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Pendahuluan : Radioterapi kanker serviks uteri dalam pelaksanaannya memerlukan verifikasi geometri sebagai salah satu rantai prosedur radioterapi. Prosedur ini dilakukan untuk mengetahui kesalahan set-up yang terdiri dari kesalahan sistematik dan acak yang nantinya digunakan untuk menentukan margin PTV yang sesuai untuk radioterapi kanker serviks uteri di Departemen Radioterapi Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Metode : Penelitian ini merupakan studi potong lintang terhadap data verifikasi dengan Electronic Portal Imaging Devices (EPID) dari 9 pasien kanker serviks uteri yang mendapatkan radioterapi dengan teknik 3DCRT/IMRT di Departemen Radioterapi RSCM antara bulan Oktober 2013 hingga Desember 2013. Pergeseran pada lapangan radiasi yang didapatkan dari hasil verifikasi dalam tiga fraksi awal dianalisis untuk memperoleh kesalahan sistematik dan acak, yang selanjutnya dihitung untuk mendapatkan margin PTV. Hasil : Sebanyak 72 data verifikasi EPID dianalisis. Didapatkan kesalahan sistematik dan kesalahan acak pada pelaksanaan radiasi (radioterapi) kanker serviks uteri di Departemen Radioterapi RSCM, berturut-turut sebesar 3.8 dan 3.0mm pada sumbu laterolateral, 5.9 dan 2.6mm pada sumbu kraniokaudal, serta 4.3 dan 3.5mm pada sumbu anteroposterior. Margin PTV yang diperoleh sebesar 9.8mm, 13.5mm dan 11,0 mm untuk masing-masing sumbu laterolateral, kraniokaudal, dan anteroposterior. Kesimpulan : Hasil penelitian ini mendapatkan kesalahan sistematik dan acak menggunakan verifikasi dengan EPID yang digunakan sebagai rekomendasi pemberian margin PTV sebesar 13.5mm dalam pelaksanaan radioterapi kanker serviks uteri dengan teknik 3DCRT/IMRT di Departemen Radioterapi RSCM. Diperlukan alat imobilisasi khusus regio pelvis untuk meningkatkan akurasi penyinaran. ...... Introduction : Geometric verification is needed as a part of chain of radiotherapy procedures in cervical cancer irradiation. This procedure used to detect set-up erros contains sistematic and random errors for the next step use to formulating adequate PTV margin for cervical cancer irradiation in Cipto Mangunkusumo Hospital. Methods : This is a cross-sectional study using Electronic Portal Imaging Devices (EPID) verification data of 9 cervical cancer patients treated with 3DCRT/IMRT in Department of Radiotherapy, Cipto Mangunkusumo Hospital between October 2013 and December 2013. Translation errors from the first three fractions were analyzed to count for systematic and random errors. These errors were then calculated to acquire PTV margin. Results : A total of 72 EPID data were analyzed. Systematic and random errors for cervical cancer irradiation in this study were respectively 3.8mm and 3.0mm in laterolateral direction, 5.9mm and 2.6mm in craniocaudal direction, and 4.3mm and 3.5mm in anteroposterior direction. PTV margin were 9.8mm, 13.5mm and 11.0mm in laterolateral, craniocaudal and anteroposterior direction, respectively. Conclusions : The result in this study acquire systematic and random errors with verificaton by EPID gave PTV margin recommendation and showed that 13.5mm margin was adequate in planning 3DCRT/IMRT technique for cervical cancer in Department of Radiotherapy, Cipto Mangunkusumo Hospital. Immobilisation devices for pelvic region might be needed to improve the accuration of radiotherapy.

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Pendahuluan: Malnutrisi dan hipoksia merupakan faktor yang mempengaruhi kegagalan terapi pada KNF stadium lokal lanjut. Kadar albumin merupakan salah satu pemeriksaan status nutrisi. Hipoksia menyebabkan radioresistensi terhadap radiasi.Tujuan dari penelitian ini adalah mengetahui korelasi antara kadar albumin praradiasi, hipoksia terhadap respon radiasi. Metode penelitian: Penelitian ini merupakan studi kohort retrospektif menggunakan data sekunder terhadap 40 pasien kanker nasofaring stadium lokal lanjut yang memenuhi kriteria inklusi di Departemen Radioterapi dan Departemen Patologi Anatomi RSUP Dr Cipto Mangunkusumo dari Desember 2012 sampai Agustus 2013. Dilakukan pencatatan kadar albumin praradiasi, berat badan serta CT scan sebelum dan sesudah radiasi. Kemudian dilakukan analisa HIF1α dengan pulasan imunohistokimia. Sel yang positif hipoksia dihitung per 10 lapang pandang besar. Setelah itu, dilakukan penilaian respon radiasi berdasarkan kriteria Recist. Hasil: Rerata kadar albumin praradiasi sebesar 3,9 +/- 0,5 g/dL, dan median persentase hipoksia sel yaitu 24,7(1-100)%. Tidak terdapat hubungan yang bermakna antara kadar albumin praradiasi terhadap respon radiasi (p≥0,05). Terdapat hubungan yang bermakna anatara hipoksia terhadap respon radiasi (p<0,05). Korelasi antara kadar albumin praradiasi dan hipoksia menunujukkan korelasi yang lemah dan tidak bermakna (r=-0,24, p=0,324). Kesimpulan: Hasil penelitian ini memperlihatkan bahwa albumin praradiasi tidak berhubungan dengan respon radiasi pada KNF stadium lokal lanjut. Terbukti bahwa hipoksia meningkatkan radioresistensi dan menurunkan respon radiasi. Tidak terdapat korelasi antara albumin praradiasi dan hipoksia. ......Introduction: Malnutrion and hypoxia had been shown to cause irradiation failure. Albumin is one of the nutritional status examination. Hypoxia caused radioresistance to irradiation. The purpose of this study was to evaluate the correlation of albumin, hypoxia towards radiation response in locally advanced nasopharyngeal carcinoma. Methods: This is a retrospective cohort study using secondary data from Departement of Radiotheraphy and Departement of Pathology Cipto Mangunkusomo hospital of 40 patients locally advanced nasopharyngeal cancer who meet the inclusion criteria from December 2012 to August 2013. Albumin preirradiation, body weight and CT scan before and after radiation were recorded. We examined the expression of HIF1 α by immunohistochemistry staining. Hypoxia cell was asessed by cell counting. Radiation response was determined by Recist criteria. Results: The mean of serum albumin is 3.9 + / - 0.5 g /dL, and the median percentage of hypoxia was 24,7(1-100)%. There was no statistically significant relationship between albumin and radiation response (p≥0.05). There was a statistically significant relationship between hypoxia and radiation response (p<0,05). There were no correlation between albumin and hypoxia (r=-0,24, p=0,324). Conclusion: This study showed that there was no correlation between albumin preirradiation and response in locally advanced nasopharyngeal cancer. It was proven that hypoxia increased radioresistance in locally advanced nasopharyngeal cancer. There was no correlation between albumin preirradiation and hypoxia.

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

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[ABSTRAK
Pendahuluan : Glioma adalah jenis tumor yang paling umum dari neoplasma intraserebral primer. Tumor ganas primer sistem saraf pusat (SSP) mencapai sekitar 2% dari semua kanker dan high grade glioma adalah jenis yang paling banyak ditemukan. High grade glioma menyebabkan tingkat morbiditas dan mortalitas yang tinggi. Saat ini belum ada data yang menggambarkan profil pasien glioma yang menjalani radioterapi di Indonesia. Metode penelitian : Penelitian ini merupakan penelitian retrospektif deskriptif analitik terhadap 121 pasien glioma yang mendapat radiasi di departemen Radioterapi RSUPN Dr. Cipto mangunkusumo dari Januari 2009 sampai Januari 2014. Data diperoleh dari catatan medisdan hasil penelusuran melalui telepon terhadap pasien atau keluarganya. Respon tumor dianalisa terhadap 22 pasien yang mempunyai CT scan atau MRI pre dan post radiasi dengan menggunakan kriteria RECIST. Hasil : Sebagian besar pasien adalah laki-laki (53,7%), dengan usia rata-rata 45 tahun. Histopatologi yang paling banyak ditemukan adalah astrositoma. Prosedur bedah yang paling banyak ditemukan pada penelitian ini adalah craniotomi removal tumor (70%). Teknik 3D CRT paling banyak digunakan yaitu pada 77,7% pasien. Nimotuzumab sebagai antibodi monoklonal digunakan pada 9% pasien. Respon parsial ditemukan 59,1%. Analisis kesintasan hidup tiga tahun dari seratus sebelas pasien yang memenuhi kriteria didapatkan angka kesintasan yaitu 46,15%. Analisis kaplan meyer menunjukkan overall treatment time merupakan faktor prognostik untuk kesintasan hidup (p = 0,016). Kesimpulan : Teknik operasi terbanyak pada pasien glioma yang menjalani radiasi di departemen radioterapi RSUPN DR. Cipto Mangunkusumo adalah kraniotomi removal tumor (70,9%). Teknik 3D CRT adalah teknik radiasi yang paling banyak digunakan. Respon parsial ditemukan 59,1%. Kesintasan hidup tiga tahun pasien glioma yaitu 46,2% dan overall treatment time merupakan faktor prognostik yang bermakna untuk kesintasan hidup

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ABSTRACT
Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis.;Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis., Introduction : Glioma is the most common type of primary intracerebral neoplasms. High grade glioma being the most frekuent type found (70,9%) causes a high morbidity and mortality rate. There is currently no data describing the profile management of patients undergoing radiotherapy glioma in Indonesia. Methods : This study Retrospective analytic descriptive study of 121 glioma patients from januari 2009 until december 2014. The data was obtained from medical records and indivual contact via telephone. Tumor response was evaluated in 22 patients with pre and post irradiation imaging (CT or MRI) using 3D volumetric data and assessed via RECIST criteria. Results : Most of our patients were male (53,7%), with median age 45 years old. Astrocytoma was the most histopathological type found. 70.9% of Patients who received radiotherapy in Cipto Mangunkusumo hospital were post craniotomi tumor removal. 3D Conformal technique was used in 81.0% of patients. Seventy nine point three had a two gray dose perfraction. Provision of chemotherapy in patients undergoing radiation still only at 7.4% of patients. Nimotuzumab as a monoclonal antibody used on 9% patient. The median overall treatment time was 45 days and delay treatment time 38 days. Fifty nine point one percent of partial respon was found. Local recurrences were found throughout the follow-up of 6.6%. Analysis kaplan meyer showed that overall treatment time was a prognostic factor for overal survival rate (p=0,016). Conclusions : : Almost seventy one percent of glioma patients who received radiotherapy had craniotomy removal tumor. 3D Conformal techniques is the most widely used. Fifty nine point one percent of partial respon founded. Three years overall survival was 46,2% and overall treatment time was found as a factor that significantly affects overall survival prognosis.]

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Pendahuluan Toksisitas akut radiasi merupakan suatu proses yang diawali dengan kerusakaPendahuluan: Toksisitas akut radiasi merupakan suatu proses yang diawali dengan kerusakan sel normal. Malondialdehyde (MDA) merupakan produk akhir dari peroksidasi lipid yang merupakan biomarker stres oksidatif. Catalase (CAT) adalah antioksidan enzimatik yang mengkatalisis H2O2 menjadi air dan oksigen. Penelitian ini bertujuan untuk mengetahui apakah kadar MDA dan aktivitas CAT dapat dijadikan prediktor derajat toksisitas akut radiasi pada kanker serviks stadium lanjut lokal. Metode penelitian: Penelitian ini merupakan studi kohort prospektif terhadap 30 pasien kanker serviks stadium lanjut lokal yang memenuhi kriteria inklusi di Departemen Radioterapi RS Cipto Mangunkusumo dari Juli sampai September 2013. Pemeriksaan kadar MDA dan aktivitas CAT dilakukan sebelum radiasi dan fraksi ke-15 dengan menggunakan spektrofotometer. Derajat toksisitas akut radiasi dinilai tiap minggunya selama radiasi eksterna dan diklasifikasikan berdasarkan kriteria RTOG. Hasil: Didapatkan rerata kadar MDA serum sebesar 7,6 +/- 1,2 nmol/mL, dan median aktivitas CAT sebesar 0,95 (0,80 ? 1,36) U/mL. Pasca 15 kali RE didapatkan peningkatan kadar MDA serum menjadi 9,5 +/- 1,9 nmol/mL (p<0,001) dan penurunan aktivitas CAT menjadi 0,82 (0,71 ? 0,96) (p<0,001). Tidak ditemukan hubungan yang bermakna antara kadar MDA dan aktivitas CAT awal serta perubahannya terhadap kejadian toksisitas akut radiasi (p>0,05). Kesimpulan: Hasil penelitian ini memperlihatkan bahwa radiasi maupun kemoradiasi terbukti menyebabkan peningkatan kadar MDA dan penurunan aktivitas CAT pada kanker serviks stadium lanjut lokal, akan tetapi kadar MDA dan aktivitas CAT tidak dapat menjadi prediktor terhadap toksisitas akut radiasi.n sel normal Malondialdehyde MDA merupakan produk akhir dari peroksidasi lipid yang merupakan biomarker stres oksidatif Catalase CAT adalah antioksidan enzimatik yang mengkatalisis H2O2 menjadi air dan oksigen Penelitian ini bertujuan untuk mengetahui apakah kadar MDA dan aktivitas CAT dapat dijadikan prediktor derajat toksisitas akut radiasi pada kanker serviks stadium lanjut lokal Metode penelitian Penelitian ini merupakan studi kohort prospektif terhadap 30 pasien kanker serviks stadium lanjut lokal yang memenuhi kriteria inklusi di Departemen Radioterapi RS Cipto Mangunkusumo dari Juli sampai September 2013 Pemeriksaan kadar MDA dan aktivitas CAT dilakukan sebelum radiasi dan fraksi ke 15 dengan menggunakan spektrofotometer Derajat toksisitas akut radiasi dinilai tiap minggunya selama radiasi eksterna dan diklasifikasikan berdasarkan kriteria RTOG Hasil Didapatkan rerata kadar MDA serum sebesar 7 6 1 2 nmol mL dan median aktivitas CAT sebesar 0 95 0 80 1 36 U mL Pasca 15 kali RE didapatkan peningkatan kadar MDA serum menjadi 9 5 1 9 nmol mL p.

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Introduction: Acute radiation toxicity was a process which caused by irradiation and initiated by normal cell damage. Malondialdehyde (MDA) is the end product of lipid peroxidation, and is usually used as a biomarker to assess oxidative stress. Catalase (CAT) is an enzymatic antioxidant that catalyzes H2O2 into water and oxygen. The purpose of this study was to determine whether the levels of MDA and CAT activity can be used as a predictor of acute radiation toxicity in locally advanced cervical cancer. Methods: This is a prospective cohort study to 30 locally advanced cervical cancer patients who meet the inclusion criteria in the Radiotherapy Department of Cipto Mangunkusumo Hospital from July to September 2013. We measure MDA level and CAT activity before irradiation and on 15th fractions using sphectrophotometry. Degree of acute radiation toxicity assessed every week during external beam radiotherapy using RTOG criteria. Results: The mean of serum MDA levels is 7.6 + / - 1.2 nmol /mL, and the median of CAT activity is 0.95 (0.80 to 1.36) U /mL. We found elevated of serum MDA level to 9.5 +/ - 1.9 nmol /mL (p <0.001) and CAT activity decreased to 0.82 (0.71 to 0.96) U /mL (p <0.001) on the 15th fraction of external beam irradiation. No statistically significant relationship is found between MDA level and CAT activity pre irradiation and its changes to the incidence of acute radiation toxicity. Conclusion: This study showed that radiation or chemoradiation shown to cause an increase in MDA levels and decrease of CAT activity in locally advanced cervical cancer patients, but MDA levels and CAT activity cannot be a predictor of acute radiation toxicity.

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ABSTRAK
Latar 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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ABSTRACT
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. ;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.

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Latar Belakang: Kasus keganasan pada regio abdominopelvis memerlukan tatalaksana radiasi. Alat imobilisasi membantu untuk meminimalisasi pergeseran lapangan radiasi yang terdiri dari systematic error dan random error. Pada penelitian ini dilakukan perbandingan alat imobilisasi penyangga lutut dan masker pelvis termoplastik. Tujuan: Mengetahui adakah perbedaan tingkat akurasi radiasi kedua imobilisasi yang akan menentukan margin PTV terbaik. Metode: Penelitian prospective randomized control trial pada pasien dengan keganasan regio abdominopelvis yang menjalani radiasi April­–Juli 2024. Systematic dan random error didapatkan dari data Treatment Planning System (TPS). Margin PTV dihitung menggunakan rumus van herk. Hasil: Didapatkan 31 pasien yang masuk dalam kriteria inklusi dan eksklusi terdiri dari 15 sampel dengan imobilisasi termoplastik dan 16 sampel dengan penyangga lutut. Margin PTV yang direkomendasikan untuk masker pelvis termoplastik 6.24 mm pada sumbu x (LL), 14,31 mm pada y(CC), dan 3,28 mm pada z(AP). Sedangkan pada penyangga lutut 7.72 mm sumbu x, 11.76 mm sumbu y, dan 5.16 mm sumbu z. Kesimpulan: Pergeseran AP termoplastik lebih baik dibandingkan penyangga lutut sesuai dengan rekomendasi internasional toleransi £ 3mm. Sedangkan untuk CC dan LL tidak ditemukan adanya perbedaan yang signifikan secara statistik. ......Background: The immobilization tool helps to minimize radiation field shifts which consist of systematic errors and random errors. In this study, a comparison of knee wedge immobilization devices and thermoplastic pelvic masks was carried out on the level of accuracy of radiation delivery. Objective: To determine whether there is a difference in the level of radiation accuracy for both immobilizations which will determine the best PTV margin. Methods: Prospective randomized control trial study in patients with malignancies in the abdominopelvic region who underwent radiation April–July 2024. Systematic and random errors were obtained from Treatment Planning System (TPS) data. PTV margin is calculated using the Van Herk formula. Results: There were 31 patients who met the inclusion and exclusion criteria consisting of 15 samples with thermoplastic and 16 samples with knee wedge. The recommended PTV margins for thermoplastic pelvic masks are 6.24 mm in the x-axis (LL), 14.31 mm in y(CC), and 3.28 mm in z(AP). Meanwhile, the knee wedge is 7.72 mm x-axis, 11.76 mm y-axis, and 5.16 mm z-axis. Conclusion: Thermoplastic AP displacement is better than the knee wedge according to international standard tolerance of £ 3mm. Meanwhile, for CC and LL, no statistically significant differences were found.

Abstrak :
Latar Belakang: KGB pelvis merupakan salah satu faktor prognostik penting dalam kanker serviks. Penggunaan booster radiasi adalah tindakan noninvasif dan memberikan hasil yang menjanjikan. Teknik SIB sebagai modalitas pemberian booster terunggul telah diaplikasikan di RSCM sejak Januari 2020, namun belum pernah dinilai tingkat keberhasilannya. Tujuan: Mengetahui perbedaan respon klinis, kesintasan, dan toksisitas akut pada populasi kanker serviks IIIC1 antara yang mendapat radiasi teknik SIB dengan teknik non-SIB. Studi ini juga bertujuan mencari faktor prognostik kesintasan. Metode: 125 pasien kanker serviks IIIC1, 35 mendapatkan teknik SIB, 90 mendapatkan teknik non-SIB. Dari populasi tersebut, dinilai respon klinis tumor primer dan KGB berdasarkan MRI evaluasi pertama. Toksisitas akut dinilai berdasarkan penilaian mingguan. Pada pasien juga dilakukan uji Kaplan-Meier untuk mengetahui kesintasan dan analisis multivariat untuk mengetahui faktor prognostik yang memengaruhi kesintasan Hasil: Median Follow-up adalah 64 minggu pada grup SIB dan 84 minggu pada grup non-SIB. Grup yang mendapatkan SIB memiliki median ukuran KGB yang lebih besar dibandingkan grup non-SIB (p= 0,000). Respon komplit tumor primer ditemui pada 92,3% pasien grup non-SIB dan 81,8% pasien grup SIB yang tidak berbeda bermakna. Respon komplit KGB ditemukan pada 95,4% pasien grup non-SIB dan 91% pasien grup SIB. Median kesintasan 83 minggu pada grup SIB dan 127 minggu pada grup non-SIB, yang berbeda bermakna secara statistik. Analisis subgrup dengan membandingkan pasien dengan ukuran KGB yang sama pada kedua grup, menunjukkan tidak ada perbedaan kesintasan pada kedua grup. Uji multivariat menunjukkan 6 variabel yang memengaruhi prognostik kesintasan pasien kanker serviks IIIC1. Ukuran tumor primer, ukuran short-axis KGB, histopatologi non-KSS, NLR preterapi adalah faktor prognostik kesintasan yang buruk, sedangkan kadar hemoglobin dan pemberian kemoterapi adalah faktor prognostik kesintasan yang baik. Kesimpulan: Kesintasan pasien yang mendapatkan SIB lebih rendah dibandingkan grup non-SIB (p= 0,048) namun dengan membandingkan ukuran KGB yang sama, memperlihatkan kesintasan yang tidak berbeda (p= 0,26). Walaupun demikian, respon lokoregional 6 bulan pada kedua grup menunjukkan hasil yang serupa (p= 0,489) ......Background: Pelvic lymph nodes is important prognostic factors in cervical cancer. The use of radiation boosters is noninvasive and provides promising results. The SIB technique as the best booster modality has been applied at RSCM since January 2020, but its level of success has never been assessed. Aims: To determine the differences in clinical response, survival and acute toxicity in the IIIC1 cervical cancer population between those who received SIB technique radiation and non-SIB technique radiation. This study also aims to find prognostic factors for survival. Methods: 135 IIIC1 cervical cancer patients included, 35 received SIB techniques, 90 received non-SIB techniques. The clinical response of the primary tumor and KGB was assessed based on the first MRI evaluation. Acute toxicity was assessed based on weekly assessments. The Kaplan-Meier test also carried out the to determine survival. Multivariate analysis is done to determine prognostic factors that influence survival.. Results: Median follow-up was 64 weeks in the SIB group and 84 weeks in the non-SIB group. The group that received SIB had a larger median lymph node size than the non-SIB group (p= 0,000). Complete response of primary tumor was found in 92.3% of patients in the non-SIB group and 81.8% of patients in the SIB group, which was not significantly different. Complete KGB response was found in 95.4% of patients in the non-SIB group and 91% of patients in the SIB group. Median survival was 83 weeks in the SIB group and 127 weeks in the non-SIB group, which was statistically significantly different. Subgroup analysis comparing patients with the same lymph node size in both groups showed no difference in survival in the two groups. Multivariate testing shows 6 variables that influence the prognostic survival of IIIC1 cervical cancer patients. Primary tumor size, short-axis lymph node size, non-SCC histopathology, pretherapy NLR are poor survival prognostic factors, while hemoglobin levels and chemotherapy administration are good survival prognostic factors. Conclusion: The survival of patients who received SIB was lower than the non-SIB group (p= 0.048) but when comparing the same lymph node size, survival was not different (p= 0.26). However, the 6-month locoregional response in both groups showed similar results (p= 0.489)

Abstrak :
Kuantitas dan kualitas asupan protein belum sepenuhnya diketahui perannya terhadap kualitas hidup. Prognostic Nutritional Index (PNI) juga belum diketahui dapat mencerminkan kualitas hidup dan apakah bisa ditingkatkan dengan asupan protein. Penelitian dengan desain potong lintang ini bertujuan untuk mengetahui korelasi antara asupan protein dengan PNI dan kualitas hidup serta korelasi PNI dengan kualitas hidup pada pasien kanker kepala leher dengan radioterapi di Departemen Radioterapi Rumah Sakit dr. Cipto Mangunkusumo, Jakarta. Sebanyak 61 subjek didapatkan dari consecutive sampling. Rerata usia subjek adalah 46,3 ± 12,4 dan 65,6% subjek berada pada kanker stadium IV dan mendapatkan terapi kemoradiasi. Sebanyak 32,8% subjek yang memiliki status gizi kurang. Median asupan protein adalah 1,42 (0,26-4,11) g/kg/hari. Nilai PNI pada subjek penelitian memiliki median 45,9 (29,4-54,2). Hasil penelitian menunjukkan adanya korelasi bermakna antara kuantitas asupan protein berdasarkan Food Frequency Questionnaire (FFQ) semikuantitatif dan beberapa aspek gejala pada kualitas hidup yaitu pada aspek pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37;p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). Kualitas asupan protein tidak berkorelasi bermakna dengan kualitas hidup. PNI berkorelasi bermakna terhadap 1 aspek fungsional yaitu physical function (r=0,378; p=0,003) dan 2 aspek gejala yaitu opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Meskipun tidak signifikan secara statistik, namun PNI memiliki arah korelasi yang positif terhadap aspek fungsional lainnya dan memiliki arah korelasi negatif terhadap aspek gejala lainnya yang berarti semakin tinggi PNI maka aspek fungsional semakin baik dan gejala semakin ringan. Studi ini tidak menemukan adanya korelasi bermakna antara asupan protein, baik kualitas maupun kuantitasnya, terhadap PNI. Hasil ini diduga berkaitan dengan penemuan bahwa sebagian besar penderita masih memiliki pola asupan yang mampu mencukupi kebutuhan kalori dan protein harian. Diperlukan studi prospektif yang menelusuri aspek prognostik kanker kepala leher dari segi kualitas hidup untuk mengetahui apakah PNI dapat memprediksi aspek kualitas hidup dengan lebih rinci. ......Quality and quantity of protein intake has not been well understood that it can affect quality of life. Moreover, Prognostic Nutritional Index (PNI) also has not been well studied upon its usage to reflect quality of life of head and neck cancer patients undergoing radiotherapy. This cross sectional study was aimed to determine the correlation between protein intake and PNI and also the correlation between PNI and quality of life in head and neck cancer patients undergoing radiotherapy at Radiotherapy Department, dr. Cipto Mangunkusumo General Hospital, Jakarta. Total of 61 subjects were recruited with consecutive sampling method with mean age of 46,3 ± 12,4 years old and 65,6% subjects were on stage IV cancer and were getting a combination of chemo and radiotherapy. Only 32,8% subjects were on low nutritional status. Median of total protein intake was 1,42 (0,26-4,11) g/kg/day. Median of PNI was 45,9 (29,4-54,2) among subjects. The result of the study showed a significant correlations between quanitity of protein intake based on semiquantitative Food Frequency Questionnaire (FFQ) with several aspects of quality of life, that were pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37; p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). This aspects were all symptomatics. PNI was significantly correlated with 1 functional aspect, which was Physical function (r=0.378; p=0,003) and 2 symptomp aspects, which were opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Although not statistically significant, but there were positive direction of correlation with other functional aspects and negative direction of correlation with other symptomps aspects. This implicates that the higher the PNI, the lower the symptoms and the better the functional status of head and neck cancer patients undergoing radiotherapy. This study did not show a significant correlation between quality and quantity of protein intake with PNI. An adequate intake of calorie and protein in most subjects were found in this study which might explain the result. More studies, preferably prospective one, may be needed to show the usage of PNI to reflect quality of life, especially involving quality of life progresivity.

Abstrak :
Tujuan: PD-L1 merupakan protein yang berperan dalam pengaturan respon imun terhadap tumor. Peningkatan ekspresi PD-L1 mengakibatkan antigen atau sel kanker dapat terhindar dari sistem imun. Hubungan ekspresi PD-L1 dengan penggunaan imunoterapi dan radioterapi secara bersamaan telah banyak dilakukan. Akan tetapi, saat ini masih belum diketahui hubungan antara ekspresi tersebut dengan toksisitas akut radiasi. Untuk itu, penelitian ini dilakukan untuk mengevaluasi hubungan antara ekspresi PD-L1 dengan toksisitas akut selama radiasi dan 2 bulan paska radiasi. Metoda: 30 pasien kanker serviks lanjut local yang mendapatkan terapi radiasi di Departemen radioterapi RSCM. Pasien dilakukan biopsy 2 kali yaitu pra radiasi eksterna dan paska radiasi eksterna untuk dilakukan pemeriksaan ELISA & IHK PD-L1. Selama menjalani radiasi eksterna dan 2 bulan paska radiasi, pasien dievaluasi toksisitas akut dengan kirteria CTCAE versi 5. Hasil: Ekspresi PD-L1 pada kanker serviks lanjut lokal yang mendapatkan radiasi tidak memengaruhi pada toksisitas akut selama radiasi eksterna dan 2 bulan paska radiasi (p>0,05). Akan tetapi, IHK PD-L1 dengan intesitas ≥ 2 dan ELISA PD-L1 yang mengalami penurunan dari pra radiasi ke paska radiasi, menunjukkan ada kecenderungan memiliki toksisitas yang lebih rendah yaitu ≤ Grade 1. Kesimpulan: Ekspresi PD-L1 tidak menurunkan toksisitas akut radiasi selama radiasi dan 2 bulan paska terapi pada pasien kanker serviks stadium lanjut lokal. Akan tetapi, pada toksisitas akut 2 bulan paska terapi menunjukkan kecenderungan mendapatkan toksisitas radiasi yang lebih rendah pada pasien yang memiliki ekspresi PD-L1. ......Objectives: PD-L1 is a protein that controls the immune response to tumors. Increased PD-L1 expression results in immune system not detecting cancer cells. There was a correlation between the expression of PD-L1 and the combined use of immunotherapy and radiotherapy. At this time, however, there is no established association between these expression and radiation acute toxicity. Methods: Totally 30 locally advanced cervical cancer patients receiving radiation therapy in the Department of Radiotherapy of RSCM. Biopsy was performed twice, pre-external radiation and post-external radiation for PD-L1 ELISA & IHC tests. The patient was evaluated for radiation of acute toxicity with CTCAE version 5 during external radiation and 2 months post-radiation. Results: The expression of PD-L1 in local advanced cervical cancer which received radiation did not affect acute toxicity during external radiation and 2 months post radiation (p > 0.05). However, PD-L1 CPI with intensity ≥ 2 and PD-L1 ELISA which decreased from pre-radiation to post-radiation, showed a tendency to have lower toxicity, namely ≤ Grade 1. Conclusion: PD-L1 expression in local advanced cervical cancer patients did not reduce the acute toxicity of radiation during external radiation and 2 months post-treatment. Nonetheless, 2 months post-therapy, acute toxicity showed a propensity to lower toxicity in patients with expression of PD-L1.