Indonesian Journal of Cancer

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ISSN / EISSN : 19783744 / 23556811
Total articles ≅ 50
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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.
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.
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.
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.
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.
Siti Nurkasanah, Aida S D Hoemardani, Evlina Suzanna Sinuraya
Indonesian Journal of Cancer, Volume 13; doi:10.33371/ijoc.v13i2.638

Abstract:Background: Squamous cell carcinoma (SCC) is an invasive skin cancer that is found in the human skin. SCC growth from the precancerous lesion is known as a wart or papilloma. Ki67 is a protein expressed by cells during proliferation. Cells with higher Ki67 expression showed abnormal regulation of apoptosis. 5-FU is an antimetabolite compound that works as a DNA/RNA pyrimidine antagonist molecule that can induce cell apoptosis. The main objective of this research is to evaluate the inhibition proliferation of precancerous squamous cell in skin lesion induced by DMBA/croton oil treated by using 5-FU cream topically compared to 5% imiquimod cream. Methods: This research assesses three different concentrations of 5-FU cream namely 1%, 2%, and 5% topically on 24 wild type mice divided into 6 groups of 4 each including positive control (with carcinogenesis but without treatment), negative control (without treatment ; normal), carcinogenesis with treatment 5-FU cream (1%, 2%, and 5%) or 5% imiquimod cream. The expression of Ki67 was analyzed using immunohistochemistry. Statistical analysis was performed by one-way ANOVA using SPSS version 23. Results: Based on this research, 5-FU cream treatment during 4 weeks (week 10-week 14) showed the decrease of cumulative number of papilloma (p
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.
Mururul Aisyi, Ayu Hutami Syarif, Nur Asih Anggraeni, Adhitya Bayu Perdana, Hutomo Rezky, Agus Kosasih, Achmad Basuki
Indonesian Journal of Cancer, Volume 13; doi:10.33371/ijoc.v13i2.622

Abstract:Background: Osteosarcoma is the most common bone malignancy in childhood and adolescence. Despite significant advances in diagnostic and therapeutic modalities, osteosarcoma has generally poor prognosis. Several studies highlighted the prognostic significance of demographic and clinical parameters in the pediatric population. Controversy exists about which obvious factors of mortality in some institutions. Meanwhile, little is known about the overall survival (OS) of pediatric osteosarcoma in Dharmais Cancer Hospital.The aim of this study is to estimate the OS in pediatric osteosarcoma.Methods: This retrospective cohort study enrolled 41 children with osteosarcoma during the period of January 2010-September 2017. Patients were selected using inclusion and exclusion criteria. Overall survival (OS) and patient variables were plotted using Kaplan-Meier.Results: Our result showed that all patients admitted to our hospital in advanced stages (IIB and III). Their median OS was 23 months (12.3-33.7 months) with the survival probability was 29.4%.Conclusions: Median OS of pediatric osteosarcoma in our institution was 23 months and the survival probability was 29.4%. It can be used as evidence showing lack of cancer awareness and early detection in our country.