Indonesian Journal of Cancer

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ISSN / EISSN : 19783744 / 23556811
Total articles ≅ 63
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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

Abstract:
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 Ah Hamid, Chaidir Arif Mochtar, Rainy Umbas
Indonesian Journal of Cancer, Volume 14, pp 16-20; doi:10.33371/ijoc.v14i1.673

Abstract:
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

Abstract:
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...
Dewi Sulistyawati, Zakiyatul Faizah, Eighty Mardiyan Kurniawati
Indonesian Journal of Cancer, Volume 14, pp 3-7; doi:10.33371/ijoc.v14i1.639

Abstract:
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.
Febri Hardiyanti, Johan Harlan, Ema Hermawati
Indonesian Journal of Cancer, Volume 14, pp 8-15; doi:10.33371/ijoc.v14i1.666

Abstract:
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.
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

Abstract:
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

Abstract:
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 (
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

Abstract:
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.
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

Abstract:
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

Abstract:
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.