2 – 156). There was no significant relationship between the number of CD4, CD8, and Foxp3 lymphocytes with tumor volume, with p = 0.858; p = 0.975, and p = 0.723 respectively. There was no significant relationship with the dimensions of the largest tumor with p = 0.481, p = 0.480, and p = 0.792, respectively. There was no significant relationship between the number of CD4, CD8, and Foxp3 lymphocytes with radiation response with p = 0.964, p = 0.296, and p = 0.787, respectively. However, we found a strong and significant positive correlation in the number of tumor cells in the stroma, CD4 - CD8 (r = 0.580, p = 0.001); CD4 - Foxp3 (r = 0.699, p < 0.001), and CD8 - Foxp3 (r = 0.652, p < 0.001).

Conclusion. Most locally advanced cancer patients who undergo radiation have a complete response. There are no significant relationships between the number of CD4, CD8, and Foxp3 lymphocytes with tumor volume, largest tumor dimensions, and radiation response. There is a strong and significant correlation between immune cells (CD4-CD8, CD4-Foxp3, and CD8-Foxp3) in the stromal environment.

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"Planning Target Volume (PTV) merupakan area treatment radioterapi yang diperoleh dengan melakukan penambahan margin pada Clinical Target Volume (CTV). Margin tersebut merupakan kompensasi dari ketidakpastian geometri yang terjadi pada saat treatment. Nilai margin diperoleh dari data online On-Board Imaging (OBI) match result 26 pasien kanker serviks yang mendapatkan penanganan dengan mesin linac Halcyon di RSUPN Dr. Cipto Mangunkusumo. Data OBI dalam arah vertikal (anterior-posterior), longitudinal (cranial-caudal), dan lateral (left-right) digunakan untuk menghitung kesalahan pengaturan, yakni berupa kesalahan sistematik dan acak sebagai variabel dari formulasi Stroom dan Van Herk. Berdasarkan formula Stroom, diperoleh nilai margin sebesar 1 cm untuk arah vertikal dan longitudinal, serta 1,6 cm untuk arah lateral. Sedangkan formula Van Herk, yaitu 1,2 cm untuk arah vertikal, 1,1 cm untuk arah longitudinal, dan 1,9 cm untuk arah lateral. Hasil tersebut menunjukkan nilai yang jauh lebih besar dibandingkan dengan margin yang digunakan pada approved treatment plan yaitu 0,7 cm untuk segala arah. Evaluasi dilakukan dengan cara pengonturan ulang PTV dan planning ulang pada 4 kasus pasien. Hasil penelitian ini menunjukkan bahwa dosis yang diterima target pada approved treatment plan lebih baik dibandingkan target yang menggunakan margin Stroom dan Van Herk. Hal ini dikarenakan nilai margin yang lebih besar berisiko mengenai organ lebih banyak, sehingga optimasi yang dilakukan harus lebih optimal agar organ at risk (OAR) menerima dosis serendah mungkin sesuai dengan constraint guidelines menurut QUANTEC.

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Planning Target Volume (PTV) is a radiotherapy volume concepts that obtained by adding margin to the Clinical Target Volume (CTV). The margin is a compensation for geometric uncertainty that occurs during treatment. PTV margin was obtained from online data on On-Board Imaging (OBI) match results of 26 cervical cancer patients treated with the Halcyon Linac machine in RSUPN. Dr. Cipto Mangunkusumo. OBI data in the vertical (anterior-posterior), longitudinal (cranial-caudal), and lateral (left-right) axis used to count setup errors, namely systematic and random errors, variables from the Stroom and Van Herk formulations. Based on the Stroom formula, the margin values ​​are 1 cm for the vertical and longitudinal axis, and 1.6 cm for the lateral axis. On the other hand, the margin from Van Herk formula was 1.2 cm for the vertical axis, 1.1 cm for the longitudinal axis, and 1.9 cm for the lateral axis. These results are larger than the margin in approved treatment plan, which is 0.7 cm for all axis. We evaluated the dosimetric difference by re-contouring PTV and replanning 4 cases of the treated patients. This study indicate that the dose received by the target in the approved treatment plan is better than the target using Stroom and Van Herk margins. That cause a large margin has a bigger risk of affecting more normal tissue area. Therefore, optimization must be more optimal to reduce organ at risk (OAR) dose as low as possible according to QUANTEC constraint guidelines."

"[ABSTRAKTujuan. Penelitian ini membahas perbandingan performa diagnostik antara pemeriksaan ultrasonografi dengan pemeriksaan klinis dalam mengukur ukuran lesi primer kanker serviks.Metode. Dilakukan uji diagnostik potong-lintang secara retrospektif terhadap pasien kanker serviks stadium IB di RSUPN Dr. Ciptomangunkusumo dari tahun 2009 hingga tahun 2014. Nilai diagnostik dari kedua pemeriksaan dihitung dengan luaran: sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, dan akurasi. Uji kesesuaian dari kedua pemeriksaan juga dihitung dengan ukuran makroskopik sebagai standar baku emas.Hasil. Dari periode tahun 2009 hingga tahun 2014, didapatkan 92 subjek yang memenuhi kriteria inklusi dengan komposisi yaitu 65 kasus (70%) kanker serviks stadium IB1 dan 27 kasus (30%) kanker serviks stadium IB2. Ultrasonografi didapatkan memiliki nilai diagnostik yaitu sensitivitas 92%, spesifisitas 96%, nilai prediksi positif 92%, nilai prediksi negatif 96%, dan akurasi 95%. Sementara itu, pemeriksaan klinis didapatkan memiliki nilai diagnostik yaitu sensitivitas 51%, spesifisitas 92%, nilai prediksi positif 73%, nilai prediksi negatif 82%, dan akurasi 80%. Dari perhitungan kesesuaian antara ukuran pemeriksaan ultrasonografi dan ukuran makroskopik, didapatkan perbedaan rata-rata 0,56 cm. Sementara itu, dari perhitungan kesesuaian antara ukuran pemeriksaan klinis dan ukuran makroskopik, didapatkan perbedaan rata-rata 0,97 cm.Kesimpulan. Penelitian ini menyimpulkan bahwa pemeriksaan ultrasonografi memiliki performa diagnostik yang lebih baik dibandingkan pemeriksaan klinis dalam mengukur ukuran lesi primer kanker serviks.

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ABSTRACTObjective. The purpose of this study is to compare the diagnostic value of ultrasound and clinical examination in measuring the size of primary tumor of cervical cancer.Methods. It is a retrospective cross sectional study for patients with cervical cancer stage IB in Cipto Mangunkusumo hospital from 2009 to 2014. Diagnostic value of both examinations were calculated with outcome: sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Resemblance test of both examinations were also calculated with macroscopic size as the gold standart.Result. From period 2009 until 2014, there were 92 subject which fulfilled the inclusion criteria, consisted of 65 cases (70%) cervical cancer stage IB1 and 27 cases (30%) cervical cancer stage IB2. Ultrasonografi was found to have diagnostic values as follow: sensitivity 92%, specificity 96%, positive predictive value 92%, negative predictive value 96%, and accuracy 95%. Meanwhile, clinical examination was found to have diagnostic values as follow: sensitivity 51%, specificity 92%, positive predictive value 73%, negative predictive value 82%, and accuracy 80%. From the calculation of resemblance between ultrasound and macroscopic size, there was an average difference approximately 0.56 cm. Meanwhile, from the calculation of resemblance between clinical examination and macroscopic size, there was an average difference approximately 0.97 cm.Conclusion. It can be concluded that the ultrasound has better diagnostic value compare to clinical examaination in examining the size of primary tumor of cervical cancer., Objective. The purpose of this study is to compare the diagnostic value of ultrasound and clinical examination in measuring the size of primary tumor of cervical cancer. Methods. It is a retrospective cross sectional study for patients with cervical cancerstage IB in Cipto Mangunkusumo hospital from 2009 to 2014. Diagnostic value of bothexaminations were calculated with outcome: sensitivity, specificity, positive predictive value,negative predictive value, and accuracy. Resemblance test of both examinations were alsocalculated with macroscopic size as the gold standart. Result. From period 2009 until 2014, there were 92 subject which fulfilled the inclusioncriteria, consisted of 65 cases (70%) cervical cancer stage IB1 and 27 cases (30%) cervicalcancer stage IB2. Ultrasonografi was found to have diagnostic values as follow: sensitivity92%, specificity 96%, positive predictive value 92%, negative predictive value 96%, andaccuracy 95%. Meanwhile, clinical examination was found to have diagnostic values as follow:sensitivity 51%, specificity 92%, positive predictive value 73%, negative predictive value 82%,and accuracy 80%. From the calculation of resemblance between ultrasound and macroscopicsize, there was an average difference approximately 0.56 cm. Meanwhile, from the calculationof resemblance between clinical examination and macroscopic size, there was an averagedifference approximately 0.97 cm. Conclusion. It can be concluded that the ultrasound has better diagnostic value compare to clinical examaination in examining the size of primary tumor of cervical cancer.]"

"Penelitian ini membahas mengenai tingkat keberhasilan verifikasi kasus kanker serviks dengan kanker nasofaring. Dalam penelitian ini telah dievaluasi data film verifikasi penyinaran pasien radioterapi untuk jenis kanker serviks dan nasofaring. Jumlah pasien untuk jenis kanker serviks berjumlah 45 pasien dan untuk jenis kanker nasofaring 45 pasien. Peneliti tidak melakukan verifikasi secara langsung dan tidak berhubungan dengan pasien, Data diperoleh dari status pasien yang tersedia di Rumah Sakit Cipto Mangunkusumo . Hasil penelitian ini menunjukkan bahwa tingkat keberhasilan verifikasi kasus kanker nasofaring lebih tinggi dibandingkan dengan kasus kanker serviks.

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My research study is focused on evaluating the verification success rates of cervical cancer and nasopharyngeal cancer survivors. 45 patients underwent radiotherapy procedures to identify specific types of the two mentioned cancers followed by data recording, for a total of 90 patients. The experimenter conducted no direct verification and had no direct contact with the patients since the data samples were obtained from Cipto Mangunkusumo Hospital. Research findings proved that the success rates of nasopharyngeal cancer verification were higher than the cervical cancer verification."

"Serviks atau leher rahim merupakan salah satu bagian dari sistem alat reproduksi wanita. Salah satu penyakit yang dapat menyerang serviks adalah kanker. Di dunia, kanker serviks adalah salah satu kanker yang menyebabkan kematian dan keganasan yang paling umum terjadi pada wanita. Kanker serviks merupakan penyakit yang memiliki peluang sembuh cukup besar jika terdeteksi sejak dini. Seiring dengan perkembangan teknologi dalam berbagai bidang, termasuk dalam bidang medis, maka pendeteksian dini kanker serviks dapat dilakukan dengan klasifikasi menggunakan bantuan dari metode klasifikasi machine learning. Pada penelitian ini, metode klasifikasi machine learning yang digunakan untuk mengklasifikasikan kanker serviks adalah metode Naïve Bayes (NB) dan Support Vector Machine (SVM) dengan seleksi fitur Grey Wolf Optimization (GWO). Seleksi fitur GWO merupakan seleksi fitur metode wrapper yang digunakan pada penelitian ini untuk mengeliminasi fitur-fitur tidak relevan dalam mengklasifikasikan data kanker serviks, agar NB dan SVM dapat mengklasifikasi dengan lebih akurat. Sehingga, metode ini disebut sebagai metode NB–GWO dan SVM–GWO. Data kanker serviks yang digunakan pada penelitian ini merupakan data numerik dari hasil citra MRI yang diperoleh dari Departemen Radiologi RSUPN Dr. Cipto Mangunkusumo. Berdasarkan hasil penelitian dengan seleksi fitur GWO, metode NB–GWO menghasilkan rata-rata akurasi, recall, dan f1-score tertinggi masing-masing sebesar 96,30%, 96,08%, 97,93%, dan 96,30%, sedangkan metode SVM–GWO menghasilkan rata-rata akurasi dan f1-score tertinggi masing-masing sebesar 95,37% dan 95,36% dengan kernel Linier, rata- rata presisi tertinggi sebesar 97,56% dengan kernel Polinomial, serta rata-rata recall tertinggi sebesar 99,75% dengan kernel RBF. Kemudian, berdasarkan hasil klasifikasi tanpa seleksi fitur GWO, metode NB menghasilkan rata-rata akurasi, presisi, recall, dan f1-score tertinggi masing-masing sebesar 91,98%, 95,21%, 92,90%, 91,95%, sedangkan metode SVM menghasilkan rata-rata akurasi, recall, dan f1-score tertinggi sebesar 92,13%, 99,24%, dan 92,19% dengan kernel RBF, serta rata-rata presisi tertinggi sebesar 93,59% dengan kernel Polinomial. Dengan demikian, metode seleksi fitur GWO dapat meningkatkan kinerja dari NB dan SVM dalam mengklasifikasikan data kanker serviks. Selanjutnya, berdasarkan hasil perbandingan kinerja dari NB–GWO dan SVM–GWO, maka secara keseluruhan metode NB–GWO menghasilkan kinerja yang lebih baik dalam mengklasifikasikan data kanker serviks dibandingkan dengan SVM–GWO.

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Cervix is one part of the female reproductive system. One of the diseases that can attack the cervix is cancer. In the world, cervical cancer is one of the cancers that cause death and malignancy that is most common in women. Cervical cancer is a disease that has a considerable chance of recovery if detected early. Along with the development of technology in various fields, including in the medical field, the early detection of cervical cancer can be done by classification using the help of machine learning classification methods. In this study, the machine learning classification method used to classify cervical cancer was Naïve Bayes (NB) and Support Vector Machine (SVM) with Grey Wolf Optimization (GWO) feature selection. GWO feature selection is a wrapper feature selection method used in this study to eliminate irrelevant features in classifying cervical cancer data, so that NB and SVM can classify more accurately. Thus, this method is referred to as the NB–GWO and SVM–GWO. Cervical cancer data used in this study is numerical data from MRI obtained from the Department of Radiology RSUPN Dr. Cipto Mangunkusumo. Based on the results of the study with GWO feature selection, NB– GWO produced the highest average accuracy, recall, and f1-score of 96.30%, 96.08%, 97.93%, and 96.30% respectively, while SVM–GWO produced the highest average accuracy and f1-score of 95.37% and 95.36% respectively with Linear kernel, the highest precision average of 97.56% with Polynomial kernel, and the highest recall average of 99.75% with RBF kernel. Then, based on the results of classification without GWO feature selection, the NB produced the highest average accuracy, precision, recall, and f1- score of 91.98%, 95.21%, 92.90%, 91.95% respectively, while SVM produced the highest average accuracy, recall, and f1-score of 92.13%, 99.24%, and 92.19% with RBF kernel, and the highest average precision of 93.59% with Polynomial kernel. Thus, GWO feature selection method was able to improve the performance of NB and SVM in classifying cervical cancer. Furthermore, based on the results of performance comparison from NB– GWO and SVM–GWO, the overall method of NB–GWO resulted in better performance in classifying cervical cancer data compared to SVM–GWO."

"Kanker serviks dapat dicegah mulai dengan mengidentifikasi pengetahun, keyakinan, dan perilaku seksual yang menjadi faktor risiko penularan HPV. Tujuan penelitian ini untuk mengidentifikasi gambaran pengetahuan dan perilaku pencegahan kanker serviks pada perempuan di Pekalongan. Penelitian deskriptif analitik ini melibatkan 443 perempuan di Pekalongan, dengan menggunakan instrumen Awareness of HPV and Cervical Cancer Questionnaire. Hasil penelitian menunjukkan responden memiliki pengetahuan cukup baik (63,9%), keyakinan rendah (57,1%), perilaku seksual kurang baik (60%), dan perilaku pencegahan kanker serviks kanker serviks yang rendah (63,0%). Rekomendasi penelitian ini adalah perlunya meningkatkan pelayanan kesehatan dengan memberikan edukasi terkait pencegahan dan deteksi dini kanker serviks.

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Cervical cancer can be prevented by identifying knowledge, beliefs, and sexual behavior that are risk factors for HPV transmission. The purpose of this study was to identify knowledge and behavior in preventing cervical cancer among women in Pekalongan. This analytic descriptive study involved 443 women in Pekalongan, using the Awareness of HPV and Cervical Cancer Questionnaire instruments. The results showed that respondents had fairly good knowledge (63.9%), low confidence (57.1%), poor sexual behavior (60%), and low cervical cancer prevention behavior (63.0%). The recommendation of this research is the need to improve health services by providing education related to prevention and early detection of cervical cancer."

"Latar Belakang: Belum tersedia penelitian yang membandingkan teknik radiasikonvensional dengan teknik bone marrow sparing (BMS) di Indonesia. Penelitian inibertujuan mengetahui teknik yang paling superior secara dosimetri dan akan menjadi data dasar untuk studi-studi klinis berikutnya. Metode: Sepuluh data Digital Imaging and Communications in Medicine (DICOM) Computed Tomography (CT) simulasi pasien kanker serviks stadium IB2 - IVA di Rumah Sakit Umum Pusat Nasional CiptoMangunkusumo pada studi eksperimental eksploratorik ini menjalani proses perencanaan radiasi teknik 3D konformal dengan 4 lapangan dan teknik BMS menggunakan intensity-modulated radiation therapy (IMRT) step-and-shoot (SS) dengan 7 lapangan, volumetric modulated arc therapy (VMAT) dengan full 2-arc dan tomoterapi spiral. Dosis 50 Gy dipreskripsikan terhadap planning target volume (PTV) dalam 25 fraksi. Parameter dosimetri pada target dan organ kritis, jumlah monitor units (MU) dan lama waktu radiasi dibandingkan melalui analisis statistik dan sistem skor keunggulan. Hasil: Seluruh teknik memberi cakupan PTV yang sangat baik. Perbedaan statistik terlihat pada rerata D98%; D95%; dan homogeneity index (HI), dengan IMRT SS dan tomoterapi merupakan teknik yang paling superior (D98% = 48 Gy; D95% = 48,98 Gy dan 48,97 Gy; HI = 0,06). VMAT memberi rerata terendah pada V40 (22,2%), Dmean (26,45 Gy) dan D2% (50,42 Gy) usus halus, namun IMRT SS paling mudah mencapai batasan dosis-volume V45 < 195 cc untuk volume usus halus yang luas. IMRT SS juga memberi rerata terendah pada V30 (86,93% dan 92,55%), V40 (65,92% dan 70,81%), Dmean (42,05 Gy dan 43,03 Gy) dan D2% (50,51 Gy dan 50,91 Gy) rektum dan buli, secara berurutan. Tomoterapi memberi rerata terendah pada V10 (83,31%), V20 (67,5%), V30 (46,04%), V40 (27,38%) dan Dmean (28,43 Gy) bone marrow, namun dengan rerata kedua tertinggi pada D2% (50,82 Gy) bone marrow. Teknik 3D konformal memberi rerata terendah pada V5 RVR (43,8%), jumlah MU (275,3) dan lama waktu radiasi (0,46 menit). Total skor keunggulan yang tertinggi diperoleh pada teknik IMRT SS (80), diikuti dengan VMAT (68), tomoterapi (65) dan terendah pada 3D konformal (43). Kesimpulan: Teknik IMRT SS, VMAT dan tomoterapi mampu menyelamatkan bone marrow pelvis dengan cakupan dosis PTV adekuat, homogenitas dan konformitas yang baik, serta memberi dosis radiasi yang aman terhadap organ-organ kritis. Secara keseluruhan, IMRT SS paling superiordibanding ketiga teknik lainnya, terutama terlihat pada dosis rektum, buli dan usus halus yang luas. VMAT paling superior menurunkan dosis usus halus secara umum.Tomoterapi paling superior menurunkan dosis bone marrow kecuali untuk parameterD2%, sedangkan 3D konformal paling superior menurunkan dosis RVR, jumlah MU dan lama waktu radiasi.

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Background: Currently there is no research that compares conventional radiotherapy

technique with bone marrow sparing (BMS) techniques in Indonesia. The aim of this

research was to discover the most superior technique dosimetrically and will be the basic data for further clinical studies. Method: Ten Digital Imaging and Communications in Medicine (DICOM) images of simulation Computed Tomography from stage IB2 - IVA cervical cancer patients at Cipto Mangunkusumo National Center General Hospital were enrolled in this experimental exploratory study and planned for four-field three-dimensional (3D) conformal radiotherapy and BMS technique using seven-field step-andshoot intensity-modulated radiation therapy (SS IMRT), full 2-arc volumetric modulated arc therapy (VMAT), and helical tomotherapy. A dose of 50 Gy was prescribed to the planning target volume (PTV) in 25 fractions. Dosimetric parameters of the target and critical organs, total monitor units (MU), and beam-on time were compared by means of statistical analysis and superiority score system. Result: All techniques provided excellent PTV coverage. Statistical difference was seen in the average of D98%; D95%; and homogeneity index (HI), with SS IMRT and tomotherapy were the most superior techniques (D98% = 48 Gy; D95% = 48.98 Gy and 48.97 Gy; HI = 0.06). VMAT delivered the lowest average of small bowel V40 (22.2%), Dmean (26.45 Gy), and D2% (50.42 Gy), but SS IMRT was the easiest to achieve V45 < 195 cc dose-volume constraint for a large volume of the small bowel. SS IMRT also delivered the lowest average of rectum and bladder V30 (86.93% and 92.55%), V40 (65.92% and 70.81%),Dmean (42.05 Gy and 43.04 Gy), and D2% (50.51 Gy and 50.91 Gy), respectively. Tomotherapy delivered the lowest average of bone marrow V10 (83.31%), V20 (67.5%), V30 (46.04%), V40 (27.38%) and Dmean (28.43 Gy), although with second-highest average of D2% (50.82 Gy). Three-dimensional conformal radiotherapy delivered the lowest average of Remaining Volume at Risk (RVR) V5 (43.8%), total MU (275.3), and beam-on time (0.46 minutes). The highest total superiority score was obtained by SS IMRT (80), followed by VMAT (68), tomotherapy (65), and 3D conformal (43). Conclusion: SS IMRT, VMAT, and tomotherapy techniques were able to spare pelvic bone marrow with adequate PTV dose coverage, good homogeneity and conformity, and

provided safe radiation dose to critical organs. Overall, SS IMRT was the most superior technique compared to the other three techniques, particularly seen in the dose of rectum, bladder and a large volume of the small bowel. VMAT was most superior to decrease the dose of the general small bowel. Tomotherapy was most superior to decrease the dose of bone marrow except for the D2% parameter, while 3D conformal was most superior to decrease the dose of RVR, total MU, and beam-on time."

"Kanker serviks merupakan kanker kedua yang umum terjadi pada wanita yang da- pat menjadi ganas. Keganasan dapat disebabkan oleh deregulasi jalur sinyal Wnt/β- katenin. Inhibisi TNKS2 dengan ligan inhibitor dapat menjadi salah satu cara un- tuk menghentikan deregulasi ini. Ligan-ligan inhibitor yang berhasil terbentuk dari fragmen-fragmen akan ditapiskan secara in silico untuk mendapatkan ligan kandi- dat obat terbaik yang lebih baik dari ligan inhibitor standar. Ligan dengan kode 1-69 merupakan ligan inhibitor yang lebih baik jika dilihat dari energi pengikatan, kelarutan, total polar surface area.

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Cervical cancer is the second most common cancer in women which can be ma- lignant. Malignancy can be caused by deregulation oleh Wnt/β-catenin signaling pathway. Inhibition of TNKS2 with ligand inhibitor can be an alternative way to stop this deregulation. All of the inhibitors which assembled from fragments were screened in silico to get the best hit which is better than standard inhibitor. Ligand with codename 1-69 is a better inhibitor than the standard in the term of binding energy, solubility and total polar surface area."