Indonesian Journal of Cancer

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ISSN / EISSN : 1978-3744 / 2355-6811
Total articles ≅ 79
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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.
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.
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
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.
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