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Abstrak :
Peran reseptor progesteron pada meningioma masih diperdebatkan. Namun ekspresi reseptor ini cenderung memberikan prognosis yang baik bagi pasien. Berbagai studi telah dilakukan untuk mengidentifikasi faktor prognosis yang mempengaruhi luaran meningioma. Telaah sistematis ini mengevaluasi berbagai studi yang menilai hubungan ekspresi reseptor progesteron terhadap derajat meningioma, serta luaran klinis berupa rekurensi, recurrence free survival (RFS), progression free survival (PFS), local control (LC), dan overall survival (OS) pada pasien meningioma. Berdasarkan hasil telaah sistematis ini, ekspresi reseptor progesteron mempunyai hubungan terbalik dengan peningkatan derajat meningioma. Ekspresi reseptor progesteron positif juga memberikan luaran yang lebih baik pada pasien pasca operasi. Studi mengenai respons radiasi terkait reseptor progesteron masih sangat jarang. ......The role of progesterone receptors in meningiomas is still debatable. However, the expression of these receptors tends to provide a good prognosis. Various studies have been conducted to identify progesterone receptors as a prognostic factors. This systematic review evaluates various studies assessing relation of progesterone receptor expression to the grade of meningioma and clinical outcomes in the form of recurrence, recurrence free survival (RFS), progression free survival (PFS), local control (LC), and overall survival (OS). Based on the results of this systematic review, progesterone receptor expression has an inverse relation with an increased grade. Positive progesterone receptor expression also have a better outcome in postoperative patients. Studies of the radiation response associated with progesterone receptors are rare.

Abstrak :
Tujuan: Menilai kesintasan pasien Glioblastoma Multiform (GBM) di RSCM dan mengidentifikasi faktor-faktor yang dapat mempengaruhi kesintasan pasien dengan GBM. Metode: dilakukan studi retrospektif pada 55 pasien GBM yang terdiagnosa secara histopatologis dan menjalani radiasi/kemoradiasi di RSCM pada Januari 2015-Desember 2019. Hasil: Mayoritas pasien adalah laki-laki dengan rasio 1,3:1 dibandingkan perempuan, rerata usia 45 tahun. Lokasi tumor tersering di lobus frontal (31,5%), lobus pariteal (26,3%) dan lobus temporal (24,2%). Median ekstensi reseksi tumor (EOR) 77% dan median volume residu tumor 50cm3. Median interval operasi-radiasi 42 hari dengan median total dosis radiasi 60 Gy. 69,1% telah mendapatkan terapi sesuai dengan panduan penatalaksanaan kanker (PPK). Median kesintasan hidup keseluruhan (OS) 13 bulan dan median kesintasan bebas progresifitas (PFS) 9 bulan. Median OS pasien dengan RTOG RPA kelas III, kelas IV dan kelas V-VI adalah 18 bulan, 13 bulan dan 6,7 bulan (p<0,001). Faktor yang memperburuk OS adalah usia ≥50 tahun (p=0,02), KPS<70 (p<0,001), volume residu tumor >20,4cm3 (p=0,001), interval waktu operasi-radiasi <4minggu (p=0,01) dan letak tumor di lobus parietal (p=0,02) pada uji univariat. Faktor yang memperburuk PFS adalah KPS <70 (p=0,001), volume residu tumor>20,4cm3 (p=0,02), terapi yang tidak sesuai PPK (p=0,004) dan letak tumor di lobus parietal (p=0,03). KPS merupakan faktor independen yang mempengaruhi OS dan PFS pada uji multivariat. Kesimpulan: KPS merupakan faktor prognostik independen yang mempengaruhi kesintasan pasien GBM. ......Aims: This study was done to assess the survival of patients with glioblastoma multiform in RSCM and to identify factors that can affect patient survival. Materials and methods: From January 2015 to December 2019, 55 patients with histopathologically confirmed glioblastoma multiform and received adjuvant radiation/chemoradiation in our department were retrospectively analyzed. Results: Most of the patiens in this study were men 1,3 times compared to women. Mean ages was 45 years old. The most common tumors site was frontal lobe (31,5%) followed by parietal lobe (26,3%) and temporal lobe (24,2%). Median extend of resection (EOR) was 77% with median residual tumor volume was 50cm3. Most of the patients (69,1%) already treated according to practice guidelines. The median total radiation dose was 60Gy. Median time to initiate adjuvant radiotherapy was 42 days. Median overall survival (OS) was 13 months and median progression free survival (PFS) was 9 months. Median OS in patients with RTOG RPA class III, class IV and class V-VI were 18 months, 13 months and 6,7 months respectively (p<0,001). Age≥50 (p=0,02), KPS<70 (p<0,0001), residual tumor volume >20,4cm3 (p=0,001), time to initiate adjuvant radiotherapy <4 weeks (p=0,01) and parietal lobes tumor site (p=0,02) were significantly associated with unfavorable OS in univariate analysis. KPS<70 (p=0,001), residual tumor volume >20,4cm3 (p=0,02), treatment that not in accordance with practice guidelines (p=0,004) and parietal lobes tumor site (p=0,03) associated with unfavorable PFS in univariate analysis. KPS was found to be the only independent factor that affected OS and PFS in multivariate analysis. Conclusions: The only factor that independently affected OS and PFS was KPS.

Abstrak :
Tujuan: Mengetahui kualitas hidup pasien anak dengan tumor otak yang telah menjalani radioterapi di Rumah Sakit Umum Pusat Nasional (RSUPN) Dr. Cipto Mangunkusumo berdasarkan PedsQL™ 4.0 skala generik serta mengetahui kesintasannya serta faktor risiko yang berpengaruh terhadap mortalitas. Metode: Dilakukan studi dengan desain potong lintang yang melibatkan 88 pasien dan sebanyak 26 diantaranya turut serta dalam penilaian kualitas hidup dengan menggunakan instrumen Pediatric Quality of Life Infentory (PedsQL™) 4.0 skala generik. Hasil: Dari 88 pasien yang terlibat dalam penelitian ini, sebanyak 31 pasien loss to follow up, 28 pasien terkonfirmasi meninggal, dan 29 pasien terkonfirmasi hidup. Kesintasan (OS) 1 tahun, 3 tahun, dan 5 tahun beturut-turut sebesar 71,6 %, 43,2%, dan 5,7%. Lokasi tumor infratentorial dan usia yang lebih muda pada saat diagnosis merupakan faktor risiko yang dapat meningkatkan mortalitas pada pasien anak dengan tumor otak pasca radioterapi dengan nilai p 0,044 dan 0,036. Nilai rerata kualitas berdasarkan laporan anak dan laporan orang tua PedsQL™ 4.0 skala generik adalah sebesar 70,686 dan 70,152. Penghasilan keluarga ≥ Rp 4.200.000,00 merupakan faktor yang meningkatkan kualitas hidup anak dengan tumor otak pasca radioterapi (p=0,008). Kesimpulan: Kualitas hidup pada pasien anak dengan tumor otak pasca radioterapi dapat dipengaruhi oleh faktor sosioekonomi yaitu penghasilan keluarga. Lokasi tumor dan usia yang lebih muda saat didiagnosis dapat meningkatkan risiko mortalitas. ......Aims: This study was aimed to show the quality of life in children with brain tumor after radiotherapy in Dr. Cipto Mangunkusumo National General Hospital based on PedsQL™ 4.0 generic core scale. This study was also aimed to show the overall survival and mortality risk factors. Methods: This cross-sectional study consisted of 88 children with brain tumor after radiotherapy. There were 26 of 88 children assessed by PedsQL™ 4.0 generic core scale. Results: Of the 88 patients involved in this study, 31 patients lost to follow-up, 28 patients were confirmed dead, and 29 patients were confirmed alive. One year, 3 years, and 5 years overall survival were respectively 71.6%, 43.2%, and 5.7%. Infratentorial tumor location and younger age at diagnosis were risk factors that can increase the incidence of mortality (p= 0.044 and 0.036). Children’s quality of life were 70.686 and 70.152 based on PedsQL ™ children and parents' reports. Family income ≥ IDR 4,200,000.00 was a factor that improved the quality of life in children with brain tumors after radiotherapy (p = 0.008). Conclusion: Quality of life in pediatric patients with brain tumor after radiotherapy could be influenced by family income. The location of the tumor and the younger age at diagnosis could increase the risk of mortality.

Abstrak :
Latar belakang: kanker nasofaring (KNF) adalah keganasan yang umum dijumpai pada nasofaring. Cukup banyak bukti menunjukkan adanya keterkaitan KNF dengan sistem kekebalan tubuh. Tidak semua subset sel T merupakan sel T efektor. Sel T regulator (TReg) yang merupakan salah satu subset dari sel T, memiliki peran penting dalam mengatur imunitas anti tumor. Sampai saat ini belum dapat disimpulkan bahwa keberadaan sel TReg pada lokasi tumor pasti akan memicu pertumbuhan tumor. Akan tetapi, adanya sel T CD4+ dan CD8+ tentunya berpengaruh terhadap kontrol perkembangan tumor. Studi ini bertujuan untuk menilai karakterisitik CD4, CD8 dan FOXP3 pada pasien KNF dan hubungannya terhadap agresivitas tumor. Metode: penelitian ini merupakan studi kohort prospektif. Sel TReg dinilai menggunakan marker FOXP3. Jumlah protein CD4, CD8 dan FOXP3 pada jaringan biopsi tumor dideteksi dan diukur dengan ELISA. Volume tumor primer dan volume total metastasis kelenjar getah bening regional didapatkan dari proses delineasi dengan pencitraan 3D. Spearmen-rho test digunakan untuk menilai korelasi antara CD4, CD8 dan FOXP3 dengan volume tumor primer dan volume total metastasis kelenjar getah bening regional. Hasil: Sebanyak 23 subjek penelitian (14 pria dan 9 wanita) terkumpul berdasarkan kriteria inklusi dan eksklusi. Stadium KNF terbanyak pada studi ini adalah stadium IV (AJCC edisi ke-8). Analisis dengan uji Spearman menunjukkan korelasi kuat antara konsentrasi protein FOXP3 dan volume tumor primer (p=0.02, r=0.60), dan juga antara konsentrasi protein CD8 dan volume tumor primer (p=0.00, r=0.81). Menariknya, juga ditemukan korelasi antara konsentrasi CD8 dan FOXP3 (p=0.00, r=0.85). Tidak ditemukan korelasi antara konsentrasi protein CD4, CD8 dan FOXP3 dengan volume total metastasis kelenjar getah bening regional. Tidak ditemukan juga korelasi antara konsentrasi FOXP3 dan stadium KNF. Sayangnya, belum dapat disimpulkan hubungan antara konsentrasi FOXP3 dan respons terapi pada penelitian ini. Kesimpulan: Keberadaan sel TReg berpengaruh terhadap agresivitias lokal tumor yang ditandai dengan peningkatan volume massa tumor primer. Korelasi antar konsentrasi CD4, CD8 dan FOXP3 memberikan gambaran interaksi dan mekanisme respons imunitas tubuh dalam menjaga keseimbangan antara sel T efektor dan sel T regulator. ......Background: nasopharyngeal cancer (NPC) is a common malignancy found in the nasopharynx area. There is quite a lot of evidence showing a link between NPC and the immune system. Regulatory T cells (TReg), a subset of T cells, have an essential role in regulating anti-tumor immunity. It has not been confirmed that TReg cells at the tumor site will trigger tumor growth. However, the presence of CD4+ and CD8+ T cells certainly affects the control of tumor growth. This study aims to assess the characteristics of CD4, CD8, and FOXP3 in NPC patients and their relationship with tumor aggressiveness. Methods: a prospective cohort study was conducted on 23 subjects (14 men and 9 women) based on the inclusion and exclusion criteria. TReg cells were assessed using the FOXP3 marker. The number of CD4, CD8, and FOXP3 proteins in tumor biopsy tissue was detected and measured by ELISA kit (MBS2702975, MBS165145, MBS162054). The volume of the primary tumor and the total volume of regional lymph node metastases were obtained from the delineation process based on 3D imaging. Spearmen-rho test was used to assess the correlation of CD4, CD8, and FOXP3 with primary tumor volume and total volume of regional lymph node metastases. Results: A total of 23 study subjects (14 men and 9 women) were collected based on the inclusion and exclusion criteria. The most common NPC stage in this study was stage IV (AJCC 8th edition). Analysis by the Spearman-rho test showed a strong correlation between; concentration of FOXP3 protein and primary tumor volume (p=0.02, r=0.60) and the concentration of CD8 protein and primary tumor volume (p=0.00, r=0.81). Interestingly, a correlation was also found between the concentration of CD8 protein and FOXP3 (p=0.00, r=0.85). There was no correlation between CD4, CD8, and FOXP3 proteins and the total volume of regional lymph node metastases. There was also no correlation between FOXP3 concentration and NPC stage. Unfortunately, it is impossible to conclude the relationship between FOXP3 concentration and treatment response in this study. Conclusions: the presence of TReg cells affects the local aggressiveness of the tumor, which is characterized by an increase in the volume of the primary tumor. The correlation between CD4, CD8, and FOXP3 concentrations provides an overview of the interactions and mechanisms of the body's immune response to maintain a balance between effector T cells and regulatory T cells.