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Tonny Loho, Agus Rizal A. H. Hamid, Rainy Umbas, Na'Imatul Mahanani
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.759

Abstract:
Background: Fluoroquinolone has been routinely given as a prophylactic antibiotic to patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. Currently, there is no data on the profile of fluoroquinolone-resistant bacteria, its association with post-biopsy sepsis, and alternative prophylactic antibiotics.Methods: A cross-sectional study was conducted in patients undergoing TRUS-guided prostate biopsy at Urology Clinic, Cipto Mangunkusumo National Central General Hospital between August and December 2015. Specimens were taken from rectal swabs prior to biopsy. Gramnegative bacilli and Gram-positive cocci were characterized on the Vitek®2 using GN and GP cards (BioMérieux, USA). Antimicrobial susceptibility testing was done by Kirby Bauer disc diffusion method. Post-biopsy infection was monitored within one week after biopsy by telephone call and diagnosed by clinical examination.Results: A total of 52 patients aged 52-80 years were enrolled. Sixty-six isolates grew from 52 swabs; 14 swabs among them grew 2 isolates. The commonest pathogen was Escherichia coli (78.8%), followed by Klebsiella pneumoniae (13.6%), Enterococcus faecium (3.0%), Acinetobacter haemolyticus, Morganella morganii subsp. morganii, and Enterococcus faecalis (1.5%), respectively. Ciprofloxacin-resistant bacteria were found in 33 (50.0%) isolates which were predominated by E. coli. Meanwhile, 90.4% and 96.2% of isolates were sensitive to amoxicillinclavulanate and ampicillin-sulbactam, respectively. Post-biopsy infection was established in 7 patients requiring no hospitalization.Conclusions: The proportion of ciprofloxacin-resistant bacteria in the rectum among patients undergoing prostate biopsy was 50.0%. Escherichia coli is the commonest resistant pathogen to fluoroquinolone. The recommended alternatives for prophylactic antibiotics are amoxicillinclavulanate and ampicillin-sulbactam. Routine pre-biopsy rectal swab cultures should also be encouraged.
I Nyoman Gede Budiana, Ida Bagus Rendra Kurniawan Artha
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.731

Abstract:
Background: Cervical cancer is one of the biggest women’s health issues in developing countries including Indonesia. This study is aimed to describe the characteristics of cervical precancerous lesions at a tertiary hospital in Bali, Indonesia.Methods: This is a descriptive study using data from the medical records of patients with precancerous cervical lesions who attended the Gynecologic Oncology Outpatient Clinic Sanglah Hospital Denpasar, Bali, Indonesia, from January to December 2017. Results: There were 276 cases (2.88%) of the cervical precancerous lesion during the study period. The majority of cases were diagnosed within the age group of 36-45 years (37.7%), had low education levels (42.7%), obese (53.5%), multiparous (73.9%), had first sexual intercourse at the age of 16-20 years (41.3%), had used IUD as a contraceptive method (41.4%), and had a cytologic diagnosis of atypical squamous cells of undetermined significance (ASC-US) that preceded the histologic diagnosis (43.2%). The most common histologic diagnosis was CIN I (43.1%) and the most common treatment was cryotherapy (56.2%).Conclusions: The majority of cervical precancerous lesion cases were diagnosed among women who were between her third and fourth decade of life, had low education level, were obese, multiparous, had a sexual debut at a younger age, and were IUD users. The majority of cases were low-grade lesions.
Adhitya Bayu Perdana, Fahreza Saputra, Mururul Aisyi
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.818

Abstract:
Childhood cancer has been a global public health scourge with considerably escalating incidence each year [1]. Although the incidence is relatively lower compared to adult malignancies, it remains the leading cause of disease-related death in children. The most frequent childhood cancer is acute lymphoblastic leukemia (ALL) with an annual incidence of 3.5 per 100,000 children in the United States [2]. Similarly, in Indonesia, ALL has the highest number of cancer cases in children [3]. The total incidence of ALL in Indonesia reaches 2.5-4.0 per 100,000 children with an estimated 2,000-3,200 annually [4]. Because of its high incidence and curability, ALL is a logical initial objective for childhood cancer program developments in Indonesia. As an indicator of successful treatment of childhood ALL, the 5-year survival rate shows contrasting figures between high-income (HIC) and lower-middle-income countries (LMIC). In the United States and most European countries, the survival rates are approximately 90% and 85% respectively. However, in Southeast Asian countries, the highest 5-year survival rate for children aged 0 to 14 was reported in Malaysia (69.4%), followed by Thailand (55.1%) [5]. Furthermore, more unfavorable results were reported in Indonesia. Studies from Dharmais Cancer Hospital and Dr. Sardjito Hospital reported the 5-year survival rate of 28.9% and 31.8% respectively [6,7]. The outcome difference between Indonesia and other countries is probably due to the high rate of relapse occurrence and toxic death during the treatment. Some studies revealed the factors that affecting the worst outcome of childhood ALL in LMIC include inadequate and delayed diagnosis, limited healthcare access, treatment abandonment, and suboptimal supportive care [8]. As pediatric oncologists in HIC have become more effective at treating childhood ALL, much of the research attempts concentrated on the risk stratification of the patients. The term “risk stratification” is used to allocate the patients into various risk groups based on the notable prognostic features for specific treatment administration. Patients with a high-risk assessment could be targeted for more aggressive treatments, while patients with lower risk could be treated less intensively to avoid the side effects and toxicities [9]. In Indonesia, risk stratification strategy encompasses clinical-hematologic parameters (age, leukocyte count, extramedullary involvement), and conventional morphological examination. These assessments represent the first step in the diagnostic pathway of ALL. Though helpful, in certain cases, the residual leukemic cells might be undetectable under bone marrow morphology examination. This led to more underdiagnosed cases, thus more patients were subjected to inadequate treatment. Fortunately, immunophenotyping is currently applied to improve the diagnosis of childhood ALL by grouping the patients based on the aberrant expression of leukemic cell antigen, even though its application is only available in several centers including Dharmais Cancer Hospital. The BCR-ABL1 fusion gene examination by PCR-based techniques has also routinely been implemented to predict the poor outcome since it was detected in 12% of childhood ALL patients [10]. However, the current above-mentioned strategy is insufficient to solve the accuracy of risk stratification of childhood ALL. In HIC, childhood ALL are classified by more comprehensive examination involving morphology, immunophenotyping, cytogenetics, and molecular techniques. The approach to classifying prognosis and to personalize treatment based on the underlying genetic biology has already implemented for understanding the pathogenesis of childhood ALL. According to studies, the molecular features of childhood ALL have been shown to have a significant prognostic value [11], and the survival rate was improved when genetic examinations are applied [12]. In recent years, high-resolution array-based genomic technologies have revolutionized the understanding of the genetic basis of childhood ALL. Several biomarkers have successfully been identified that are provenly associated with poor prognosis in childhood ALL, including the deletion/mutation of IKZF1 (IKAROS), CDKN2A, ETV6, EBF1, JAK2, and many more [13]. The majority of these genetic changes were originally identified by sophisticated methods such as single nucleotide polymorphism (SNP) arrays, gene expression profiling (GEP), array-based comparative genomic hybridization (aCGH), and more recently next-generation sequencing (NGS) [14]. Despite being highly sensitive for detection of multiple copy number changes, these approaches are not feasible for routine diagnostic use in LMIC which requires significant EDITORIAL Indonesian Journal of Cancer, Vol 14(4), 115–116, December 2020 DOI: http://dx.doi.org/10.33371/ijoc.v14i4.818 www.indonesianjournalofcancer.or.id P-ISSN: 1978-3744 E-ISSN: 2355-6811 116 | financial investment. Therefore, molecular techniques that suit available resources and infrastructure should be developed in LMIC, and most importantly the cost should be affordable for patients. One feasible method is Multiplex Ligation-dependent Probe Amplification (MLPA). MLPA is a rapid multiplex PCR-based technique that enables the comparative analysis of multiple mutation spots [15]. MLPA provides a low-cost, simple alternative to array-based techniques for much routine clinical practice, even though it is unsuitable for whole-genome analysis. Furthermore, one benefit compared to other quantitative PCR-based techniques is that MLPA allows 50 or more different genomic DNA to be analyzed in a single tube reaction. Several studies have demonstrated the implementation of specific MLPA probe mixes for hematological malignancies, including ALL, chronic lymphocytic leukemia (CLL), and myelodysplastic syndrome (MDS). These studies have also shown the sensitive and accurate identification of clinically...
Indah Jamtani, Adianto Nugroho, Syamsu Hudaya, Rofi Y. Saunar, Aditomo Widarso, Taslim Poniman
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.770

Abstract:
Introduction: Resection of renal cell carcinoma liver metastases (RCCLM) is known to provide a good survival outcome. Simultaneous RCCLM resection with the primary tumor is commonly done in cases with direct extension of locally advanced RCC to liver parenchyma. Cases of safe simultaneous resection of liver and kidney in malignancy have not been reported before in Indonesia. Case Presentation: We aim to describe two cases of left-sided RCC with right-sided RCCLM who underwent simultaneous kidney and liver resection. Both patients had good short-term survival with no intra-operative and post-operative complications.Conclusion: Although simultaneous kidney and liver resection poses challenges of substantial morbidity, a safe surgical and multidisciplinary approach could be implemented in selected cases with a good surgical outcome.
Putu Erika Paskarani, Luh Ayu Widayanti, Anak Agung Ayu Ngurah Susraini, Herman Saputra, Ni Putu Sriwidyani
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.762

Abstract:
Introduction: Kimura’s disease (KD) in Indonesia is quite rare. It is a distinct benign reactive process; however, it is usually mimicking malignancy. It usually affects young adults with a peak incidence in three decades, and men are mostly affected compared to women with a 3:1 ratio. KD is a chronic inflammatory disorder characterized by lymphoid hyperplasia, eosinophilia, and associated with soft tissue swelling that usually arises in head and neck regions with regional lymphadenopathy.Case Presentation: Herein, we report a case in a 55-year-old man from East Indonesia who presented a huge lump on his left head and neck regions. The lump started about 8 years ago. Physical examination found a tumor mass of 20 x 10 cm with indistinct border and multiple lymphadenopathies left coli with the biggest size of 1.3 x 0.7 x 0.5 cm. Peripheral blood examination shows marked eosinophilia. Nasopharyngeal CT scan revealed soft tissue masses and multiple lymphadenopathies suspected of malignancy; however, thorax plain radiology did not show any sign of metastatic process. Histopathological examination shows reactive follicular proliferation, extensive eosinophilia, focal area Folliculolysis, and polykaryocytes of the WarthinFinkeldey type.Conclusion: Based on a complete history, laboratory findings, and histopathological examination, this case is concluded as Kimura’s disease. Although clinical findings and radiological examination suspected it as malignancy, those discrepancies were confirmed as a benign lesion by specific histopathological and laboratory findings. Commonly, most patients have a favorable prognosis and good response to therapy.
Samuel Jason Rolando Tua, Hendy Rachmat Primana, Agus Hadian Rahim, Ahmad Ramdan, Herry Herman
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.740

Abstract:
Introduction: Chondrosarcoma is the second most common primary bone sarcoma and arising in the spine. It is estimated to be 2% to 12% in incidence from various series. The use of neoadjuvant and adjuvant chemotherapy for chondrosarcomas is controversial. Low- and intermediate-grade chondrosarcomas respond poorly to chemotherapy. Although not much data on the efficacy of chemotherapy in the treatment of high-grade chondrosarcomas, it should be considered in any young patient with a high-grade tumor. Radiation is recommended when anything other than wide excision is performed for chondrosarcoma of any grade.Case Presentation: A 24-year old female presented to the clinic with a chief complaint of persistent low back pain and a lump in her back. Initially, the lump was the size of a tennis ball three years ago. At the time of the examination, the lump was at the size of a volleyball about 65 x 63 x 58 centimeters. Systemic and general examinations were unremarkable. There were no comorbid conditions. From the results of the Clinicopathological Conference conducted by neurologists, pathologists, radiologists, orthopedic spine and oncology surgeons, it is advisable to conduct investigations such as x-rays, CT scans, MRI, biopsy, and surgery is recommended for evaluation of expansion of chondrosarcoma, evolving the spinal cord, and for resection of tumors.Conclusion: Early diagnosis and complete resection of tumor and treatment of relevant symptoms represent a viable treatment for this rare disorder to achieve increased life expectancy, low recurrence of tumor, and improvement of quality of life.
Sinta Prastiana Dewi
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.741

Abstract:
Introduction: Breast cancer is the most common female malignancy worldwide. Breastconserving surgery followed by adjuvant radiotherapy is a preferable treatment option. Hypofractionated radiotherapy is an attractive fractionation scheme because of its shorter treatment duration. This paper aims to report the short-term and long-term toxicity of hypofractionated radiotherapy in breast cancer patients at our institution. Case Presentation: A 58-year-old woman with right breast cancer T2N1M0 had undergone breast-conserving surgery with axilla lymph node dissection. This patient underwent adjuvant whole breast radiotherapy with a dose of 42.56 Gy in 16 fractions followed by tumor bed boost with a dose of 16 Gy in 8 fractions. After undergoing the fourth fraction of boost, she had hyperpigmentation on her radiation area (RTOG skin toxicity grade 1). At the 6-month follow-up, the hyperpigmentation still appeared. Until the 24-month follow-up, after she completed radiotherapy, there was no sign of tumor recurrence and toxicity.Conclusion: Hypofractionated radiotherapy could be an option for breast cancer treatment that provides equivalent local control, survival, and side effects to conventional fractionation radiotherapy.
Ryan Yudistiro, Ivana Dewi Mulyanto, Febby Hutomo, Daniel Chung, Andree Kurniawan, Fajar L. Gultom, Ralph Girson Gunarsa
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.711

Abstract:
Introduction: Lymphoma and tuberculosis in several cases share similar clinical features that are difficult to differentiate. Lymphadenopathy, fever, malaise, weight loss, and respiratory symptoms are clinical features that could be found in both lymphoma and tuberculosis. Positron Emission Tomography/Computed Tomography Fluorodeoxyglucose (F-18 FDG PET) is a pivotal modality for imaging patients with cancer. Several non-malignant diseases like tuberculosis infection show high FDG uptake and lead to low specificity of F-18 FDG PET.Case Presentation: This case report describes a 55-year-old male patient with a history of Diffuse Large B-cell Lymphoma (DLBCL) who was suspected of having a recurrent disease. The patient has had a 6-month remission period after 6 cycles of R-CHOP regimen chemotherapy. He denied any known history of tuberculosis infection and HIV. F-18 FDG PET was performed to assess the extent of suspected lymphoma recurrent disease. F-18 FDG PET demonstrated multiple hypermetabolic bilateral neck region, mediastinum, and bilateral axilla lymphadenopathies. There were also multiple high FDG uptakes in the liver, mesocolon, and bones. The patient was suspected of having a lymphoma recurrent disease based on these findings. He underwent an excisional biopsy in the neck and was found to have lymphadenitis granulomatous disease from tuberculosis. Based on the histopathology finding, the patient received anti-tuberculosis drugs for 12 months and showed relief of signs and symptoms. F-18 FDG PET for anti-tuberculosis treatment evaluation revealed a complete metabolic response.Conclusion: Tuberculosis should be one of the differential diagnoses when a lymphoma recurrent disease is suspected. Clinical features, laboratory results, and imaging findings sometimes show similarities between lymphoma and tuberculosis. Histopathology evaluation is mandatory to confirm the diagnosis.
Mururul Aisyi, Fifi Dwijayanti, Reni Wigati, Haridini Intan Mahdi, Laswita Yunus, Chainurridha Chainurridha, Tri Aprilliana Wulandari
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i4.738

Abstract:
Background: Sepsis is the leading cause of morbidity and mortality in children worldwide, with around 75,000 inpatients each year and nearly 50% dying in pediatric hospitals. Acute lymphoblastic leukemia (ALL) in childhood is a malignancy originating from lymphoid progenitor cells, usually at the age of 2–6 years. Children with ALL contribute 30% to childhood cancer cases under 15 years old. Sepsis in pediatric patients increases mortality significantly. A previous study showed that the prevalence of sepsis in pediatrics is still high. Thus, this study aims to report ALL patients with sepsis in our institution.Methods: This study was a descriptive cross-sectional study at the National Cancer Center (NCC) - Dharmais Cancer Hospital. We recruited acute lymphoblastic leukemia (ALL) patients aged 2-18 years with suspected or documented sepsis based on Systemic Inflammatory Response Syndrome (SIRS) by The International Consensus Conference on Pediatric Sepsis. The data were collected by medical records from January 2014 to December 2018.Results: A total of 94 pediatric patients in the study included 57 males and 37 females with an average age of 5 years. The age range was 1–18 years with a median age of 5 years. The prevalence of sepsis in pediatric with ALL was 11 patients (11.7%) and 45.5% of deaths. The clinical conditions were as follows: abnormal temperature (8 [72.7%]), abnormal blood pressure, systolic (7 [63.6%]) and diastolic (7 [63.6%]), abnormal pulse rate (9 [81.8%]), abnormal respiratory rate (8 [72.7%]), and normal saturation (6 [54.5%]). We also did a laboratory check followed by all sepsis patients who had abnormal leukocytes (11 [100%]), and abnormal lymphocytes count (8 [72.7%]).Conclusions: The mortality rate and prevalence of sepsis in children with ALL in our institution are still high. Further prospective studies are required to explore the risk factors and predictors of sepsis based on its severity and adherence of health workers to implement guidelines on patients with sepsis in the hospital.
Yohana Azhar, Hasrayati Agustina, Maman Abdurahman, Dimyati Achmad
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i3.737

Abstract:
Background: Breast cancer is the most common cancer in Indonesia, a low-middle income country in Southeast Asia. We provide a regional hospital-based cancer registry of the central hospital in West Java, Indonesia. This study aims to characterize the presentation, diagnosis, evaluation, and management of breast cancer; to develop a regional breast cancer registry in West Java to monitor cancer care patterns; to evaluate cancer treatment outcomes.Methods: The data were collected from the medical records deposited in the Hasan Sadikin General Hospital Information System. The team has been contracted to operate the registry & organize an advisory board to standardize definitions of coding terminology of the registry’s reporting system and to monitor the cancer care pattern. Data validation was conducted by a team in the cancer registry, consisting of health officers, pathologists, and registrars. Data management and analysis were conducted by the cancer registry team.Results: A total of 913 women diagnosed with breast cancer, from January 2014 until December 2018, were studied. The median age was 49.5 years old. The initial diagnosis was at the age of 42.4 years old on average. About 64.5% were diagnosed with stage-3 and -4 cancers, and 75.1% had undergone a mastectomy, of which 47.3% of the intent was palliative. Of those who have hormonal receptors, only 26.9% were positive, and 36.5% were not assessed for immunohistochemistry evaluation. Inappropriate surgical management of breast cancer was common at the community level, which included indiscriminate diagnostic lumpectomy (21.9%), incomplete mastectomy and omission, or suboptimal lymph node axillary clearance (47.4%). Only 3.0% of patients received breast-conserving surgery and were treated with mastectomy and reconstruction. Conclusions: Breast cancer in West Java is often recognized at the late stage. Treatment was suboptimal, leading to poor survival. A more aggressive approach to early detection and treatment needs to be developed to improve the outcomes of this potentially curable disease.
Kristanto Yuli Yarso, Monica Bellynda
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i3.743

Abstract:
Introduction: Percutaneous Ethanol Ablation (PEA) has been recommended as the first-line treatment option for symptomatic benign cystic or predominantly cystic thyroid nodules, and it has been shown to be more effective and safer than other techniques in previous studies. Here, we present a case of a 44-year-old man with thyroid nodules who underwent PEA.Case Presentation: We report the case of a 44-year-old man with a painless mass that is getting bigger on his right neck. The physical examination measured 3.0 × 3.0 × 3.0 cm, mobile on swallowing, no pain on palpation. Thyroid function tests show a euthyroid state (TSH 2.4 mIU/L, FT4 1.2 ng/dL). The ultrasound examination in January 2020 showed a colloid cyst on the right thyroid, measured 3.03 × 2.82 × 3.56 cm (TIRADS 1). Cytological examination showed the results of non-infectious cystic fluid. The patient underwent US-guided PEA using 7 ml of ethanol by the moving-shot technique. The procedure was well tolerated by the patient and no adverse events were noted. A week after the procedure, there was a visible and progressive reduction of the nodule with no complaint from the patient. A month after the procedure, the patient came back with no recurrences, complaints, or other complications.Conclusions: PEA for thyroid lesions is an effective and safe method. PEA should be the first option for the treatment of pure cystic and predominantly cystic nodules. PEA is a safe procedure that is easy to repeat and to be performed on an outpatient basis.
Bob Andinata, Dewi Iriani, Adlina Karisyah
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i3.723

Abstract:
Introduction: Breast cancer metastasis at the parotid gland is uncommon. There were only 21 cases reported until the recent year, and none of them came from Indonesia. The reports showed that breast cancer metastasis is more often found at the liver, lung, bone, and brain. Therefore, any masses found on the parotid are usually considered as a double primer.Case Presentation: We report a case of a woman, firstly diagnosed with luminal A stage IIA breast cancer at 39 years old. The patient had undergone breast-conserving therapy (BCT), followed by adjuvant hormonal therapy before being diagnosed with bone metastasis four years later. She also complained about a painful mass on her left upper neck. Ultrasonography and CT-scan resulted in insignificant abnormality. After a year with increasing painful mass, we performed FNAB. The result showed metastatic adenocarcinoma with a suspicious breast cancer origin. We did total parotidectomy with facial nerve preservation to alleviate the pain. Pathology results showed a confirmed diagnosis of breast cancer metastasis. The patient was given radiotherapy as local control and was scheduled to receive chemotherapy as systemic therapy.Conclusions: Parotid mass with a clinical symptom in the patient with the history of breast cancer should be evaluated firstly by imaging and may be followed by cytology or pathology evaluation to confirm whether it is primary or secondary malignancy. If the parotid metastasis from breast cancer is confirmed, we should consider adding systemic therapy after completing the local control.
Aria Utama Nur Qohari, Ahmad Zulfan Hendri
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i3.693

Abstract:
Background: Perioperative blood transfusion is correlated to adverse effects which lead to mortality on a few cases of patients with malignancy, especially kidney tumors. The objective of this study is to evaluate the relationship between blood transfusion timings and survival of patients with bladder cancer who undergo radical cystectomy and measure the differences in the outcomes between patients undergoing intraoperative blood transfusion and patients undergoing blood transfusion after surgery.Methods: This research is a retrospective analytic study with a cohort design. Thirty patients with bladder tumors who performed radical cystectomy and did not undergo perioperativechemotherapy were included in the study data. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed by the Kaplan-Meier method and compared between groups with log-rank tests. Chi-square test was used for comparative evaluation of each group. Univariate and multivariate analyzes were performed to evaluate the relationship between clinical and pathological variables with risks such as RFS, CSS, and OS. P
Brahmana Askandar, Very Great Ekaputra, Teuku Mirza Iskandar
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i3.719

Abstract:
Background: Vitamin D and its receptor (VDR) play a crucial role in the development of gynecological cancers. This study aims to evaluate the VDR expression and blood vitamin D 1.25 (OH)2 levels in cervical cancer patients and healthy women.Methods: This is a cross-sectional study. In vitro quantitative examination (ELISA) was used for the measurement of vitamin D 1.25 (OH)2 and Sandwich-ELISA was applied for quantitative determination in vitro concentration of Human VDR in serum.Results: The number of research subjects consisting of 20 cervical cancer patients based on clinical and histopathological results and 20 women without cervical cancer based on clinical and pap smear results. The mean vitamin D 1.25 (OH)2 levels in the cervical cancer group of 209.23 ± 71.476 pg/mL were significantly lower than in the group of normal women of 339.79 ± 139.003 pg/mL (P=.001). The mean VDR expression in the cervical cancer group of 5.38 ± 5.478 ng/mL was significantly higher than the group of normal women of 1.89 ± 1.657 ng/mL (P=.018). The best cut-off value for vitamin D levels is 239.25 pg/mL (sensitivity 70% and specificity 75%). The cut-off value for VDR expression is 2.23 ng/mL (sensitivity 60% and specificity 75%). Low vitamin D levels increase the risk of cervical cancer incidence by 2.7 times greater, and an increase in VDR expression increases the risk of cervical cancer incidence 2 times greater.Conclusions: The study results indicated a higher expression of VDR and lower levels of vitamin D 1.25 (OH)2 in cervical cancer compared to normal women. Low levels of vitamin D increase the risk of cervical cancer incidence by 2.7 times greater, and higher VDR expression increases the risk of cervical cancer incidence 2 times greater.
Mururul Aisyi, Puji Lestari, Siti Nadliroh, Anita Meisita, Didin Solachudin, Dewi Kristanti, Adhitya Bayu Perdana, Bambang Karsono
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i3.729

Abstract:
Background: BCR-ABL1 fusion gene, which originated from t (9;22), is an important biomarker for diagnosis, therapeutic approach, and prognosis in childhood leukemia. However, there are no data in Indonesia about the profile of BCR-ABL1 fusion gene for this disease. This study intends to demonstrate the profile of the BCR-ABL1 fusion gene in childhood leukemia at “Dharmais” Cancer Hospital.Methods: This descriptive retrospective study included 79 patients with childhood leukemia who performed the BCR-ABL1 examination in “Dharmais” Cancer Hospital during 2008–2018. Demographic data, leukemia types, BCR-ABL1 examination results, and protein isoforms developed by BCR-ABL1 fusion were obtained from Cancer Registry Data.Results: Among 79 patients’ data recorded in this study, 65.8% (52/79) were male and 34.2% (27/79) were female. A total of 74.7% (59/79) patients were diagnosed with Chronic Myelogenous Leukemia (CML), 21.5% (17/79) with Acute Lymphoblastic Leukemia (ALL), and 3.8% (3/79) with Acute Myelogenous Leukemia (AML). The profile of positive BCR-ABL1 in CML patients was 72.8% (43/59). About 97.7% (42/43) of CML patients with positive BCR-ABL1 fusion gene expressed 210-kDa protein, while only 2.3% (1/43) expressed 190-kDa protein.Conclusions: This study found that, from a total of 79 respondents, 45 of them showed a positive BCR-ABL result, with details of 43 in CML and 2 in ALL. Among the total of 43 CML patients with positive BCR-ABL1, 42 (97.7%) of them expressed 210-kDa protein isoform. Further research to investigate the relationship between protein isoforms and their clinical effects may also be important to discuss. The valuable recommendation suggests that BCR-ABL1 examination should be performed for all childhood leukemia patients in Indonesia, especially for CML and ALL.
Wilson Matthew Raffaello, Andree Kurniawan
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i3.720

Abstract:
Introduction: Sarcopenic obesity is an emerging problem in cancer patients. However, this is often difficult to diagnose without the measurement of body composition. Sarcopenic obesity is associated with increased mortality, chemo-toxicity, and other complications in cancer patients. Until now, there is scarce information about sarcopenic obesity in the cancer population.Method: We identified 1955 articles related to sarcopenic obesity in adult cancer patients using PubMed, PubMed Central, and Cochrane Library databases from January 1, 1989, until January 1, 2020. Firstly, we screened the titles and abstracts which mentioned sarcopenic and obesity, especially in pathogenesis. 29 articles could proceed to the next step; then, they were screened for the full text. All steps were reviewed by two authors.Results: At last, they were 9 articles included. Sarcopenic obesity is defined as the coexistence of sarcopenia and obesity, an increase in fat mass in the body. Sarcopenic obesity carried cumulative risks from each of the two individual body compositions. CT-scan offers the highest available precision in determining body composition parameters, especially in the cancer population. Multiple causes and interactions between hormonal changes, aging, disuse, neuronal, poor nutrition, physical inactivity, and low-grade inflammation played roles. Sarcopenic obesity is associated with chemotherapy toxicity. High protein intake should be initiated to ensure adequate protein intake. Resistance training is beneficial in improving muscle mass and strength by focusing on strength training, flexibility, and balance.Conclusions: Sarcopenic obesity is an emerging problem but is often neglected. Further research needs to be conducted especially in explaining the pathogenesis of sarcopenic obesity. The combination of physical exercise and diet modification is the best management to improve sarcopenia obesity in cancer patients.
Muhammad David Perdana Putra, Kristanto Yuli Yarso, Mudib Mudib, Zhafirah Ramadhanty
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.715

Abstract:
Background: This study aimed to develop a patient satisfaction level-questionnaire (UNS-BsQ8) for breast fibroadenoma patients in Indonesia and to test the reliability and validity of the questionnaire by using established models. Methods: A total of 83 women with breast fibroadenoma completed the questionnaire after their surgeries. We assessed the construct validity and the reliability by referring to its Pearson’s r table value and Cronbach’s α coefficient. Results: It showed that 83 subjects completed all 8 questions of the instrument between January 1–31, 2020; the Pearson’s value of all items of the UNS-BsQ8 with the lowest value of r = .398 in question number 8, followed by r = .411 in question number 7 with an r-value of r > .1584 indicated that these questions were valid. Cronbach’s α coefficient of > .60 indicated questionable internal consistency. Conclusions: The result of this study proves that UNS-BsQ8 is accepted, valid, and reliable. It can be used for future investigation, especially in patients undergoing minimally invasive surgery.
Dila Junita, Edmond Rukmana Wikanta
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.700

Abstract:
Introduction: Juvenile hypertrophy of the breast (JHB) is a benign condition that can lead to gigantomastia in adolescence. The development of breast enlargement in adolescence can cause both physical and psychosocial problems. Therefore, appropriate investigation and proper management at an early stage of the disease are very important. One of the treatment modalities is breast reduction surgery which ideal and offers an improvement in the quality of life. Case Presentation: A 13-year-old female with massive bilateral breast enlargement for a period of 8 months. The patient also complained of severe back pain and neck discomfort since her breast progressively enlarged. Psychosocial problems were recorded. Right breast reduction was performed and closed with inverted-T mammoplasty. The post-operative period was uneventful, and the patient was discharged on day 5 after the operation. Conclusions: Reduction mammoplasty is well accepted by adolescents with juvenile breast hypertrophy and can improve physical and psychological outcomes.
Dini Rizkie Wijayanti, Jamal Zaini, Achmad Hudoyo, Aziza Ghanie, Westi Atw
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.701

Abstract:
Background : Radiation-induced pulmonary toxicity occurs in patients with lung cancer who received irradiation. The objective of this study was to determine the proportion of radiation pneumonitis among lung cancer patients that were exposed to radiation treatment in Persahabatan Hospital. There is no data about proportion of radiation pneumonitis in Indonesia.Methods: This was a retrospective study conducted in Persahabatan Hospital during June 2013– July 2015 using the medical record of lung-cancer patients who received irradiation.Results: 33 lung-cancer patients fulfilled the inclusion criteria. Most of them were male (66.7%), in age ≥ 51 years (63.6%), had a smoking history (75.8%) with moderate Brinkman Index (60%), were given irradiation doses of 3,000–4,000 (60.6%) with irradiation fractions of 10–19 (60.6%), had no history of chemotherapy (54.5%), and were diagnosed with adenocarcinoma (66.7%) and stage-IV cancer (84.84%). The proportion of radiation pneumonitis based on chest X-ray (CXR) was 39.4%; which consisted of hazy ground-glass opacities, hazy ground-glass opacities, and fibrosis, and only fibrosis. There were significant differences in age, radiation doses, and history of chemotherapy with the proportion of radiation pneumonitis (p < .05).Conclusion: The proportion of radiation pneumonitis based on CXR was 39.4%. There were significant differences in age, radiation doses, and history of chemotherapy with the proportion of radiation pneumonitis.
Fifi Dwijayanti, Hendi Setiadi, Martya Rahmaniati Makful
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.747

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At the end of 2019, the novel coronavirus (CoV) of severe acute respiratory syndrome (SARS), named SARS- CoV-2 was approved as a microbial agent that causes viral pneumonia in patients who are linked epidemiologically to the seafood market in Wuhan (Wuhan) Hubei province, China [1]. The World Health Organization (WHO) stated the coronavirus or COVID-19 as a pandemic because it has spread globally in the world since March 11, 2020 [2]. There have been more than 8 million cases reported with more than 450 thousand deaths around the world until June 19, 2020 [3]. Indonesia reported the first cases of COVID-19 in early March 2020 and currently 43,803 cases with 2,373 deaths [4]. Indonesia has the highest cases of COVID-19 in Southeast Asia [5]. WHO stated that according to the current evidence, coronavirus is transmitted among people through respiratory droplets and contact routes [6-8]. Droplet transmission is different from airborne disease. Droplet transmission occurs when a person closely contacted (within 1 m) with someone who has respiratory symptoms (e.g. coughing or sneezing,) and was therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets. Droplet transmission may also occur through fomites in the immediate environment around the infected person [9]. Increasing cases occur continuously become alert for our institution as health care providers.
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.703

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Diabetes mellitus (DM) and cancer are both global diseases whose numbers continue to grow. Higher risk of developing cancer in diabetic patients, especially in liver, endometrial, pancreatic, kidney, colorectal, bladder, and breast cancer, was already shown in several previous studies. This review will explain the possible DM pathogenesis that plays a role in carcinogenesis using the simple but thorough concept of insulin resistance, hyperglycemia, and chronic inflammation. By knowing the link, it is hoped that this review can be useful in developing cancer prevention plans for those with diabetes.
Andy Zulfiqqar, Indrawarman Soerohardjo, Sumadi Lukman Anwar
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.709

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Background: Current options for management of bladder cancer (BCa) still depend on traditional clinical determinants of stage and histological grade which often do not reflect the biological entity of the tumors. Therefore, new biomarkers are required to better determine suitable treatments for different types of bladder cancers. Recent research has shown osteopontin (OPN) expressions correlate with clinic-pathological variables and outcomes of bladder cancer. This study aimed to evaluate the expression of OPN in the Indonesian population, and it’s potential role as an immune-targeting therapy of BCa. Methods: Total RNAs from formalin-fixed paraffin-embedded tissues were extracted from 49 patients with bladder cancer consisting of normal histopathology (n = 4), chronic cystitis (n = 15), non-muscle-invasive bladder cancer (NMIBC, n = 15), and muscle-invasive breast cancer (MIBC, n = 15). The expression of OPN was measured using reverse transcription-polymerase chain reaction. Results: The baseline clinical and histo-pathological characteristics were not statistically different. The expression of OPN was statistically higher in bladder cancer compared to normal histology tissues (P < .001). The expression of OPN was statistically higher in MIBC compared to NMIBC (P < .001). Conclusions: The expression of OPN was significantly higher in bladder cancer and compared to NIMBC, the OPN expression in MIBC was significantly higher rendering the potential role of OPN expression as a surrogate biomarker marker to determine suitable treatment options for patients with bladder cancer.
Andree Kurniawan, Nata Pratama Hardjo Lugito, Bernard Agung Baskoro, Devina Adella Halim
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.736

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Introduction: The number of confirmed cases of Coronavirus Disease 2019 (COVID-19) in the world has been increasing significantly since December 2019. Cancer patients are one of the vulnerable populations to become severe cases of COVID-19 or death when they are contacted with COVID-19. A treatment delay is associated with higher breast cancer-specific mortality and all-cause mortality. However, there is still limited data about how to manage cancer patients in this pandemic of COVID-19. This study aims to appraise the current evidence about the management of cancer patients during the COVID-19 pandemic.Method: We searched and found 16 articles evaluating the management of cancer patients during the COVID-19 pandemic by searching in PubMed and EMBASE databases. We only included articles discussing COVID-19 and cancer in adults. There were three observational trials, four review articles, two case reports, six letters to the editor, and one guideline.Results: There were several recommendations regarding patient care in the COVID-19 era. Firstly, outpatient visits, such as follow-up and surveillance of cancer patients, should be postponed. Alternatively, they can do teleconsultation, and their drugs will be delivered to their homes. Stratification and screening for the risk of COVID-19 infection should be done to those who needed urgent or emergency surgery. Otherwise, elective surgery should be postponed. However, several cases can be proceeded after discussion in the Multidisciplinary Team (MDT). Adjuvant and palliative chemotherapy should also be done as scheduled after discussing in MDT. Patients with ongoing radiation treatment should be continued as daily scheduled. Meanwhile, new patients should be carefully evaluated, and those with stable cancer can be postponed for treatment Conclusions: There is still scarce evidence related to the management of cancer patients during the COVID-19 pandemic. Further studies, in terms of stratification, risk, and management of cancer patients during the pandemic, need to be done to get better evidence on it.
Indonesian Journal of Cancer, Volume 14; doi:10.33371/ijoc.v14i2.692

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Background: The stigma of cancer as a deadly disease greatly affects the patient’s perspective in shaping self-concept, which impacts on hopes and influences the stability of psychological well-being. The purpose of this study was to prove that the self-concept influences the hopes and psychological well-being of cancer survivors. Methods: This was a cross-sectional study. Samples were 90 cancer survivors from three public health centers in Surabaya, Indonesia taken by simple random sampling. All participants completed the instruments of the Tennessee Self-Concept Scale, Herth Hope Index, and Ryff’s Psychological Well-Being Scale. All the instruments were valid and reliable based on the test. Ethical feasibility has been conducted. The Pearson Product-Moment Correlation Test was applied to analyze the data with P < .05. Results: The demographic characteristics of cancer survivors include the age majority of 46-65 years (53%), female sex (80%), married (61%), having stage-III cancer (44%), diagnosed of cancer for 1–6 years (56%), having support system from nuclear families (73%), and actively involved in the community (66%). The mean score of self-concept is 78.2, hope 38.2, and psychological well- being 76.3. Self-concept had a significant effect on hope (r = .783, P = .000) and psychological well-being (r = .611, P = .000) Conclusions: Cancer survivors who had positive self-concepts are more likely to accept themselves, which triggers the formation of high hope for recovery and the achievement of positive psychological well-being.
Jonathan Velazquez- Mujica , Hung Chi Chen, Juan Carlos Reyes Cerda
Indonesian Journal of Cancer, Volume 14, pp 31-34; doi:10.33371/ijoc.v14i1.696

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Introduction: Accidental Iatrogenic damage of the pedicle or perforators has been frequently reported as a cause of failure of free flaps. Free radial forearm flap helps to cover defects that are not possible to cover with local flaps or skin graft.Case Presentation: A 91 years old patient with Bowen Disease had multiple actinic keratosis and a history of squamous cell carcinoma over the forehead, which was removed 4 years before. The recurrent tumor was detected and wide excision of the tumor was done. It resulted in a large defect of 8 x 5.5 cm2 in diameter at the forehead with exposure of bone, therefore, a free radial forearm flap was performed for reconstruction with right superficial temporal artery and vein as recipient’s vessel. We observed leakage of blood through the radial artery near to the anastomosis due to iatrogenic damage during flap harvesting.Conclusions: Nowadays, repairing iatrogenic damage through the main pedicle or perforators of the pedicle is possible with super-microsurgery technique due to the improvement of the skills and smaller sutures avoiding the obstruction of the lumen of the pedicle or perforator. This is considered a salvage procedure instead of harvesting new free flaps and can be useful for all kinds of free flaps.
Rama Firmanto, Agus Rizal Ardy Hariandy Hamid , Chaidir Arif Mochtar, Rainy Umbas
Indonesian Journal of Cancer, Volume 14, pp 16-20; doi:10.33371/ijoc.v14i1.673

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Background: Despite the high recurrence rate, radical prostatectomy (RP) remains as a preferable surgical treatment of localized prostate cancer. Adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) are available approaches in preventing biochemical progression after RP. We aim to investigate the use of radiotherapy, both ART and SRT, in those who underwent RP.Methods: We used a retrospective cohort study design, with samples recruited from prostate cancer patients who underwent RP between January 2008 and December 2016. Patients who had undergone RP at Cipto Mangunkusumo Hospital, Jakarta, Indonesia were included in the present study. More in detail, three and five subjects were treated with ART and SRT, respectively. We only included those who had a minimum of one year of follow-up. Variables including age, preoperative prostate-specific antigen (PSA), clinical staging, pathological staging, Gleason score, and death were recorded. We analyzed the overall survival time using the Kaplan-Meier method.Results: From 34 patients included in the study, 26 underwent RP alone, while 5 patients underwent adjuvant radiotherapy and 3 patients underwent salvage radiotherapy after RP. The mean ages in the three groups were 61.46 ± 5.76, 58.2 ± 4.86 and 62.67 ± 7.5, respectively. The preoperative PSA value was above 10 mg/dL in 61.5% in patients without RT, 100% in patients with ART after RP, and none in SRT. 17 (51.5%) out of 33 subjects were ≥T2 clinical stage and 24/30 (80%) subjects were ≥pT2. Timing for ART and SRT ranged from 1.07 to 6.3 and 5.27 to 21.43 months after RP, respectively. The 10-year survival rates were 84.6% in patients with RP alone, 80% in patients with ART+RP, and 66.7% in patients with SRT+RP. The average survivals of those who had RP alone as well as ART and SRT were 44.56 ± 32.64, 46.79 ± 24.02, and 71.71 ± 38.74 months.Conclusions: The average survival of those who received SRT is better than those who underwent ART and RP alone. Prospective studies with larger samples are needed to evaluate the efficacy of radiation therapy after radical prostatectomy.
Bayu Brahma
Indonesian Journal of Cancer, Volume 14, pp 1-2; doi:10.33371/ijoc.v14i1.728

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The novel coronavirus disease (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to many countries, including Indonesia. The outbreak started within early March 2020 and in just less than a month the virus has infected 1285 patients and 114 death in Indonesia by March 30, 2020 [1]. It does not only take many lives of patients, but also our colleagues as health care providers. On behalf of the Indonesian Journal of Cancer, we would like to express our deepest condolences to all patients and especially to our doctors, nurses, and all health care workers, who could not survive in the battle against this virus.Looking at how serious the disease is, it is estimated that the situation will give major changes to cancer patients’ management, and unfortunately, it is happening in the middle of our efforts to upgrade cancer management in Indonesia. It is going to be a hard time, but we must be ready to overcome the COVID-19 crisis in the field of oncology. Let us take a brief look at published articles and recommendations in oncology.A recent publication by Liang et al. [2] in China revealed that cancer patients with COVID-19 had higher risk of severe events, which were defined by more frequent intensive care unit admission, requirement of mechanical ventilator, and higher death rate, hence they also proposed to withhold chemotherapy and elective surgery for stable cancer in the endemic areas. However, this initial result of 18 cancer patients out of 1590 COVID-19 cases should be interpreted cautiously because of insufficient evidence to be recommended in every cancer patient [3]. More robust evidence is needed to address this issue in the field of cancer, from prevention, screening, advances in therapies, until palliative management. In the meantime, some guidelines have been proposed by several oncology socities [4-6]. Postponing cancer screening and elective surgeries such as in benign disease and risk-reducing surgery sound-wise for the time being, but surgical oncologists should remember that most of the cancer surgeries cannot be considered “elective”. American College of Surgeons has also released a triage guideline for surgical cases and recommended using the Elective Surgery Acuity Scale (ESAS) from St. Louis University to assist surgical decision-making [5]. To date, no direct evidence has been reported to support withholding radiotherapy, chemotherapy, and immunotherapy in daily cases, although some practice changes in several situations such as postponing, switching, or stopping aggressive adjuvant treatment in stable and low-risk cancer could be considered [4-5]. We must underline the potential harm of delaying cancer treatment and the benefit of reducing the risk of COVID-19 infection or vice versa. Individual discussions with patients should be made because many factors will contribute to giving the best answer.We are preparing for skyrocketing COVID-19 cases in Indonesia within the next few days or weeks. How do we prepare without letting behind our main goal as oncologists to care for cancer patients? A published article by Ueda et al. [7] could be a good example for us to start with and to learn how they managed the cancer service during the early outbreak in Washington. They started with patients’ triage, education for patient and family through handouts and web-site, and strengthening the policy of “stay at home”. A phone triage line, providing personal protective equipment (PPE), and also test to symptomatic medical staff, were provided. In outpatient service, rescheduling visits of “well” patients, or postponing the second consultation for patients who already had treatment access in initial health care, were being conducted. Telemedicine also plays an important part of their strategy. Cancer surgery was their priority when PPE, team members, and bed capacity were available. A surgeon-to-patient phone call discussion was made when a delay in schedule was expected. Many patients with aggressive hematologic malignancies were managed not to get a treatment delay and planned to conduct a limitation for clinical trials except for the studies that will bring benefit to participants. They also mentioned that it is imperative to discuss ethical issues in the end-of-life setting when a final-stage patient acquires COVID-19 [7].Managing cancer surgeries in our surgical oncology unit is not so simple even in the time before COVID-19, since many complex and urgent cancer cases were referred to us. When the outbreak occurred, the continuity to perform surgery has been even more challenging for us. We decided to proceed with the surgery and several adjustments were made to make sure the safety of patients and team members. Neither benign cases nor breast reconstructions are performed at the moment. Emergency conditons, aggressive-behavior cancer, and post-neoadjuvant chemotherapy surgeries are also prioritized. The onco-microsurgical reconstruction is only performed for complex head and neck cancer, soft tissue sarcoma, and cancer treatment-related lymphedema with the risk of having dermatolymphangioadenitis. Having an urgent complex case on the table, I am fortunate and honored to work with dedicated colleagues and operating room team who are willing to follow our strict rules: we do not do multiple surgeries or outpatient clinic service on the scheduled day; the surgery must be started early to avoid late hours working time; which could reduce the physical and mental health of each team member; everyone must stay focused with their parts, so “quick-in-quick-out” surgery can be accomplished to prevent or reduce patients’ immunosuppressive effect due to a long surgery; a well-screened patient and the availability of PPE is mandatory before the surgery is started. It is just a modest example and we are aware that adjustment of our current protocol should be done when...
I Gusti Ayu Sri Mahendra Dewi, Desak Putu Gayatri Saraswati Seputra
Indonesian Journal of Cancer, Volume 14, pp 27-30; doi:10.33371/ijoc.v14i1.682

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Introduction: Pheochromocytoma is a rare neuroendocrine tumor derived from the chromaffin cells of adrenal medulla. The incidence ranges from 0.005% to 0.1% in the general population.Case Presentation: This case series reported 4 patients with pheochromocytoma who were diagnosed at Sanglah General Hospital Denpasar over a period of three years (2017–2019). The age ranged from 15–59 years with the mean age of 41 + 18.9 years. A similar proportion was found for both sexes. Clinical features include lumps, headaches, flank region pain, palpitations and cold sweat. Hypertension was found in 3 cases. Local examination revealed the solid mass in the flank region in all cases; enlarged lymph nodes were found in one case, namely in the paraaortic region. Abdominal MSCT examination findings showed: a solid mass with cystic components in suprarenal; sizes ranging from 1.9 x 2.6 x 2.2 cm to 21.6 x 14.3 x 17.8 cm; bilateral (1 case), unilateral (3 cases); contrast enhancement and hypervascularization, without calcification (4 cases); central necrotic (1 case). All patients underwent radical adrenalectomy. Microscopic features showed the tumor mass which consisted of the proliferation of chromaffin cells forming alveolar (Zellballen) and solid nest patterns separated by capillary blood vessels. The cells were polygonal-shaped with clear cytoplasm, round-shaped nucleus, and moderate pleomorphic. Mitosis was not found. These histomorphologic findings supported the diagnosis of pheochromocytoma.Conclusions: Diagnosis and optimal treatment plans can be established through rapid and precise recognition of pheochromocytoma in order to achieve better outcomes.
Putu Erika Paskarani, Herman Saputra , Ni Putu Sriwidyani, I Gusti Ayu Sri Mahendra Dewi, Luh Putu Iin Indrayani Maker, I Made Muliartha
Indonesian Journal of Cancer, Volume 14, pp 21-26; doi:10.33371/ijoc.v14i1.677

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BackgroundClaudin-1 is a tight junction protein in the cell that organizes paracellular permeability and epithelial polarity and maintains apical cell-to-cell adhesion. Deregulation of claudin-1 homeostasis will play pivotal role in tumorigenesis, migration, and metastasis of colorectal cancer through a complex signaling pathway. This study investigated the association of claudin-1 expression and clinicopathological factors in colorectal adenocarcinoma. Methods This study was a cross-sectional study of 43 colorectal cancer patients. Each clinicopathological parameter data was divided into 2 categories; depth of tumor invasion (T3, T4), degree of tumor differentiation (low, high grade), tumor location (right, left), sex (man, woman) and age (
Febri Hardiyanti , Johan Harlan, Ema Hermawati
Indonesian Journal of Cancer, Volume 14, pp 8-15; doi:10.33371/ijoc.v14i1.666

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Background: Cervical cancer is the second most frequent malignant tumor among women in the world and the most common type of cancer found among women in developing countries, including Indonesia. It has been predicted that the number of people who have this cancer will increase in the future due to lifestyle changes. The study aims to determine the association between the knowledge and the preventive behavior of cervical cancer among woman employees in the companies in Jakarta. Methods: This research is a quantitative analytical study, with a cross-sectional design. The purposive sampling method was performed to choose the respondents, who are the employees of 3 companies in Jakarta. One hundred married women were selected as the research respondents, namely 32 ET employees, 37 BTI employees, and 31 AT employees. The data were collected using the questionnaires on the knowledge of cervical cancer as an independent variable and the preventive behavior of cervical cancer as a dependent variable. The data collection was conducted from March to April. The statistical trial analysis was performed with the Chi-Square test. Results: From the results of the research, it was found that 74% of the employees have enough preventive behavior of cervical cancer. A total of 73% of employees have good cervical cancer knowledge. The Chi-square test between the knowledge and preventive behavior of cervical cancer obtains P=.043 ; OR 3.68, 95% CI 1.005–13.474. It means there is an association between the knowledge and the preventive behavior of cervical cancer among woman employees in the companies in Jakarta. Conclusions: Good cervical cancer knowledge is significantly associated with good cervical cancer preventive behavior among woman employees in the companies in Jakarta.
Dewi Sulistyawati, Zakiyatul Faizah , Eighty Mardiyan Kurniawati
Indonesian Journal of Cancer, Volume 14, pp 3-7; doi:10.33371/ijoc.v14i1.639

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Background: Cervical cancer is one of the deadliest diseases for women’s lives. It is estimated that almost every hour, one died because of cervical cancer and 70% of new cases are found in an advanced stage. Many factors could cause cervical cancer, one of the risk factors is the age of the early coitarche. This study aims to determine the association between the age of coitarche and cervical cancer.Methods: This study was an analysis of observational study with a case-control design. There were two groups in this study; the case group of outpatients who were diagnosed with cervical cancer and the control group of outpatients who had normal cervical cytology by Papanicolaou screening. The 39 respondents of both the control and case groups, calculated using the Lemeshow’s formula for consecutive sampling, were interviewed for their details concerning reproductive and sexual histories, socio-economic status, hygiene, and education. The independent variable in this study was the age of coitarche; the dependent variable was cervical cancer. The data were analyzed descriptively and using the bivariate analysis (Chi-square) with α=0.05.Results: It is identified that 39 respondents for each group (case and control) have almost the same percentage of the age of coitarche in One-Stop Oncology Polyclinic (POSA’s outpatient); early coitarche of 43.6% and late coitarche of 56.4%. The age of early coitarche in Obstetrics and Gynecology’s outpatients, as a control group, is rare (4 of 39 respondents; 10.3%) and most of them did their sexual debut at the age of >18 years (89.7%). The chi-square test showed there was a correlation between the age of coitarche and cervical cancer (P=.002; OR=6.76; 95% CI 2.01–22.75).Conclusions: Early coitarche has a potential effect on cervical cancer.
Moamar Andar Roamare Siregar, Chaidir Arif Mochtar, Rainy Umbas, Agus Rizal Hamid
Indonesian Journal of Cancer, Volume 13, pp 116-126; doi:10.33371/ijoc.v13i4.658

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Background: The number of men with benign prostate hyperplasia undergoing transurethral resection of prostate (TURP) with the subsequent development of prostate cancer has been increasing. This study aimed to compare the surgical, oncological, and functional outcomes of robotic and laparoscopic radical prostatectomy techniques in patients with the history of TURP.Methods: Literature search of electronic databases was performed through Pubmed, Science Direct, SCOPUS, and CENTRAL databases. Cochrane Risk of Bias Tool was then employed to assess the risk of bias in each study. Grey literature was also searched from sources such as Cancer Care Ontario and conference abstracts. Critical appraisals of included studies were conducted using the Newcastle-Ottawa Scale.Results: The searches located 1258 citations, but only 11 studies were included in the final selection. Most studies had a good methodological quality based on the Ottawa Scale. The mean age of samples was varied among each study from 61.8 to 70.8 years. The TURP history significantly affects biochemical recurrences (OR 2.29, 95% CI 1.14–4.59), intraoperative blood loss (MD 57 ml; 95% CI 6–108 m), prolonged operative duration (MD 20 minutes; 95% CI 3–37 minutes), and surgical complications (OR 2.54, 95% CI 1.79–3.60) following radical prostatectomy for prostate cancer. In the subgroup analysis, only prolonged operative duration and surgical complications were significant both in laparoscopic and robotic radical prostatectomy. There was no association between the TURP history and the positive surgical margin rate in total and subgroup analyses. Conclusions: The previous TURP history affects the outcomes of patients who underwent radical prostatectomy, either laparoscopic or robotic.
Tjandra Kristiana, I Gusti Ayu Sri Mahendra Dewi , Luh Putu Iin Indrayani Maker, Herman Saputra, Ni Putu Sriwidyani, I Made Muliarta
Indonesian Journal of Cancer, Volume 13, pp 127-132; doi:10.33371/ijoc.v13i4.680

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Background: Prostate cancer is the second most common malignancy in men and the fifth most common cause of death worldwide. In Asia, 59.3% of patients come for the advanced stage treatment. PTEN inactivation is identified in about 20% of primary prostate tumors in radical prostatectomy and the loss of PTEN is associated with poor clinical and pathological outcomes. The purpose of this study is to prove that there is an association between PTEN expression and risk grade group Gleason prostate adenocarcinoma in Sanglah Public Hospital, Denpasar.Methods: This is a cross-sectional study. The sample size of this study was 35 paraffin blocks. These samples were selected by proportional stratified random sampling from hematoxylin-eosin preparation. Prostate adenocarcinoma was regrouped into 3 categories based on NCCN risk stratification: low risk grade group Gleason (Gleason score ≤ 6), intermediate risk grade group Gleason (Gleason score 7), and high-risk grade group Gleason (Gleason score 8–10). Immunohistochemistry examination of PTEN was performed and the expression was evaluated by scoring method. The data were analyzed by Chi-square and logistic regression.Results: The analysis result showed that there is an association between PTEN expression and risk grade group Gleason that is statistically significant. The loss of PTEN expression associated with higher risk grade group Gleason is of the higher proportion with p=0.001; PR 3.339; 95% CI: 1.296–8.599, but there is no association between the proportion loss of PTEN expression heterogeneously or homogeneously and the risk grade group Gleason with p=0.742; PR 0.663; 95% CI: 0.179–2.457.Conclusions: This study has proved that PTEN expression is associated with higher risk grade group Gleason prostate adenocarcinoma.
Aisyiah Rahmi Putri , Siti Khaerunnisa, Indra Yuliati
Indonesian Journal of Cancer, Volume 13, pp 104-109; doi:10.33371/ijoc.v13i4.610

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Background: Cervical cancer ranks fourth of all cancers in women worldwide and linked to human papillomavirus (HPV) infection. Despite the evidence of methods for cervical cancer prevention, such as pap smear test and HPV vaccination, most of the women remain unscreened and never get HPV vaccination. Most cervical cancer cases are not diagnosed early enough, leading to poor outcomes. This study aims to examine the association of risk factors with cervical cancer incidence in Dr. Soetomo Hospital Surabaya and also records the patients’ knowledge of cervical cancer preventions, history of HPV vaccination, and pap smear screening test.Methods: This is a case-control study. Questionnaires were given to 60 newly diagnosed cervical cancer patients and 60 non-cervical cancer patients at The Gynecologic-Oncology Clinic of Dr. Soetomo Hospital Surabaya in the period of March 2016 until August 2016. The analysis was made using bivariate and multivariate logistic regression analysis.Results: The bivariate logistic regression analysis confirmed that parity more than two times (p=0.001), history of birth control pills consumption more than 10 years (p=0.04), passive smoking (p=0.001) and not knowing that cervical cancer can be prevented (p=0.001) were significantly associated to the incidence of cervical cancer. The multivariate logistic regression analysis confirmed that not knowing that cervical cancer can be prevented (OR=6.85), the history of passive smoking (OR=4.04), parity more than two times (OR=2.89) and history of birth control pills consumption more than 10 years (OR=6.52) were the independent factors that were associated with the cervical cancer incidence.Conclusions: Parity more than two times, history of birth control pills consumption more than 10 years, history of passive smoking, not knowing that cervical cancer can be prevented and never having a pap smear test were the factors associated with cervical cancer incidence.
Jonathan Kevin , Renate Parlene Marsaulina, Alberta J Jesslyn Gunardi, Irena Sakura Rini
Indonesian Journal of Cancer, Volume 13, pp 133-136; doi:10.33371/ijoc.v13i4.664

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Introduction: Neglected basal cell carcinoma (BCC) of the nose can grow into giant BCCs, rare cases with extensive nasal defects. Such large defects would require complex reconstruction such as free flaps or multiple local flaps. Lateral forehead flap may provide a simpler alternative with good functional and cosmetic results.Case Presentation: We present a case of a 76-year-old man with neglected giant BCC of nose extending to right lower eyelid and upper lip. Wide excision of the tumor leaves a 12cm x 10cm defect. Reconstruction was performed using lateral forehead flap and donor site was covered with split-thickness skin graft from thigh. The second surgery was done after four months to create nostrils and wider eye-opening. Six months later, flap was viable and there was no sign of recurrence. Nasal reconstruction is planned to further improve cosmetics. In this case, neglect is due to low social-economic status and adaptation to painless tumors. The use of lateral forehead flap allows for simpler and faster surgery suitable for elderly. Delayed reconstruction was needed to ensure optimal tissue healing. Conclusions: Neglected BCC causes disfigurement with remarkable morbidity, requiring complex reconstruction. The lateral forehead flap is a simple and reliable reconstruction method for extensive nasal defects with good functional and cosmetic outcomes.
Venansius Herry Perdana Suryanta , Muhammad Naseh Sajadi Budi
Indonesian Journal of Cancer, Volume 13, pp 137-139; doi:10.33371/ijoc.v13i4.665

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Introduction: Limb salvage surgery involves all of the surgical methods to achieve the eradication of a malignant neoplasm and restoration of the limb with a satisfactory oncologic, functional, and cosmetic outcome. Rates of local recurrence are 4% to 10%. There is a chance of local recurrence from the contamination of biopsy path. Neoadjuvant chemotherapy has a guarding effect on managing neoplasm infiltration at the biopsy location.Case Presentation: An 18 year old male experienced a new painless lump at his right anterior thigh with size about 5 cm in diameter since 5 months ago. Previously, he underwent limb salvage surgery with megaprosthesis about 6 months ago due to osteosarcoma at his right distal femur. He also got neoadjuvant and adjuvant chemotherapy for 6 cycles. Mass removal was done and 1.5 cm mass in diameter was found within quadriceps muscle with a soft consistency and well-defined border from the previous biopsy site that had not been resected. The specimen result was osteosarcoma surrounded by tumor-free tissue. Postoperatively, he still had the same range of motion function as before.Conclusions: We need to consider the previously contaminated biopsy path that could lead to local recurrence. Factors that affect the prediction of the recurrent disease are the disease-free time period, location of recurrence and histological response to therapy and the capability to achieve total surgical removal. Tumor removal followed by the local radiation and chemotherapy is the preferred treatment for recurrence.
Mururul Aisyi, Ayu Hutami Syarif, Anita Meisita, Agus Kosasih, Achmad Basuki, Resti Mulya Sari
Indonesian Journal of Cancer, Volume 13, pp 140-143; doi:10.33371/ijoc.v13i4.675

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Introduction: Chronic Myeloid Leukemia is a hematological malignancy driving from myeloproliferative process. It is typified by the presence of the Philadelphia chromosome manifesting in certain distinct complications, including pathological fracture. Pathological fracture is recognized as an extramedullary disease that occurs as a result of transformation of CML into blast crisis phase.Case Presentation: Here, we report a case of pediatric male CML. After being failed with imatinib therapy, he turned to nilotinib and was unable to achieve a major molecular response. He presented with high blast count and pain in the left arm. He was diagnosed with pathological fracture and blast crisis phase CML. Taken the young age and displacement of fracture into consideration, he was conservatively treated by a combination of immobilization and a higher dose of targeted therapy, nilotinib. The 2-month evaluation revealed clinical union and reduction of blast cells.Conclusions: Regarding the minimal displacement and age presentation, pathological fracture in pediatric CML requires non-invasive treatment and optimization of antileukemic therapy.
Indonesian Journal of Cancer, Volume 13, pp 110-115; doi:10.33371/ijoc.v13i4.654

Abstract:
Background: Cancer and its therapeutic management trigger the multiorgans physical disorders, that can cause the patient to worry and become anxious about the condition. Three acupoints of acupressure therapy stimulates relaxation of the body and can reduce anxiety. The purpose was to determine the influence of three acupoints of acupressure therapy to improve the anxiety level in cancer patients based on types of cancer therapy.Methods: This was an interventional study using pre-experiment pre-test post-test design. Samples were 30 cancer patients living at the Indonesian Cancer Foundation East Java Branch Surabaya Indonesia, taken by purposive technique sampling based on inclusion criteria. The instrument was Beck Anxiety Inventory that it was valid and reliable based on the test. Ethical feasibility tests has been carried out. Acupressure therapy is given on acupoint St36, Li4 and Li11. It conducted 2 times per week for 4 weeks. Wilcoxon Signed Rank Test was applied to analyze this result with p < 0.05.Results: There was a significant effect of acupressure for improving anxiety levels in both groups with p value in the chemotherapy group 0.001 and in the chemoradiotherapy group 0.002. But a greater influence occurred in the chemotherapy group compared to chemoradiotherapy group.Conclusions: Acupressure therapy in three acupoints can stimulate relaxation condition, it can decrease the anxiety level for cancer patients with all types of cancer therapy.
Syamsu Hudaya , Adianti Khadijah
Indonesian Journal of Cancer, Volume 13, pp 86-90; doi:10.33371/ijoc.v13i3.659

Abstract:
Background: Bleomycin, etoposide, and cisplatin (BEP) is a standard first-line therapy for metastatic germ cell tumor (GCT), while paclitaxel, ifosfamide, and cisplatin (TIP) are commonly used as salvage therapy after failed BEP treatment. The unavailability of first-line drugs can be the reason for the use of second-line therapy. In this paper, we reviewed two initial cases of patients with metastatic GCT treated with TIP as first-line chemotherapy in our center.Case Presentation: We reviewed the medical record and followed up two patients who had been treated with TIP as first-line chemotherapy for metastatic GCT due to lack of BEP regiment. We evaluated efficacy and toxicity of this treatment. These two patients were diagnosed with seminoma, with intermediate-risk according to International Germ Cell Cancer Collaborative Group (IGCCCG) classification. Both achieved complete response after four courses of TIP chemotherapy with toxicities mainly consisted of myelosuppression.Conclusions: TIP demonstrated efficacy serves as the first-line therapy for germ cell tumors with an acceptable safety profile. Further studies with larger subjects are still needed for evaluation. However, TIP is more expensive compared to BEP, making BEP is still superior to TIP in public hospital setting where cost-effectiveness of treatment is important.
Ajoedi Ajoedi, Muhammad Al Azhar, Siti Nadliroh, Sri Hartini, Rizka Andalusia, Arief Budi Witarto
Indonesian Journal of Cancer, Volume 13, pp 80-85; doi:10.33371/ijoc.v13i3.670

Abstract:
Background: Immunotherapy using immune checkpoint inhibitors has currently emerged as an effective treatment for a subset of colorectal cancer (CRC) patients. The roles of PD-1 and PD-L1 expression levels in peripheral blood to predict patient’s response to immune checkpoint inhibitors are not well established. Therefore, we analyzed PD-1 and PD-L1 mRNA expression levels of peripheral blood in Indonesian CRC patients and explored the association with the clinicopathological features.Methods: Peripheral blood of 25 CRC patients and 10 healthy individuals were collected in Dharmais Hospital-National Cancer Center from 2017 to 2018. PD-1 and PD-L1 mRNA expression levels were analyzed using real time PCR. The associations with clinicopathological variables were analyzed with fisher-exact test or chi square test.Results: PD-1 mRNA expression levels were significantly lower in CRC patients compared to healthy individuals (HI) (mean: 0.0015 ± 0.0013 and 0.017 ± 0.010 respectively, p < 0.001). Although PD-L1 mRNA expression levels were lower in CRC patients, the difference was not statistically significant (mean in CRC and HI: 0.021 ± 0.013 and 0.034 ± 0.028 respectively, p = 0.125). The expression of PD-L1 was higher in CRC females compared to males (p = 0.03). The expression levels of PD-L1 were not associated with different ages (p = 0.673), stages (p = 0.298), histological type of colorectal cancer (p=0.852), patient status (p = 1.000), and body mass index (p = 0.514).Conclusions: The mRNA expression levels of PD-1 and PD-L1 were lower in CRC patients compared to healthy controls. Expression of PD-L1 were correlated with sex, but not correlated with ages, stages, histological type of CRC, patient status, and body mass index.
Ramlan Halimi, Achmad Rizky Herda Pratama
Indonesian Journal of Cancer, Volume 13, pp 69-74; doi:10.33371/ijoc.v13i3.652

Abstract:
Background: Benign Prostatic Hyperplasia (BPH) is the most common pathological condition in man that causes Lower Urinary Tract Syndrome (LUTS). The most popular therapeutic modality for BPH is Transurethral Resection of Prostate (TURP). This study describes the TURP outcome in BPH patient with prostate size > 75 grams compared to < 75 grams in Karawang General Referral Hospital.Methods: We performed a retrospective review of clinical outcome from BPH patient with LUTS who underwent TURP procedure between January 2017 – April 2018. Data was taken through patient medical records and processed descriptively to describe complications, quality of life, and clinical laboratory data. Qualitative data compared with Chi-Square test.Results: During this study, we evaluated 40 patients, 20 patients with prostate size > 75 grams (group 1) and 20 patients with prostate size < 75 grams (group 2). Mean age in group 1 was 65.6 ± 9.9 years and in group 2 was 65.3 ± 10.2 years. International Prostate Symptom Score (IPSS) after TURP between group 1 and group 2 showed a significant difference, while incomplete emptying was found mostly in group 2 (p < 0.05). There was no significant difference in Quality of Life Score between group 1 and group 2 (p > 0.05). From laboratory results, we found a reduction of hemoglobin in both groups with p-value < 0.05 or no significant difference.Conclusions: Transurethral Resection of Prostate (TURP) procedure for patient with prostate size > 75 grams is safe and effective with lower complications and there is no significant difference compared to patient with prostate size < 75 grams.
Andree Kurniawan
Indonesian Journal of Cancer, Volume 13, pp 96-103; doi:10.33371/ijoc.v13i3.628

Abstract:
Introduction: Sarcopenia in cancer patients, especially in advanced stage, recently known as an emerging problem. Firstly, sarcopenia is found in elderly patients. The diagnosis of sarcopenia needs evaluation of muscle composition and function and physical activity. Sarcopenia will give negative impacts such as increased mortality, chemo-toxicity, and decreased quality of life. Here, we review the current evidence describing the definition, impact, risk factors, mechanisms, diagnosis and treatment of sarcopenia in cancer patients.Method: We identified 48 studies and/or review articles evaluating sarcopenia in cancer patients by searching PubMed and EMBASE databases. Results: Sarcopenia is reported across all stages and types of cancers. There is a new definition of sarcopenia that is reported in 2019 paper. The risk factors or causes of sarcopenia in cancer are complex depending on the clinical settings of each patient. SARC-F questionnaire can be used to screen cancer patients in clinical settings. The diagnostic evaluation and cut-off measurement of sarcopenia especially in cancer varied across studies. The loss of muscle mass that happens during chemotherapy will make a poor prognosis. Sarcopenia can worsen chemotherapy toxicity. Combination exercise with adequate dietary supplementation, adequate energy, and protein are important in the management of sarcopenia in cancer patients.Conclusions: Patients with cancer belong to a population at risk of developing sarcopenia before and after chemotherapy. Sarcopenia diagnosis needs the evaluation of muscle mass and muscle strength or physical performance. Physical activity exercise is the best strategy to reduce sarcopenia in cancer patients.
Widiyono Widiyono , Sri Setiyarini, Christantie Effendy
Indonesian Journal of Cancer, Volume 13, pp 59-68; doi:10.33371/ijoc.v13i3.632

Abstract:
Background: Depression is a psychological distress that often occurs on cancer patients. Depression can increase patient perception about pain, resulting reduced drug efficacy and longer length of stay. Drug treatment for depression sometimes has side effects. Another intervention to decrease depression on cancer patients is music therapy. Music therapy might avoid polypharmacy in cancer patients. The purpose of this study was to determine the effects of self-selected individual music therapy toward depression of cancer patients.Methods: The method used in this study was the randomized control trial (RCT). Simple Random Sampling was assigned randomly by three researcher assistants to participants (N=70) of intervention and control group. The intervention used was self-selected individual music therapy (SeLIMuT). SeLIMuT was applied four times in 2 days with a duration of 15 minutes each session. Beck Depression Inventory (BDI) was employed for selection purposes. The data were analyzed using Mann-Whitney with p < 0.05 and 95% CI. The effectiveness of therapy was analyzed by the effect size test using abs r.Results: Based on the result of the bivariate analysis, there was an effect of giving self-selected individual music therapy to reduce depression with depression gap in both groups with p-value of 0.001 (p < 0.05). The value of the effect test obtained abs r = 0.82 (r > 0.5). At the end, the self-selected individual music therapy had moderate effect toward depression of cancer patients.Conclusions: Music therapy is safe, inexpensive, and easy to use, for and by patients. The nurse can safely recommend any of these interventions for depression on cancer patients. Specific selections or types of music may have different effects on different patients and may provide different effects at different time, so the use of self-selected individual music therapy is recommended.
Rinto Hariwibowo, Agus Rizal Ah Hamid, Chaidir Arif Mochtar
Indonesian Journal of Cancer, Volume 13, pp 75-79; doi:10.33371/ijoc.v13i3.656

Abstract:
Background: The variation of sizes, shapes, and location of kidney cancer complicates the choices of surgical treatment.To determine which technique to use, R.E.N.A.L. nephrometry scoring systems were established. This study was conducted to evaluate R.E.N.A.L.-NS profile in kidney cancer patients at CMHMethod: The data were collected retrospectively from patients that underwent both open and laparoscopic Radical (RN) and Partial Nephrectomy (PN) procedure from 2014-2017. R.E.N.A.L.-NS was calculated based on (R)adius, (E)xophytic/ Endophytic properties, (N)earness to the collecting system, (A)nterior or Posterior position of the tumor, and (L)ocation of the tumor. It was categorized into three complexity: low (4-6 points), medium (7-9 points), and high (10-12 points). Subjects then divided based on the procedure given. Profile of R.E.N.A.L.-NS was shown based on each procedure.Result: In this study, 63 patients were included. 52 underwent RN and 11 underwent PN. In low complexity tumors, all patients received PN. In medium complexity tumors, 22 (78.5%) patients received RN and 6 (21.5%) received PN. All high complexity tumors received RN. Mean renal score in all patient 9.03 (+1.72), RN 9.59 (+1.11), PN 6.36 (+1.6). Higher (R), (N), and (L) scores mean a higher prevalence of RN.Conclusion: Higher complexity tumors were more likely to be treated with RN. Furthermore, (R), (N), and (L) score can be useful to determine RN or PN as a treatment of choice. This study could be used as a reference to another study regarding R.E.N.A.L.-NS in Indonesia.
Rendy Cahya Soetanto, Muhammad Naseh Budi, Darmadji Ismono
Indonesian Journal of Cancer, Volume 13, pp 91-95; doi:10.33371/ijoc.v13i3.663

Abstract:
Background: Pelvic chondrosarcoma may be difficult to manage due to its proximities with vital structures. The study aimed to explain an alternative surgical technique for acetabular reconstruction.Case Presentation: We present a case of a 48-year-old female with large chondrosarcoma of the superior and inferior pubic rami with medial acetabular wall involvement. Pelvic type 3 resection was performed. There was a defect at medial acetabulum after resection. The defect was covered by autograft from iliac and fixation using screws. Rotational pelvic stability was maintained using a reconstruction plate. The functional outcome was assessed 6 months after operation using MSTS and the score was 30, which was painless, full weight bearing, normal gait, and no pain. Conclusions: Reconstruction of the pelvis after tumor resection requires a careful preoperative patient evaluation and extensive bone and soft tissue resection to achieve negative tumor margins and stable reconstruction of the osseous and soft tissue defects.
Toar Jean Maurice Lalisang , Yarman Mazni, Sahat Matondang
Indonesian Journal of Cancer, Volume 13; doi:10.33371/ijoc.v13i2.640

Abstract:
Background: Pancreaticoduodenectomy (PD) is associated with major morbidity and mortality especially in low volume centers. A centralized model is not suitable for Indonesia, due to its geographical characteristics and the underlying structure of its health funding. As an alternative, an outreach program was developed and delivered by a dedicated hepatopancreatobiliary (HPB) team. The aim of this study was to describe the outcomes of such approach. Methods: A retrospective study of all patients undergoing Pancreaticoduodenectomy or total pancreatectomy by a single HPB team was performed. A “hub and spoke” model /decentralization strategy was used to deliver the care between a tertiary center and eight peripheral centers. Patient demographics, system measures, and outcomes were collected. Results: A total of 213 patients were identified as undergoing a resection within the period of 1993–2017. A total of 47 resections (22%) were performed at a peripheral center. The median age was 51 years and 91(46%) of patients had ampullary carcinoma. The perioperative mortality was 17% but improved over time. Only 19/198 (9.5%) patients with the malignant disease received adjuvant therapy. The median (95%CI) survival for patients with pancreatic and ampullary cancer was 12 (9-15) and 24 (14-34) months respectively. Conclusions: A hub and spoke model as a decentralization strategy for managing patients with peri-ampullary tumors can lead to an improvement in access and outcomes. However further work is required if they are to achieve outcomes achieved by international high-volume centers within centralization programs.
Indonesian Journal of Cancer, Volume 13; doi:10.33371/ijoc.v13i2.631

Abstract:
Background: Previous publication reported a significant disparity of genital cancer incidence between genders. The aim of this study is to investigate period prevalence (PP) and incidence (Irs) of genital cancer in Isfahan/Iran. Methods: Information equivalent to those collected by the USA Surveillance, Epidemiology, and End Results (SEER) program was obtained from the Isfahan Cancer Registry. Period prevalence (PP) was calculated per 100.000 persons. The cancer sites studied were defined according to the International Classification of Diseases (ICD-O; Third Edition) and recorded by topography code. Results: Between the years 2011 to 2015, among all registered cases (3024 cases), 60% applied to the male genital system. The mean (SD) age at diagnosis was higher for men 69.4 (14.7) than women 57.8 (15) (t-test; P
Bagus Ramasha Amangku, Syaiful Ichwan, Septelia Inawati Wanandi, Novi Silvia Hardiany
Indonesian Journal of Cancer, Volume 13; doi:10.33371/ijoc.v13i2.633

Abstract:
Background: HIF-2α is a transcription factor in hypoxic condition, and high expression levels of it correlate with the concepts of metastasis, therapy opposition and reduced quality of prognosis in various forms of cancerous growth. Due to the exceedingly infiltrative ability of brain glioma cells, gliomas cannot be completely deteriorated with surgery and the relapse rate is high. This study goal to identify the relative expression of HIF-2α gene in the direction of glioma malignancy and its classification. Methods: Specimens used in this research comprise of 20 glioma samples obtained from glioma patients in Cipto Mangunkusumo Hospital. Relative expression of HIF-2α was measured by utilizing quantitative Real Time-Polymerase Chain Reaction (RT-PCR). Cycle threshold (CT) values were achieved correlated with the amplified DNA, and then the relative expression was attained by using Livak method of calculation. Results: The results produced a greater average of relative expression of HIF-2α in the grade III and IV types (18.64; n=7) rather than in the lower grades (5.68; n=13). However, the data is statistically inconsequential. Conclusions: High-grade glioma tends to express HIF-2α mRNA higher compared to the lower grade. Therefore, it is possible to use HIF-2α as a prognostic marker for glioma- diagnosed patients, although additional experiments need to be performed to strengthen these facts.
Rasha Mohamed Abdel Latif, Kamel Farag Selim
Indonesian Journal of Cancer, Volume 13; doi:10.33371/ijoc.v13i2.635

Abstract:
Background: The metastatic renal cell carcinoma (mRCC) patients treated with upfront cytoreductive nephrectomy (CN) combined with immunotherapy results in overall survival (OS) improvement. It is unclear whether mRCC patients treated with target therapy will also benefit from CN. The aim of the study was to identify the benefit of upfront CN followed by targeted therapy (TTs) versus TTs alone on OS of patients with mRCC, and to evaluate pre-operative variables for selection of patients who would benefit from CN, and also the response rate (RR) and the progression-free survival (PFS). Methods: A retrospective study was performed in our Department on patients diagnosed with mRCC within the period of January 2013 to April 2018. Data that were collected included patients and tumor characteristics. Patients were divided into two groups: 1) received upfront CN followed by TTs, and the 2) one treated with TTs alone. Survival analysis was performed using Kaplan-Meier method, univariate analysis with log-rank test was used to estimate predictors of survival in the CN group, and Cox regression was used for multivariate analysis. Results: The median OS of all patients was 14 months, and was 19 and 10.5 months in CN and non-CN respectively with significant difference (P˂0.001). Lower hemoglobin level (P=0.012), high neutrophil count (P˂0.001), low albumin level (P=0.006), number of metastatic sites ≥3 (P˂0.001), and patients with number of risk factors ≥3 (P˂0.001) have a negative impact on OS in CN group. Conclusions: Upfront CN before TTs in mRCC carries better survival than TTs alone. Five pre-operative variables (i.e. hemoglobin level, neutrophil count, albumin level, number of metastatic sites, and number of risk factors) were identified as suitable for selection of patients who will benefit from CN.
Zhafirah Ramadhanty, Kristanto Yuli Yarsa, Ari Probandari
Indonesian Journal of Cancer, Volume 13; doi:10.33371/ijoc.v13i2.621

Abstract:
Background: The number of breast cancer patients in Indonesia is increasing but there are still only a few researches that assess their quality of life. RAND SF-36 is a quality of life instrument that is widely used. In Indonesia, the validity and reliability of the instrument is still under development, especially in breast cancer patients. Various health status questionnaires have been used in physical rehabilitation studies involving patient with pacemaker, but for women with breast cancer, the usefulness of these questionnaires as measures of physical, mental, and social well-being has not been firmly established. Methods: A previously validated RAND SF-36 questionnaire in patients with pacemaker was given to 252 breast cancer survivor community members. We assessed the construct validity and the reliability by referring to its Pearson’s r table value and Cronbach’s α coefficient. Results: One hundred and fourteen breast cancer survivor community members participated and completed all 36 questions of the instrument between September- November 2018. Questions number 2, 28, and 35 showed lower Pearson’s r value (r0.1548 indicating that these questions were valid. Cronbach’s α coefficient >0.90 indicated good internal consistency. Conclusions: The Indonesian version of the SF-36 quality of life questionnaire is a suitable instrument and can be used for research in Indonesian breast cancer patients.
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