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Abstrak :
Karsinoma hepatoselular memiliki prognosis yang buruk akibat keterbatasan terapi seperti terlambat diagnosis, kurangnya biomarker spesifik, dan ketidakpekaan terhadap agen tumor ini. Imunoterapi berbasis sel NK autologus dengan stimulasi eksosom menjadi modalitas pengembangan imunoterapi berbasis sel NK untuk pasien karsinoma hepatoseluler. Sel NK pasien karsinoma hepatoseluler diisolasi dari darah vena perifer dan eksosom diisolasi dari serum darah donor sehat. Karakterisasi eksosom dengan particle size analyzer dan flow cytometry. Stimulasi eksosom ke sel NK selama 24 jam kemudian evaluasi ekspresi reseptor NKp44, NKp46, NKp30, NKG2D, KIR2D, dan NKG2A serta ekspresi perforin dan granzyme B. Visualisasi interaksi sel NK dengan fraksi sel mononuklear lainnya (CD4, CD8, CD11c, dan CD19) dengan imunofluorens. Ukuran partikel < 100 nm, muatan listrik negatif dan CD63+CD81+ (positif ganda) hasil isolasi eksosom. Terjadi peningkatan ekspresi reseptor NKp44, NKp46, NKp30, NKG2D, penurunan ekspresi NKG2A, serta peningkatan ekspresi perforin dan granzyme B pada sel NK terinduksi eksosom. Tidak ada interaksi sel berupa sinapsis imun antara sel NK terstimulasi eksosom dengan fraksi sel mononuklear lain pasien karsinoma hepatoseluler. Stimulasi eksosom ke sel NK pasien karsinoma hepatoseluler memulihkan kemampuan sitotoksik sel NK. ......Hepatocellular carcinoma has a poor prognosis due to limitations of therapy such as late diagnosis, lack of specific biomarkers, and insensitivity to this tumor agent. Autologous NK cell-based immunotherapy with exosome stimulation is a modality for developing NK cell-based immunotherapy for hepatocellular carcinoma patients. NK cells from hepatocellular carcinoma patients were isolated from peripheral venous blood, and exosomes were isolated from the blood serum of healthy donors. Exosome characterization with a particle size analyzer and flow cytometry. Stimulation of exosomes on NK cells for 24 hours, then evaluation of expression of NKp44, NKp46, NKp30, NKG2D, KIR2D, and NKG2A receptors, as well as perforin and granzyme B expression. Visualization of interactions of NK cells with other mononuclear cell fractions (CD4, CD8, CD11c, and CD19) by immunofluorescence. Particle size < 100 nm, negative electric charge, and CD63+CD81+ (double positive) exosome isolated results. There was increased expression of receptors NKp44, NKp46, NKp30, NKG2D, decreased expression of NKG2A, and increased expression of perforin and granzyme B in exosome-induced NK cells. There was no cell interaction in the form of immune synapses between exosome-stimulated NK cells and other mononuclear cell fractions in hepatocellular carcinoma patients. Stimulation of exosomes into NK cells of hepatocellular carcinoma patients restores the cytotoxic ability of NK cells.

Abstrak :

Latar Belakang: Kanker hati, khususnya karsinoma sel hati (KSH), adalah masalah kesehatan utama secara global, dengan rekurensi dan tingkat kematian yang tinggi. Peradangan kronis dan stres oksidatif adalah faktor utama dalam perkembangan KSH. Studi sebelumnya menunjukkan bahwa parasetamol, obat anti-inflamasi umum, dapat mencegah KSH dengan menghambat jalur siklooksigenase (COX) dan mengurangi peradangan serta stres oksidatif. Penelitian ini bertujuan untuk mengetahui efek hepatoprotektif asetaminofen terhadap insiasi KSH oleh Diethylnitrosamine (DEN) pada tikus jantan.

Metode : Tikus Jantan jenis Sprague-Dawley (usia 5-6 minggu, Berat badan 240-290gr) dibagi kedalam kelompok kontrol dan perlakuan (masing-masing 6 tikus tiap kelompok) kedua kelompok diinisiasi KSH dengan injeksi DEN (50mg/kgBB) intraperitoneal setiap minggu selama 10 minggu. Kelompok perlakuan diberikan asetaminofen 200 mg/kg/hari peroral 1 minggu sebelum diberikan DEN sampai 24 minggu. Dilakukan pemeriksaan biomarka fungsi hati (AST, ALT,AFP, Bilirubin dan albumin) dan dilakukan pemeriksaan histopatologi sel hati. Data dianalisis menggunakan SPSS. Normalitas data dinilai dengan uji Shapiro-Wilk. Setelah itu, dilakukan uji analisis numerik tidak berpasangan berupa uji T-test tidak berpasangan

Hasil : Kelompok asetaminofen (perlakuan) menunjukkan perbedaan yang signifikan dalam nilai AST, ALT dan bilirubin dari waktu ke waktu serta nilai AST, ALT dan bilirubin yang lebih baik dari kelompok kontrol (p < 0.05). Tikus dalam kelompok kontrol mengalami kerusakan hati yang substansial dan kematian dini, sedangkan tikus dalam kelompok perlakuan menunjukkan peningkatan kelangsungan hidup dan fungsi hati yang lebih baik. Analisis histopatologis mengungkapkan lebih sedikit perubahan nekrotik dan prakanker pada kelompok perlakuan. Selain itu, tingkat albumin berhubungan signifikan dengan manifestasi sirosis (p = 0.005), dan tingkat ALT serta bilirubin berkorelasi dengan kondisi prakanker (p < 0.05).

Kesimpulan: Asetaminofen dengan dosis 200 mg/kg berat badan memiliki efek protektif pada hepatosit tikus terhadap kerusakan hati dan potensi karsinogenesis yang diinduksi oleh DEN. Studi ini dapat dikembangkan lebih lanjut untuk penelitian lanjutan yang mempertimbangkan penggunaan asetaminofen pada pasien dengan fibrosis hati yang menjalani reseksi hati untuk mencegah kekambuhan dan mengurangi peradangan pada pasien yang menjalani reseksi hati. ......Background: Liver cancer, particularly hepatocellular carcinoma (HCC), is a major global health issue, with high recurrence and mortality rates. Chronic inflammation and oxidative stress are key factors in the development of HCC. Previous studies have shown that paracetamol, a common anti-inflammatory drug, can prevent HCC by inhibiting the cylclooxygenase (COX) pathway and reducing inflammation and oxidative stress. This study aims to investigate the hepatoprotective effects of acetaminophen against diethylnitrosamine (DEN)-induced liver carcinoma in male rats.

Methods: Male Sprague-Dawley rats (5-6 weeks old, 240-290g) were divided into control and treatment groups (6 rats each). Both groups initiated HCC with DEN (50 mg/kg body weight) intraperitoneally once a week for 10 weeks. The treatment group additionally received acetaminophen (200 mg/kg/day) from one week before DEN administration until the 24th week. Liver function biomarkers (AST, ALT, AFP, Bilirubin and albumin) were measured, and liver tissues were histopathologically evaluated. Data were analyzed using SPSS, employing Shapiro-Wilk tests for normality and unpaired T-tests for comparisons.

Results: Acetaminophen group resulted in significant differences in Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), and bilirubin values over time and had better AST, ALT, bilirubin levels compared to control group (p < 0.05). Control group rats exhibited substantial liver damage and early death, whereas the treatment group showed improved survival and liver function. Histopathological analysis revealed fewer necrotic and pre-cancerous changes in the treatment group. Albumin levels were significantly associated with cirrhosis manifestation (p = 0.005), and ALT and bilirubin levels correlated with pre-cancerous conditions (p < 0.05).

Conclusions: Acetaminophen at 200 mg/kg body weight has protective effect on rat hepatocytes against DEN-induced liver damage and potential carcinogenesis. This study can be further developed for future research to be considered for use in patients with liver fibrosis undergoing liver resection to prevent recurrence and reduce inflammation in patients undergoing liver resection.

Abstrak :
Sorafenib adalah tata laksana sistemik pertama pada hepatoseluler karisonoma. Resistensi HCC terhadap sorafenib dapat berkembang cepat dan melibatkan disregulasi apoptosis. Apoptosis diregulasi oleh protein anti-apoptosis dan pro-apoptosis seperti Bcl-2 dan Bax serta dimediasi oleh caspase. Alpha-mangostin telah ditemukan menginduksi apoptosis dengan meningkatkan rasio Bax/Bcl-2 serta caspases di sel kanker payudara serta mengembalikan resistensi doksorubisin di HCC. Tujuan dari penelitian ini adalah untuk mempelajari efek alpha-mangostin di sel HepG2 tahan terhadap sorafenib. Lini sel HCC, sel HepG2 dibagi menjadi 6 kelompok;.01% DMSO, alphamangostin 20μM, sorafenib 10μM, sorafenib 10μM + sorafenib 10μM, sorafenib + alpha-mangostin 20μM, and sorafenib 10μM + sorafenib 10μM + alpha-mangostin 20 μM. Sel diambil dan dihitung, serta RNA diisolasi diikuti dengan sintesis cDNA. Ekspresi dari Bcl-2, Bax, caspase-9, dan -3 diukur menggunakan q-RT PCR. Pemberian alfa-mangostin terhadap sel HepG2 tahan sorafenib secara signifikan meningkatkan ekspresi mRNA Bcl-2 dan Bax bersamaan, sedangkan perbedaan rasio Bax/Bcl-2 tidak ditemukan signifikan. Sementara, ekspresi dari mRNA caspase-9 juga tidak menunjukkan perubahan yang signifikan. Namun, ditemukan peningkatan yang signifikan pada ekspresi mRNA caspase-3, tetapi juga menurun signifikan setelah administrasi sorafenib dan alpha-mangostin bersamaan. Kesimpulan: Alfa-mangostin menginduksi apoptosis di sel HepG2 tahan sorafenib ditunjukkan dengan peningkatan caspase-3 pada pemberian. Namun, mekanisme apoptosis dapat tidak melibatkan jalur intrinsik yang diindikasikan oleh perubahan yang tidak signifikan pada rasio Bax/Bcl-2 dan caspase-9. ..... Sorafenib is the first-line systemic treatment in hepatocellular carcinoma. Sorafenib-resistance HCC may develop rapidly, which may involve apoptosis dysregulation. Apoptosis is regulated by anti-apoptotic and pro-apoptotic proteins such as Bcl-2 and Bax and mediated by caspases. Alpha-mangosin has been reported to induce apoptosis by increase Bax/Bcl-2 ratio and caspases in breast cancer cells as well as reverse doxorubicin resistance in HCC. The purpose of this research is to explore alpha-mangostin effect in sorafenib-surviving HepG2 cells. HCC cell line, HepG2 cells were divided into 6 groups; 0.01% DMSO, alphamangostin 20μM, sorafenib 10μM, sorafenib 10μM + sorafenib 10μM, sorafenib + alpha-mangostin 20μM, and sorafenib 10μM + sorafenib 10μM + alpha-mangostin 20 μM. The cells were taken and counted, and RNA was isolated followed with cDNA synthesis. The expression of Bcl-2, Bax, Bax/Bcl-2 ratio caspase-9 and -3 were measured using q-RT-PCR. The treatment of alpha-mangostin to sorafenib-surviving HepG2 cells significantly increase Bcl-2 and Bax mRNA expression concurrently. In the ratio of Bax/Bcl-2 mRNA, the change was not significant. Meanwhile, the expression of caspase-9 mRNA was neither found to significantly change. However, the expression of caspase-3 mRNA was found to be significant, yet significantly lower in the coadministration of sorafenib and alpha-mangostin. Conclusion: Alpha-mangostin induces apoptosis in sorafenib-surviving HepG2 cells due to increase of caspase-3 upon its administration. However, the mechanism may not be through the intrinsic pathway given the insignificant changes in Bax/Bcl-2 ratio and caspase-9 expression.

Abstrak :
ABSTRAK
Aglaonema simplex is an aquatic plant that has been widely used as ornamental plants. the genus contains polyhydroxy alkaloids that exhibit the glycosidase inhibitor activity. this paper reports a phytochemical screening of in vitro Aglaonema simplex plantlets and the potential compounds as alternatives of SR-B1 ligand that plays a role in reducing atherosclerosis. the phytochemical screening was conducted using Thin Layer Chromatography and Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy on methanol crude extracts of leaves, stems and roots. SR-B1 ligand activities were tested on HepG2 cell line stably transfected with SR-B1 promoter. The results showed that the extracts contained secondary metabolites belonging to the terpenoids, steroids, phenolics, alkaloids and glycosides. Luciferase assay suggested that the stem and root extracts increased the expression of SR-B1 at 1.61- and 1.72-fold higher than the control, respectively. thus, Aglaonema simplex is one of the potential sources of the phytochemicals for the treatment of atherosclerosis. the tissue culture technology may be applicable for sustainable production of the identified compounds from the plant.

Abstrak :
Abstrak
A 43-year old male presented with persistent discomfort and pain upper abdomen (epigastrium) more on left side associated with fever on and off, along with fatigue and loss of appetite for the last four months. Physical examination revealed mass on left hypochondrium extending to epigastrium with mild distension of the abdomen. Imaging studies of the patient showed dextrocardia on chest x-ray postero-anterior (PA) view, thoracic and abdominal CT scan showed situs inversus totalis with multiple SOL (space occupying lesion) in right lobe of liver with largest measuring 8x6 cm2 in the 4th segment. USG-guided FNAC of the mass showed features of hepatocellular carcinoma. Thereupon, hepatocellular carcinoma in situs inversus totalis was diagosed to this patient and was clinically staged as T3aN0M0. He was given sorafenib 400 mg orally twice daily with an advice to come for regular assessment every 4 week.

Abstrak :
Karsinoma hepatoseluler (KHS) adalah kanker primer liver dan penyebab kedua kematian akibat kanker. Eksosom pada lingkungan mikro KHS berfungsi untuk komunikasi antar sel dan bila endositosis ke sel NK dapat menyebabkan perubahan pada sel NK. Penelitian ini bertujuan menganalisis eksosom dari darah pasien KHS, perubahan fenotipe sel NK, dan uji pewarnaan histologi (peroksidase, toluidine blue) untuk mengamati perubahan granula azurofilik sel NK akibat endositosis eksosom. Metode penelitian meliputi isolasi sel NK dari donor sehat dan eksosom darah pasien KHS, karakterisasi eksosom dengan PSA, stimulasi sel NK dengan eksosom, flow cytometry reseptor pada sel NK dan CD81+ pada eksosom, imunofluoresens endositosis eksosom ke sel NK, pewarnaan toluidine blue dan peroksidase.Hasil menunjukkan eksosom berukuran 34,7 nm, bermuatan -4,33 mV dan positif CD81+. Perubahan reseptor sel NK sehat yang dipaparkan eksosom KHS tidak signifikan (P>0,05). Imunofluoresens memperlihatkan endositosis eksosom ke sel NK. Pewarnaan sel NK toluidine blue menunjukkan metakromasia dan peroksidase negatif. Sel NK+eksosom mengalami perubahan hasil pewarnaan. Peneliti menyimpulkan bahwa eksosom dari darah pasien KHS sesuai kriteria MISEV 2018.Tidak terjadi perubahan fenotipe sel NK sehat yang dipaparkan eksosom dari darah pasien KHS. Pewarnaan peroksidase dan toluidine blue dapat digunakan sebagai metode pengamatan endositosis eksosom ke sel NK. ......Hepatocellular carcinoma (HCC) is the primary liver cancer and the second leading cause of death from cancer. Exosomes in the HCC microenvironment function for communication between cells and when endocytosed to NK cells can cause changes in NK cells. This study aims to analyze exosomes from the blood of HCC patients, changes in NK cell phenotype, and histological staining tests (peroxidase, toluidine blue) to observe changes in NK cell azurophilic granules due to exosome endocytosis. NK cells from healthy donors and blood exosomes of KHS patients were isolated, exosomes characterized by PSA, stimulation of NK cells with exosomes, and flow cytometry of receptors on NK cells and CD81+ on exosomes were done. Endocytosis of exosomes onto NK cells were observed through immunofluorescence, then metacromasia and azurofilic granules of NK cells were observed after toluidine blue and peroxidase staining. Results showed The exosome is 34.7 nm in size, has a charge of -4.33 mV and is CD81+ positive. Changes in healthy NK cell receptors exposed to HCC exosomes were not significant (P>0.05). Immunofluorescence demonstrates exosome endocytosis in NK cells. Toluidine blue NK cell staining showed negative metachromasia and peroxidase. In NK cell+exosome there is a change in staining results. We concluded exosomes from the blood of HCC patients comply with MISEV 2018 criteria. There is no change in the phenotype of healthy NK cells exposed to exosomes from the blood of HCC patients. Peroxidase and toluidine blue staining can be used as a method of observing exosome endocytosis in NK cells.

Abstrak :
Karsinoma hepatoseluler merupakan penyebab utama keempatkematian akibat kanker di dunia pada tahun 2018. Namun, kebanyakan pasien baru didiagnosis pada stadium lanjut. Satu-satunya kemoterapi oral untuk karsinoma hepatoseluler stadium lanjut adalah sorafenib, suatu inhibitor multikinase. Salah satu mekanisme yang berkontribusi terhadap resistensi sorafenib adalah modulasi transporter obat. Studi melaporkan efek kemosensitisasi dari alfa-mangostin, suatu xanton yang diekstrak dari Garcinia mangostana Linn., yang memungkinkan penggunaannya sebagai terapi adjuvan. Penelitian ini bertujuan menganalisis pengaruh alfamangostin terhadap ekspresi mRNA transporter obat pada galur sel HepG2 yang tahan terhadap sorafenib. Sel HepG2 pada awalnya dilakukan pemberian sorafenib 10 μM. Sel yang tahan sorafenib tersebut kemudian dibagi menjadi empat kelompok perlakuan, yaitu dengan DMSO, sorafenib (SOR) 10 μM, alfa-mangostin (AM) 20 μM, dan kombinasi SOR 10 μM-AM 20 μM. Ekspresi mRNA dari transporter obat ABCB1 (P-gp), ABCG2, MRP2, MRP3, OCT1, dan OATP1B3 diperiksa dengan qRT-PCR setelah isolasi RNA dan sintesis cDNA yang dilakukan sebelumnya. Penurunan ekspresi mRNA transporter P-gp diamati pada kelompok SOR+SOR dibandingkan dengan kelompok SOR+DMSO. Sebaliknya, transporter efluks lainnya menunjukkan ekspresi yang lebih tinggi pada kelompok SOR+SOR. Menariknya, dua kelompok yang ditambahkan perlakuan alfa-mangostin (SOR+AM dan SOR+SORAM) menunjukkan ekspresi mRNA MRP2, MRP3, OCT1, dan OATP1B3 yang secara signifikan lebih tinggi (p <0,05) dibandingkan dengan kelompok SOR+DMSO. Secara umum, pemberian alfa-mangostin menyebabkan peningkatan ekspresi mRNA dari semua transporter obat pada penelitian ini. Penafsiran secara cermat tetap diperlukan meskipun terdapat efek akhir pada transporter influks yang cukup besar pada studi ini. ...... Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer mortality worldwide in 2018. Most patients unfortunately are diagnosed at advanced stage. Hence, the only oral chemotherapy for advanced unresectable HCC is sorafenib, a multikinase inhibitor. One of the mechanisms contributing to sorafenib resistance is drug transporters modulation. Studies reported chemosensitizing effect of alphamangostin, a xanthone extracted from Garcinia mangostana Linn., leading to its use as adjunctive treatment. This study aimed to analyse the impact of alpha-mangostin towards drug transporters’ mRNA expression in sorafenibsurviving HCC HepG2 cell line. HepG2 cells were initially treated with sorafenib 10 μM. The sorafenib surviving cells later were divided into four groups of treatment, namely with vehicle (DMSO), sorafenib (SOR) 10 μM, alpha-mangostin (AM) 20 μM, and combination of SOR 10 μM-AM 20 μM. The mRNA expressions of P-gp, ABCG2, MRP2, MRP3, OCT1, and OATP1B3 drug transporters were examined with quantitative reverse transcriptase-polymerase chain reaction following the RNA isolation and cDNA synthesis. Decreased mRNA expression of P-gp was observed in SOR+SOR group as compared to SOR+DMSO group. In contrast, other efflux transporters showed higher expression in SOR+SOR group. Interestingly, two groups treated with alpha-mangostin (SOR+AM and SOR+SOR-AM groups) showed statistically significant (p<0.05) higher mRNA expression of MRP2, MRP3, OCT1, and OATP1B3 compared to SOR+DMSO group. Generally, alpha-mangostin treatment increased the mRNA expression of all the drug transporters in the present study. Cautious interpretation was nonetheless required despite the considerable net effect on uptake transporters.

Abstrak :

Tujuan: Penelitian ini membandingkan efikasi dan keamanan radioterapi tubuh stereotaktik (SBRT) dengan atau tanpa kemoembolisasi transarterial (TACE) untuk pasien dengan karsinoma hepatoselular (KHS) stadium BCLC B dan C yang tidak memenuhi syarat untuk reseksi atau ablasi. Metode: Dari Januari 2016 hingga Maret 2019, sebanyak 33 pasien KHS dengan stadium BCLC B dan C, menjalani SBRT+TACE (n = 22) atau SBRT saja (n=11) di RSUPN Dr.Cipto Mangunkusumo. Kesintasan hidup keseluruhan (OS), kesintasan hidup bebas progresifitas (PFS), kontrol lokal (LC), dan toksisitas, dianalisis secara retrospektif. Hasil: Usia rerata adalah 56,5 tahun, dengan mayoritas pasien datang dengan CTP A (81,8%), BCLC stadium B (60,6%). Sebagian besar pasien memiliki tumor dengan PVT (75,8%), ukuran tumor >10 cm (66,7%), dengan rerata diameter terbesar 12,3 cm. Dosis radiasi bervariasi antara 27,5-50 Gy dalam 4-10 fraksi, dengan median EQD2 48 (35-, 5-72) Gy dan median BED10 57,6 Gy (42,6-86,4) Gy. Waktu follow-up rerata adalah 41 minggu untuk semua pasien. Pasien yang diterapi dengan SBRT+TACE menunjukkan peningkatan OS yang signifikan (46 bulan vs 23 bulan, p=0,008). Tingkat OS 1, 2, dan 3 tahun adalah 51%, 37%, dan 27% untuk kelompok SBRT+TACE; dan 18%, 9%, dan 0% untuk kelompok SBRT, masing-masing (p=0,008). Tingkat PFS 1, 2, dan 3 tahun adalah 31%, 19%, dan 13% untuk kelompok SBRT+TACE; dan 10%, 10%, dan 0% untuk kelompok SBRT, masing-masing (p=0,114). Tingkat LC 3, 6, dan 12 bulan adalah 88,9%, 92,9%, dan 75%. Tidak ada perbedaan toksisitas akut dan lanjut antara dua kelompok. Kesimpulan: Kombinasi SBRT+TACE menunjukkan tingkat OS yang lebih baik daripada SBRT saja pada pasien dengan KHS BCLC Stadium B dan C.

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Purpose: This study compared the efficacy and safety of stereotactic body radiation therapy (SBRT) with or without transcatheter arterial chemoembolization (TACE) for patients with BCLC stage B and C hepatocellular carcinoma (HCC) who were ineligible for resection or ablation therapies. Methods and materials: From January 2016 to March 2019, 33 patients with BCLC stage B and C HCC, underwent either SBRT+TACE (n = 22) or SBRT only (n =11) in RSUPN Dr.Cipto Mangunkusumo. The overall survival (OS), progression free survival (PFS), local control (LC), and toxicities were analyzed retrospectively. Results: The mean age was 56.5 years, with the majority of patients presenting with CTP A (81.8%), BCLC stage B (60.6%). Most patients had tumor with PVT (75.8%), tumor size >10 cm (66.7%), with the mean of largest diameter of tumor was 12.3 cm. The radiation dose varies between 27.5-50 Gy in 4-10 fractions, with a median of EQD2 is 48 (35-, 5-72) Gy and a median of BED10 is 57.6 Gy (42.6-86.4) Gy. The median follow-up time was 41 weeks for all patients. Patients treated with SBRT+TACE showed significantly improved OS (46.0 months vs. 23 months, p = 0.008).  The 1-, 2-, and 3-year OS was 51%, 37%, and 27% for the SBRT+TACE group; and 18%, 9%, and  0% for the SBRT group, respectively (p=0,008). The 1-, 2-, and 3-year PFS was 31%, 19%, and 13% for the SBRT+TACE group; and 10%, 10%, and  0% for the SBRT group, respectively (p=0,114). The 3, 6, and 12 month LC was 88,9%, 92,9%, dan 75%. However, there was no difference in acute and late toxicities between two groups. Conclusions: SBRT+TACE had better OS rates than SBRT only in patients with BCLC stage B and C HCC.

 

Abstrak :
Hati adalah organ terbesar dalam tubuh dan organ metabolisme yang sangat penting. Hepatocelullar Carcinoma (HCC) merupakan pertumbuhan abnormal dari hepatosit yang ditandai dengan peningkatan jumlah hepatosit yang mampu membelah dan menyertai perubahan sel hati yang menjadi ganas. Karsinoma hepatoselular berisiko terjadi retensi cairan karena rusaknya sel hepatosit yang mengakibatkan terganggunya aliran darah menuju ke hati sehingga menimbulkan distensi pembuluh darah dan terganggunya aliran tersebut juga mengakibatkan terganggunya produksi albumin untuk bisa mempertahankan tekanan onkotik. Asites, varises gastroesofagus yang tidak ditangani segera dapat menurunkan kualitas hidup bahkan kematian. Asites dan edema merupakan penyebab yang paling sering ditemukan pada pasien yang harus menjalani perawatan di rumah sakit. Penulisan karya ilmiah ini menggunakan metode studi kasus dengan menggunakan pemantauan cairan dan nutrisi dibuktikan bahwa pemantauan ini efektif untuk menangani kelebihan volume cairan dibuktikan dengan tidak bertambahnya komplikasi yang terjadi pada pasien. ......The liver is the largest organ in the body and a very important metabolic organ. Hepatocellullar Carcinoma (HCC) is an abnormal growth of hepatocytes which is characterized by an increase in the number of hepatocytes capable of dividing and accompanying changes in liver cells that become malignant. Hepatocellular carcinoma is at risk of fluid retention due to damage to hepatocyte cells which results in disruption of blood flow to the liver, causing distension of blood vessels and disruption of this flow also results in disruption of albumin production to maintain oncotic pressure. Ascites, gastroesophageal varices that are not treated immediately can reduce the quality of life and even death. Ascites and edema are the most common causes in hospitalized patients. The writing of this scientific paper using a case study method using fluid and nutrition monitoring proved that this monitoring is effective for treating excess fluid volume as evidenced by not increasing complications that occur in patients.

Abstrak :
ABSTRACT
The prognosis of hepatocellular carcinoma (HCC) patients with tumor thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is extremely poor. We reviewed the recent surgical treatments and outcomes of this form of advanced HCC. TT is classified into three types according to its anatomic location relative to the heart: the inferior hepatic type (type I), where the TT is in the IVC below the diaphragm; the superior hepatic type (type II), where the TT is in the IVC above the diaphragm, but still outside the RA; and the intracardiac type (type III), where the TT is above the diaphragm and has entered the RA. Type I can be treated relatively easily by standard radical hepatectomy. For type II, the intrathoracic IVC is approached via the abdominal cavity and an incision in the diaphragm with total hepatic vascular exclusion (THVE). For type III, hepatectomy plus thrombectomy is generally performed under cardiopulmonary bypass. If the TT is only just inside the RA, THVE can be performed by mobilizing the liver caudally. The median overall survival of HCC patients with TT in the IVC or RA, who undergo curative resection, is 19.0-30.8 months. As postoperative recurrence is likely to develop, even after curative surgery, effective postoperative adjuvant chemotherapy is required.