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Introduction and Aim: Nasopharyngeal cancer (NPC) prognosis has been associated with cyclin D1 and Ki-67. These tumor markers had never been tested in NPC patients in Indonesia before. Therefore, this study aims to evaluate the relationships between Ki-67 and cyclin D1 expression levels and the clinicopathological features of nasopharyngeal cancer (NPC) patients. Materials and Methods: During the years 2015 until 2018, thirty-one nasopharyngeal cancer patients were studied in a cohort study at RSUPN Dr. Cipto Mangunkusumo. Patients aged 18 years, diagnosed with NPC according to the histopathological results, metastasis NPC, Eastern Cooperative Oncology Group 0–1, and those who had completed first-line chemotherapy treatment with 5–fluorouracil were included in this study. The Ki-67 and cyclin D1 expression levels were evaluated with the h-score. The NLR values were collected prior to the treatment. The 2-year survival rate was analyzed based on the optimal cut-off value obtained. The optimal cut-off values of Ki-67 and cyclin D1 were categorized into high- and low-expression groups to observe the 2-year mortality. Results: The relationships between Ki-67 and cyclin D1, clinical, pathological, and prognosis of patients were examined. Patients with Ki-67 high expression had a worse 2-year survival rate than those with low expression (p0.05). Ki-67 expression was found to be significantly related to adverse outcomes (p0.05, OR: 41.107, 95% CI: 2.600–649.940), while the cyclin D1 expression was not significantly related to adverse outcomes (p0.05). Conclusion: Ki-67 expression was associated with poor prognosis in NPC patients. Nevertheless, further research is required to explore the specific mechanism of cyclin D1 expression in NPC prognosis.

BACKGROUND: Older patients are at a higher risk of being frail. Frailty implies that even a minor stressor can have major negative implications on physical, psychological domains. Geriatric-8 (G-8) screening tool shows good screening properties for identifying vulnerable elderly patients with cancer. AIM: We, therefore, decided to investigate the utility of G-8 associated with acute toxicity and prolonged overall treatment time (OTT) in elderly cancer patients treated with radiotherapy (RT). MATERIALS AND METHODS: A prospective observational cohort study is performed. Eligible subjects are patients aged ≥60 years and were referred for curative or palliative RT. We use the G-8 questionnaire for consecutive patients before starting RT. We recorded acute toxicity and OTT and identified potential predictors. RESULTS: A total of 52 consecutive geriatric patients were included with an average age of 67 years. Of all those subjects, 21% had head-and-neck cancers, 29% gynecology cancers, 23% breast cancers, and 27% other cancers. According to the G-8, 65% of the patients were potentially frail. Toxicity Grade ≥3 was observed among 32% of subjects who were potentially frail according to the G-8 and 0% of the subject who was fit (p = 0.007). Prolonged OTT was observed in 61.8% of potentially frail and 27.8% of the subjects who were fit (p = 0.020). On multivariate analysis, only chemoradiation was strongly associated with acute toxicity Grade ≥3 odds ratio 11.1 (95% confidence interval 1.4–83.6; p = 0.019). CONCLUSION: The utility of G-8 in daily practice seems to be limited. Only concurrent chemoradiation was associated with acute toxicity. Future prospective studies should investigate whether the G-8 is a good predictor for other relevant clinical outcomes and survival in our local settings.

Radiotherapy can potentially cause damage to the salivary gland, muscles, and nerve that is important to oropharyngeal swallow, leading to xerostomia and dysphagia. Reporting a case of radiotheraphy-induced xerostomia and dysphagia in HNC patients. A 34 years old man with NPC stage IV B (T4N3M0) came with difficulty swallowing, dryness in the throat and mouth, coughing while eating and drinking, choking, hoarseness, and pain when swallowing. The patient had done 14 times of radiation administration with a total dose of 60 Gy with conformal 3D radiation technique. The amount of saliva measured 0.02 ml/minute. A standing secretion was found in the vallecula, right and left piriformis and postkrioid sinuses in preswallowing assessment. The presence of penetration or aspiration of secretions into the airway were detected. The patient was diagnosed with neurogenic dysphagia and advised to use NGT for diet and consult medical rehabilitation. Literature searching was conducted on March 31, 2021 in the 3 journal database, including PubMed, Cochrane, and EBSCOhost, using particular keywords based on PICO. The inclusion criteria were full text article, observational studies, case-control, cohort, randomized controlled trial, systematic review, written in English, and studies investigating the correlation between HNC patient with radiotherapy and dysphagia or xerostomia. There were 3 systematic reviews, 1 cohort, and 2 cross-sectional studies investigating the correlation between chemoradiotherapy in head and neck cancer and xerostomia/dysphagia. Chemoradiotherapy correlated with dysphagia and xerostomia in head and neck cancer. Xerostomia and disfagia were prevalent in HNC patients after radiotherapy. Besides, there was association between the dose of radiotherapy and incidence or severity of xerostomia and dysphagia.

PDF file - 44K, Comparison of the 99bp and 213bp PCR for measuring the EBV DNA load in NP brushings. Both primer pairs gave similar results.

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Purpose: Nasopharyngeal carcinoma (NPC) is consistently associated with Epstein-Barr virus (EBV) and highly prevalent in Indonesia. EBV-DNA load can be used for early diagnosis and may have prognostic value. In this study, EBV-DNA load was evaluated in minimal invasive nasopharyngeal (NP) brushings and whole blood for initial diagnosis and therapy assessment against the standard-of-care diagnosis by biopsy with EBV-RISH and standard EBV-IgA serology.Experimental Design: NP brushings and blood samples were collected from 289 consecutive ENT patients suspected of NPCs and 53 local healthy controls. EBV-DNA load was quantified by real-time PCR and serology by peptide-based EBV-IgA ELISA. Tissue biopsies were examined by routine histochemistry and by EBER RNA in situ hybridization.Results: Repeated NP brushing was well tolerated by patients and revealed high viral load in the 228 NPC cases at diagnosis than 61 non-NPC cancer cases and healthy controls (P < 0.001). The diagnostic value of EBV-DNA load in blood and EBV-IgA serology was inferior to the NP brush results. The level of EBV-DNA load in brushes of patients with NPC was not related to T, N, or M stage, whereas elevated EBV-DNA load in blood correlated with N and M stage. EBV-DNA levels in brushings and whole blood showed a significant reduction at 2 months after treatment (P = 0.001 and P = 0.005, respectively), which was not reflected in EBV-IgA serology.Conclusions: NP brush sampling combined with EBV-DNA load analysis is a minimal invasive and well-tolerated diagnostic procedure, suited for initial diagnosis and follow-up monitoring of NPCs. Clin Cancer Res; 19(8); 2175–86. ©2013 AACR.

This study aims to describe the factors associated with dysplastic changes in sinonasal inverted papilloma (SIP) including somatic EGFR mutation, FoxM1 expression, HPV status, and their association with dysplastic changes.A cross-sectional, analytical study was conducted comprising 34 samples of histologically-confirmed diagnosis of SIP. The samples were further grouped into 2 groups: 20 samples without associated dysplastic changes, and 14 samples with associated dysplastic changes. The numbers of FoxM1 positively-expressed cells, EGFR mutation, and HPV status were compared among two groups using appropriate comparative statistics.There was statistically-significant difference of FoxM1 expression between SIP and SIP with dysplasia (10% vs 100%; p0.001). EGFR mutation was identified in 6 samples (30.0%) of the SIP and 5 samples (35.7%) of SIP with dysplasia. No difference of EGFR mutant proportion among two groups. HPV DNA was detected in 5 samples (25.0%) of SIP versus 9 samples (64.3%) of SIP with dysplasia. There was significant difference of HPV status among two groups (p=0.022). The high-risk subtypes were found in most HPV positive samples (57.1%), while low-risk subtypes and out panel subtypes were found 14.3% and 21.4%, respectively.FoxM1 was overexpressed in SIP with malignant transformation. FoxM1 along with HPV status is associated with dysplastic changes in the SIP. FoxM1 immunostaining is potential to be a biomarker of malignant transformation in SIP.

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign tumor of blood vessels but clinically malignant, with distinctive growth patterns, and required various surgical approaches. The tumor arises from superior posterior sphenopalatine foramen with nasal obstruction and recurrent epistaxis symptoms. Purpose: To discuss the best surgical approach regarding the JNA stage. Case Report: A 13-year-old boy came complaining of recurrent unilateral epistaxis, unilateral nasal obstruction, and swelling of the right cheek. Tumor had expanded from nasopharynx to anterior maxillary region and intracranial. Clinical Question: Is open surgery with a lateral approach the best choice for clearing up the tumor mass and preventing recurrency in JNA which had expanded to anterior maxillary area and intracranial? Method: Literature search was conducted through PubMed, Clinical Key, Cochrane, and Google Scholar using keywords which were “juvenile nasopharyngeal angiofibroma”, “open surgery”, and “tumor recurrence”, obtained 71 papers which were screened using the inclusion and exclusion criteria. Result: The primary treatment for JNA is surgery, and the surgical approaches vary from anterior, lateral, and inferior. The literature search obtained one retrospective cohort study complied with this case, which reported 33 patients with JNA. Interventions on 25 patients with lateral surgical approaches and 8 patients with other approaches. There were 3 patients with lateral approach intervention and 2 patients with other approaches, had JNA tumor recurrence. Conclusion: The lateral approach is the best approach for clearing up the entire tumor mass and preventing recurrency in JNA cases with expansion to anterior maxillary region and intracranial. ABSTRAK Latar Belakang: Angiofibroma nasofaring belia (ANB) adalah tumor pembuluh darah yang secara histologis jinak tetapi klinis ganas, dengan pola pertumbuhan beragam dan membutuhkan teknik pendekatan pembedahan yang berbeda. Tumor berasal dari area superoposterior foramen sfenopalatina, mempunyai gejala klinik berupa sumbatan hidung dan epistaksis berulang. Tujuan: Menentukan tatalaksana pendekatan terbaik pembedahan ANB sesuai perluasan tumor. Laporan Kasus: Pasien laki-laki berusia 13 tahun dengan keluhan epistaksis berulang dari hidung kanan, hidung tersumbat, dan bengkak di daerah pipi kanan. Tumor sudah meluas ke nasofaring sampai ke intrakranial. Pertanyaan Klinis: Apakah pembedahan terbuka dengan pendekatan lateral merupakan pilihan terbaik untuk mengangkat seluruh massa tumor serta mencegah rekurensi, pada kasus ANB dengan perluasan ke area anterior maksila serta ke intrakranial? Metode: Pencarian literature menelusuri Pubmed, Clinical Key, Cochrane, dan Google Scholar menggunakan kata kunci “juvenile nasopharyngeal angiofibroma”, “open surgery”, dan “tumor recurrence” diperoleh 71 naskah yang selanjutnya disaring dengan kriteria inklusi dan eksklusi. Hasil: Terapi utama ANB adalah pembedahan dengan arah pendekatan yang bervariasi tergantung dari lokasi massa tumor, yaitu pendekatan dari anterior, lateral, atau inferior. Dari pencarian literatur diperoleh satu penelitian retrospektif yang melaporkan 33 kasus ANB, dimana 25 kasus dilakukan intervensi pendekatan lateral dan 8 pasien dengan cara pendekatan lainnya, dan didapati 3 kasus dengan pendekatan lateral dan 2 kasus dengan pendekatan lain mengalami rekurensi. Kesimpulan: Pembedahan dengan pendekatan lateral merupakan cara pendekatan terbaik untuk mengangkat massa tumor sebersih mungkin dan mencegah terjadinya rekurensi pada kasus ANB dengan perluasan ke anterior maksila serta ke intrakranial.

Background: Nasopharyngeal cancer is commonly associated with Epstein–Barr virus (EBV) infection, especially undifferentiated non-keratinized histology. EBV DNA quantification through nasopharyngeal brushing was previously reported to be not related to disease stage. This study aimed to reinvestigate the relationship of EBV viral load in tumor tissue with tumor extensiveness by more accurate EBV DNA quantification through microscopically confirmed tumor cells from nasopharyngeal biopsy. Method: The specimens for EBV DNA quantification were derived from histopathology slides which were pre-treated following the QIAsymphony® SP protocol for tissue DNA extraction. Then, the extracted DNA underwent real-time polymerase chain reaction (RT-PCR) using the artus® EBV RG PCR Kit for EBV DNA quantification. The tumor volume was determined by delineating the gross tumor based on 3D imaging of the patient’s nasopharynx. Result: Twenty-four subjects were included in this study. All subjects were stage III and above, with more males (75%) than females. EBV viral load in tumor cells was found to have no correlation to tumor volume both in local and nodal regions. The median local tumor volume was 81.3 cm3 ± 80 cm3. The median EBV viral load in tumor cells was 95,644.8 ± 224,758.4 copies/100 ng of DNA. The median nodal or regional tumor volume was 35.7 ± 73.63 cm3. Conclusion: EBV viral load from tumor cells from nasopharyngeal biopsy has no relationship with tumor extensiveness in nasopharyngeal cancer. The presence and amount of EBV in tumor cells did not translate into larger or smaller tumors. The EBV viral proteins and RNAs were perhaps more likely to confer some prognostic information due to the fact that those molecules were related to carcinogenesis.

Kanker Nasofaring (KNF) merupakan keganasan yang sering ditemukan di Asia.1 Puncak insidensi KNF berada pada usia dewasa muda dan pada pasien usia 55 – 59 tahun.2 Radioterapi merupakan terapi standar untuk KNF stadium awal, sedangkan pada stadium lokal lanjut diberikan kemoradiasi.1 KNF telah terbukti memiliki keterkaitan dengan Epstein Barr Virus (EBV). Dengan berkembangnya biologi molekular, konsentrasi DNA tumor dalam plasma dan serum pada pasien KNF dapat diukur secara kuantitatif dengan polymerase chain reaction (PCR).3 Plasma EBV DNA berguna dalam hal diagnosis, pemantauan respon terapi, dan prediktor prognosis pada pasien KNF.1,3 Penulisan tinjauan pustaka ini ditujukan untuk menambah pengetahuan mengenai manfaat pemeriksaan kadar plasma EBV DNA pada pasien KNF.

Hurthle cell carcinoma is a rare subtype of follicular thyroid carcinoma. Its aggressive nature and poor prognosis require prompt diagnosis and treatment, which is often challenging. We herein report a case of a woman who complained of lumps on her left and right neck which move with swallowing motion for 15 years, and have gotten bigger in the previous 6 months. Follicular thyroid carcinoma was first suspected based on previous fine needle aspiration biopsy. Total thyroidectomy and selective neck dissection procedure were performed and histopathology examination post-surgery showed Hurthle cell carcinoma. The patient also received thyroid replacement hormone therapy. This case discusses the diagnosis and management of Hurthle cell carcinoma leading to better patient outcome.

Introduction EBV infection in nasopharyngeal cancer ensued in latent infection mode. In this latent infection various EBV oncoproteins such as EBNA1 and LMP1 was expressed. EBV oncoproteins could theoretically recruit immune cells, which might help to control cancer. Therefore, this study was aimed to elucidate the association with EBV oncoproteins (EBNA1 and LMP1), immune markers (CD4, CD8, and FOXP3) from nasopharyngeal cancer microenvironment with tumor progression. Method Nasopharyngeal biopsy was obtained from patients suspected to have nasopharyngeal cancer. Those samples with microscopically confirmed nasopharyngeal cancer were tested for EBNA1, LMP1, CD4, CD8, and FOXP3 concentration with ELISA, then verified with IHC. Each patient tumor volume was assessed for primary nasopharyngeal tumor volume (GTVp) and neck nodal metastases tumor volume (GTVn). Correlation test with Spearman correlation and scatterplot were carried out. Result Total 23 samples with nasopharyngeal cancer were analyzed. There was moderate correlation (ρ = 0.45; p value = 0.032) between LMP1 and GTVp. There was strong correlation (ρ = 0.81; p value ρ = 0.6; p value = 0.002) between FOXP3 and GTVp. The CD8 concentration has moderate correlation with both EBNA1 (ρ = 0.46; p value = 0.026) and LMP1 (ρ = 0.47; p value = 0.023). While FOXP3 has moderate correlation with only LMP1 (ρ = 0.58; p value = 0.004). No correlation was found between all the markers tested here with GTVn. Discussion We found larger primary nasopharyngeal tumor was associated with higher CD8 marker. This was thought due to the presence of abundance CD8 T cells in the nasopharynx, but those abundance CD8 T cells were suspected to be dysfunctional. The nasopharyngeal cancer was also known to upregulate chemokines that could recruit T regulatory FOXP3 cells. Furthermore, T regulatory FOXP3 cells differentiation was induced through several pathways which was triggered by EBNA1. The correlation found in this study could guide further study to understand nasopharyngeal carcinogenesis and the relationship with our immune system.

Cases of Human papillomavirus (HPV)-associated oral and oropharyngeal cancer are increasing. Proper diagnostic tools are required to detect HPV among patients, especially in areas where high technology is lacking.To provide mapping of HPV prevalence in Southeast Asia and to determine the effectivity of p16 as a surrogate biomarker for HPV infection in oral and oropharyngeal cancer.Medical records of 56 patients diagnosed with oral and oropharyngeal squamous cell carcinomas (SCC) were reviewed. HPV PCR DNA and p16 immunohistochemistry (IHC) examination were performed to detect HPV positivity.HPV PCR prevalence in oropharyngeal SCC is 42.9% and 28.6% in oral SCC. P16 IHC has 67% sensitivity and 75% specificity in detecting HPV in oropharyngeal cancer, and 33% and 72% in oral cancer.We conclude that p16 IHC with a 5% cut-off can be used as a surrogate biomarker for oropharyngeal SCC, but not oral SCC, in areas where resources are restricted. However, further diagnostic tools may be needed.

Background:Nasopharyngeal cancer is commonly associated with EBV infection, especially the undifferentiated non keratinized histology. EBV DNA quantification through nasopharyngeal brushing was previously reported not related with disease stages. This study aimed to reinvestigate relationship of EBV viral load in tumor tissue with tumor extensiveness by more accurate EBV DNA quantification through microscopically confirmed tumor cells from nasopharyngeal biopsy. Method:The specimens for EBV DNA quantification was derived from histopathology slides which was pre-treated following QIAsymphony® SP Protocol for tissue DNA extraction. Then the extracted DNA underwent real time Polymerase Chain Reaction (RT-PCR) using artus® EBV RG PCR Kit for EBV DNA quantification. The tumor volume was determined by delineating gross tumor based on 3D imaging of the patient’s nasopharynx.Result:Twenty-four subjects were included in this study. All subjects were stage III and above with more males (75%) than females. EBV viral load in tumor cells were found to have no correlation with tumor volume both in local and nodal. The median local tumor volume was 81.3 cm3 ± 80 cm3. The median EBV viral load in tumor cells was 95,644.8 copies/100ng of DNA ± 224,758.4 copies/100ng of DNA. The median nodal or regional tumor volume was 35.7 cm3 ± 73.63 cm3.Conclusion:EBV viral load from tumor cells from nasopharyngeal biopsy has no relationship with tumor extensiveness in nasopharyngeal cancer. The presence and number of EBV in tumor cells did not translate into larger or smaller tumor. The EBV viral proteins and RNAs were perhaps more likely to confer some prognostic information due to the facts that those molecules were related with carcinogenesis.

Nasopharyngeal carcinoma (NPC) is a prevalent disease in certain geographical locations especially in South East Asia. The majority of patients will present with complaints of nasal symptoms, aural as well as neck mass. Other clinical manisfestations are also possible if the disease has spread to the surrounding structures, with the involvement of multiple cranial nerve palsies. Since sometimes nasal complaints can be subtle, a high index of suspicion is crucial. The choice of treatment for NPC is chemoradiation either in a single mode or concurrently. Of note, patients also experience numerous complications from chemoradiation that impairs quality of life.

Introduction Nasopharyngeal cancer in Indonesia has a poor survival rate and there is only few studies regarding nasopharyngeal cancer in Indonesia. Therefore, this study was made to present Indonesian nasopharyngeal cancer data with special focus on survival of nasopharyngeal cancer profile that receives radiation therapy. Methods This was a retrospective study conducted in the Department of Radiation Oncology, Dr. Cipto Mangunkusumo Hospital (RSCM). Moreover, survival analysis was done using Kaplan Meier, log rank and cox regression test. Results A total of 398 patients were included with the median follow-up time of 16 (0–65) months. The 3-year survival in patients with stage I–III was >50% while the survival of 5 years was >50% only in early stage patients. The median survival for men was 46 months and for women 42 months. For OTT ≤ 49 days survival of 3 years and 5 years is 67.1%. Stage III–IVB, size N2-N3, and overall treatment time >49 days were the prognostic factors for nasopharyngeal cancer patients. After multivariate analysis, only stage III–IVB was statistically significant as a prognostic factor independent of survival. Conclusion Most of nasopharyngeal cancer patient came in advanced stage. The median time needed for patients to get radiation therapy and median OTT were good. Only stage III–IVB was statistically significant as a prognostic factor independent of survival.

Nasopharyngeal cancer is a cancer closely related to Epstein-Barr virus (EBV) infection. EBV protein has been shown to be related to various oncogenic development. Suppression of tumor suppressor genes, upregulating molecules to prevent immune attack, downregulating pro-apoptotic proteins, and stimulating local immune suppressive environment are among some roles that EBV proteins can exert on host cells. All those factors combined together with underlying genetic susceptibility of host cells further increase the chance of nasopharyngeal cancer development. Approach targeting those carcinogenesis pathways has been tested with marginal benefit. A newer approach boosting immune cells to increase recognition of tumor antigen and promoting cytotoxic T cell attack has shown promising clinical benefit. Further combination of those immunotherapies with other modality, in particular radiotherapy, has resulted in amplification of cancer killing.

Undifferentiated nasopharyngeal carcinoma (NPC) is 100% associated with Epstein-Barr virus (EBV) as oncogenic driver. NPC is often diagnosed late due to initial vague complaints and obscured location. Prior studies suggest that measurement of EBV DNA load and RNA transcripts in nasopharyngeal (NP) brushings is useful for minimally invasive NPC diagnosis. However, whether these EBV markers relate to local virus replication or reflect tumor origin remains to be demonstrated. To resolve this, we analysed EBV-DNA characteristics and quantified latent and lytic viral RNA transcripts in NP brushings and matching frozen NP-biopsy specimens from patients suspected of having NPC. We observed non-fragmented and Cp-promotor methylated EBV-DNA in both NP brushings and biopsies suggestive of tumor origin. Using quantitative RT-PCR we determined expression levels of 7 critical latent (EBER1, Qp-EBNA1, EBNA2, BART, LMP1, LMP2, BARF1) and 5 lytic (Zta, Rta, TK, PK and VCA-p18) RNA transcripts. Although latent and early lytic RNA transcripts were frequently detected in conjunction with high EBV viral load, in both brushings and biopsies the latent transcripts prevailed and reflected a typical NPC-associated latency-II transcription profile without EBNA2. Late lytic RNA transcripts were rare and detected at low levels mainly in NP brushings, suggestive of abortive viral reactivation rather than complete virus replication. EBV-IgA serology (EBNA1, VCA, Zta) did not correlate to the level of viral reactivation in situ. Overall, viral RNA profiling, DNA fragmentation and methylation analysis in NP brushings and parallel biopsies indicate that NP brush sampling provides a true and robust indicator of NPC tumor presence.

Studi retrospektif ini bertujuan untuk mengetahui perbandingan respon terapi radiasi antara teknik konvensional 2D dengan pengecilan lapangan radiasi teknik 2D, 3DCRT atau brakiterapi pada pasien kanker nasofaring stadium dini (stadium I – IIa). Dari 20 sampel didapatkan respon komplit pada 17 pasien (85%) dan respon parsial pada 3 pasien (15%) (p=0.219). Efek samping akut yaitu dermatitis radiasi grade 3-4 adalah 5% (p=0.435), mukositis grade 3-4 adalah 15% (p=0.510) dan xerostomia grade 3-4 adalah 0% (p=0.517). Secara statistik tidak didapatkan perbedaan bermakna tetapi secara klinis mempunyai kesan ada kecenderungan bahwa dengan pengecilan lapangan radiasi teknik brakiterapi dan 3D-CRT lebih baik dalam hal efek samping akut mukositis dibanding teknik 2D

Background Molecular and biological characterization of nasopharyngeal cancer (NPC) is scarce. Clinical trials of emerging treatment such as immunotherapy for NPC in endemic area is lacking. Currently the most extensively studied immune related molecule that potentially become the target for treatment is PD-1/PD-L1. PD-L1 profile of NPC patients in Indonesia has never been studied before. This study aimed to elucidate PD-L1 profile from NPC specimens in Indonesia. Methods Nasopharyngeal biopsy specimen was taken for PD-L1 protein examination with enzyme-linked immunosorbent assay (ELISA) method. Tissue specimen was homogenized and then ELISA test was conducted using ABCAM AB214565 kit. All protocols from the manufacturer kit was followed. Total protein concentration from homogenized tissue specimen was obtained through Bradford protein assay method. Then, PD-L1 concentration per mg protein of tissue specimen was calculated. Results Twenty-four nasopharyngeal biopsy specimens was obtained. The average age of all patients was 45 years old. Sixteen (66.67%) out of 24 specimens were confirmed histologically to be undifferentiated nasopharyngeal carcinoma. The rest, 8 other specimens have normal histology. Average PD-L1 concentration from NPC specimens was 2,186.67 ± 1,399.32 pg/mg protein (Range: 461.76 to 4,805.85 pg/mg protein). Average PD-L1 concentration from non NPC specimens was 612.43 ± 314.04 pg/mg protein (Range: 326.87 to 1,155.19 pg/mg protein). Conclusions From this preliminary result, PD-L1 protein (both in tumor cells and in immune cells) from NPC specimens has been shown to be elevated compared to normal nasopharyngeal epithelium. This finding indicate that further work is warranted to test anti PD-L1 drug for NPC patients that has failed all the standard treatment. Furthermore, our upcoming work would be exploring relationship between PD-L1, EBV, and tumor microenvironment from our NPC specimens. Legal entity responsible for the study The authors. Funding University of Indonesia. Disclosure All authors have declared no conflicts of interest.

Latar belakang: Kasus kanker tiroid hanya terjadi sekitar 2,5% dari seluruh kasus tumor dengan mayoritas terjadi pada perempuan, hampir 80% kasus yang terjadi adalah tipe papiler. Ada berbagai panduan klinis untuk diagnosis, terapi, dan follow up untuk Karsinoma tiroid berdifferensiasi (DTC). Tujuan: Menentukan perencanaan operasi serta manajemen pasca operasi untuk mencegah komplikasi dan kekambuhan. Tinjauan pustaka: Pada DTC, operasi dan terapi radioiodine dilanjutkan pemberian substitusi levotiroksin tetap merupakan prosedur terapi yang sudah mapan. Angka kekambuhan yang tinggi dan komplikasi pasca operasi yang bervariasi menyebabkan perlunya diagnosis dan tatalaksana yang tepat. Kesimpulan: Makalah ini dibuat untuk membahas bagaimana cara menegakkan diagnosis dan tatalaksana kasus karsinoma tiroid berdiferensiasi, sehingga pemilihan tatalaksana menjadi lebih tepat dan menekan angka kekambuhan. Background: Thyroid carcinoma cases occur only about 2.5% of all tumor cases with the majority occur in women, almost 80% of cases is the papillary type. There are many clinical practice guidelines for diagnosis, therapy, and follow up of Differentiaied Thyroid Carcinoa (DTC). Purpose: Challenge in the management of thyroid cancer is in determining surgical planning and postoperative management to prevent recurrence. Literature review: For DTC, surgery and radioidodine therapy followed by levothyroxine substitution remain the established therapeutic procedures. High recurrence rates and varied postoperative complications lead to the need for proper diagnosis and management. Conclusion: This paper was made to discuss how to make diagnosis and management of DTC cases to suppress the rate of recurrence.

Purpose: Nasopharyngeal carcinoma (NPC) is consistently associated with Epstein-Barr virus (EBV) and highly prevalent in Indonesia. EBV-DNA load can be used for early diagnosis and may have prognostic value. In this study, EBV-DNA load was evaluated in minimal invasive nasopharyngeal (NP) brushings and whole blood for initial diagnosis and therapy assessment against the standard-of-care diagnosis by biopsy with EBV-RISH and standard EBV-IgA serology. Experimental Design: NP brushings and blood samples were collected from 289 consecutive ENT patients suspected of NPCs and 53 local healthy controls. EBV-DNA load was quantified by real-time PCR and serology by peptide-based EBV-IgA ELISA. Tissue biopsies were examined by routine histochemistry and by EBER RNA in situ hybridization. Results: Repeated NP brushing was well tolerated by patients and revealed high viral load in the 228 NPC cases at diagnosis than 61 non-NPC cancer cases and healthy controls (P < 0.001). The diagnostic value of EBV-DNA load in blood and EBV-IgA serology was inferior to the NP brush results. The level of EBV-DNA load in brushes of patients with NPC was not related to T, N, or M stage, whereas elevated EBV-DNA load in blood correlated with N and M stage. EBV-DNA levels in brushings and whole blood showed a significant reduction at 2 months after treatment (P = 0.001 and P = 0.005, respectively), which was not reflected in EBV-IgA serology. Conclusions: NP brush sampling combined with EBV-DNA load analysis is a minimal invasive and well-tolerated diagnostic procedure, suited for initial diagnosis and follow-up monitoring of NPCs. Clin Cancer Res; 19(8); 2175–86. ©2013 AACR.

Background: Overexpression of Rad51 protein in many tumor cells has been proven to increase radioresistance and can be related to the resistance of chemosensitivity of tumor cells. This preliminary study was conducted to determine the relationship between the Rad51 expression level in nasopharyngeal carcinoma and the response of the treatment based on the measurement of the tumor reduction. Methods:Thirteen cases of the NPCs were analyzed. The expression levels of the Rad51 were examined from the pretreatment biopsies. Furthermore, tumor reductions were determined based on the change in sum longest diameter of the nasopharyngeal CT-scan before and after therapy. Results: The expression level of the Rad51 was associated with the reduction of tumor mass. The P value was 0.049 and the correlation coefficient was 0.479. Conclusion:The tumor cells Rad51 expression levels may affect the tumor reduction of NPC after the therapy.

Undifferentiated nasopharyngeal carcinoma (NPC) is 100% associated with Epstein‐Barr virus (EBV) as oncogenic driver. NPC is often diagnosed late due to initial vague complaints and obscured location. Prior studies suggest that measurement of EBV DNA load and RNA transcripts in nasopharyngeal (NP) brushings is useful for minimally invasive NPC diagnosis. However, whether these EBV markers relate to local virus replication or reflect tumor origin remains to be demonstrated. To resolve this, we analysed EBV‐DNA characteristics and quantified latent and lytic viral RNA transcripts in NP brushings and matching frozen NP‐biopsy specimens from patients suspected of having NPC. We observed non‐fragmented and Cp‐promotor methylated EBV‐DNA in both NP brushings and biopsies suggestive of tumor origin. Using quantitative RT‐PCR we determined expression levels of 7 critical latent (EBER1, Qp‐EBNA1, EBNA2, BART, LMP1, LMP2, BARF1) and 5 lytic (Zta, Rta, TK, PK and VCA‐p18) RNA transcripts. Although latent and early lytic RNA transcripts were frequently detected in conjunction with high EBV viral load, in both brushings and biopsies the latent transcripts prevailed and reflected a typical NPC‐associated latency‐II transcription profile without EBNA2. Late lytic RNA transcripts were rare and detected at low levels mainly in NP brushings, suggestive of abortive viral reactivation rather than complete virus replication. EBV‐IgA serology (EBNA1, VCA, Zta) did not correlate to the level of viral reactivation in situ. Overall, viral RNA profiling, DNA fragmentation and methylation analysis in NP brushings and parallel biopsies indicate that NP brush sampling provides a true and robust indicator of NPC tumor presence., What's new? Nasopharyngeal carcinoma (NPC) often is diagnosed at late stages, in part because physical examination of the nasopharyngeal (NP) space is difficult. Moreover, despite a strong association with Epstein‐Barr virus (EBV) infection, optimal EBV‐based diagnostic modalities for NPC are lacking. Here, EBV DNA load, methylation status and EBV latent and lytic RNA profiles obtained from NP brush biopsy were found to be robustly indicative of tumor presence at the site of initiation. EBV (immediate) early mRNAs were frequently detected, suggesting local abortive viral reactivation. Using the described EBV markers, NP brushing may be a practical minimally invasive approach for NPC diagnosis.

Latar belakang: Lipoblastoma merupakan tumor mesenkim jinak pada bayi dan anak-anak. Gejalaklinik bervariasi tergantung lokasi dan gejala penekanan pada organ sekitarnya. Tujuan: Menentukantatalaksana bedah terbaik untuk kasus lipoblastoma kepala leher pada anak. Kasus: Dilaporkan seoranganak laki berusia 5 tahun dengan benjolan di pelipis kiri yang meluas ke pipi kiri sejak berusia 3 thn,makin membesar tidak disertai nyeri Metode: Pencarian literatur secara terstruktur dilakukan denganmenggunakan PubMed, EBSCO, dan Cochrane, sesuai dengan pertanyaan klinis. Pemilihan artikeldilakukan berdasarkan kriteria inklusi dan eksklusi. Satu artikel yang terpilih kemudian dinilai kualitasnyadengan kriteria telaah kritis dari Oxford. Hasil: Telaah studi menunjukan bahwa ekstirpasi tumor komplitmerupakan tata laksana terbanyak yang dipilih pada kasus lipoblastoma kepala leher anak. Pada pilihantatalaksana dengan eksisi parsial didapatkan adanya beberapa rekurensi tumor. Kesimpulan: Berdasarkanliteratur yang memiliki tingkat bukti yang paling tinggi, menunjukkan bahwa teknik ekstirpasi komplitmerupakan pilihan yang terbaik. Kata kunci: Lipoblastoma, kepala leher, teknik bedah ABSTRACT Background: Lipoblastoma is a rare benign mesenchymal tumor of infancy and early childhood.Symptoms vary depending on localization, and signs of compression of adjacent organs may be seen. Purpose: To determine the best surgical management of head and neck lipoblastoma in children. Case :A 5 years old boy with painless rapid growing mass in the left temple and cheek. Method: A structuredliterature search was performed using PubMed, EBSCO, and Cochrane, according to clinical questions.The selection of articles was based on inclusion and exclusion criteria. One selected article was assessedfor quality with criteria of critical appraisal from Oxford. Results: Most study showed that complete tumorextirpation was the most preferred procedure in cases of child head neck lipoblastoma. In managementwith partial excision, there were some recurrence of tumor. Conclusion: Based on the literature that hadthe highest level of evidence, complete extirpation techniques were the best choice. Keywords: Lipoblastoma, head of neck, surgical technique

Background: Acinic cell carcinoma is an uncommon type of parotid malignant tumour. One commonsymptom of this low grade malignancy is slowly growing parotid mass. Pain in parotid area and facialnerve paresis are important symptoms that indicate malignancy. From clinical manifestations, it is difficultto differentiate between this kind of malignancy with benign parotid tumour. Fine needle aspiration biopsyand CT scan are important in diagnosing acinic cell parotid carcinoma, and surgery is the main therapy. Purpose: We present this case to enlighten general practitioners and also otorhinolaryngologists aboutthis kind of parotid malignancy that has similar presentation with benign parotid tumour. Case: Onecase of acinic cell carcinoma of the parotis was reported. A 53 years old man was diagnosed as stage IVacinic cell carcinoma. Case management: The patient underwent radical parotidectomy. He was plannedfor chemotherapy and radiotherapy but untill now, he still refused further treatment. Conclusion: Aciniccell carcinoma is one of malignant tumour that has a good prognosis, especially if diagnosed early andadequately treated. Key words: malignant parotid tumour, acinic cell carcinoma, fine needle aspiration biopsy,parotidectomy. Abstrak : Latar belakang: Karsinoma sel asinus adalah salah satu tipe keganasan kelenjar liur yang jarang sekaliterjadi. Karsinoma ini bersifat low grade yang ditandai oleh benjolan pada daerah parotis yang tumbuhsecara lambat. Dari pemeriksaan klinis, keganasan ini sulit dibedakan dengan tumor jinak. Salah satugejala yang membedakan dari tumor jinak adalah rasa nyeri dan paresis nervus fasialis. Pemeriksaan biopsiaspirasi jarum halus dan tomografi komputer dapat menegakkan diagnosis karsinoma parotis jenis ini.Terapi utamanya adalah parotidektomi. Tujuan: Kasus ini diajukan agar para dokter umum dan dokterspesialis Telinga, Hidung, Tenggorok dapat mengenali adanya karsinoma parotis yang bermanifestasiklinis seperti tumor jinak ini. Kasus: Dilaporkan satu pasien, laki-laki berusia 53 tahun yang didiagnosiskarsinoma sel asinus kelenjar parotis stadium IV. Penatalaksanaan: Pada pasien ini dilakukan operasiparotidektomi radikal dan direncanakan untuk radiasi dan kemoterapi. Sampai saat ini, pasien masihmenolak untuk tatalaksana lebih lanjut pascabedah. Kesimpulan: Karsinoma sel asinus merupakan kasuskeganasan yang memiliki prognosis baik, terutama jika didiagnosis dini dan diterapi secara adekuat. Kata kunci: tumor ganas parotis, sel asinus, biopsi aspirasi jarum halus, parotidektomi.

Latar belakang: Jabir deltopektoral merupakan salah satu pilihan untuk rekonstruksi defek yang luasakibat tindakan ekstirpasi tumor dan pemberian radioterapi pada keganasan kepala leher. Jabir deltopektoralbukan merupakan pilihan utama dalam rekonstruksi defek kepala leher, namun pada kondisi tertentu, jabirtersebut memiliki tingkat keberhasilan yang lebih baik dibandingkan dengan metode jabir yang lain. Tujuan: Mengingatkan kembali para ahli THT tentang indikasi dan teknik penggunaan jabir deltopektoral pada kasusrekonstruksi defek akibat reseksi tumor dengan telaah sistematis kepustakaan. Kasus: Dilaporkan tiga kasuspenggunaan jabir deltopektoral sebagai penutup defek, satu kasus laki-laki 73 tahun dengan unknown primarytumor dengan penyulit diabetes melitus yang dilakukan tindakan diseksi leher radikal. Dua kasus lain dengandefek akibat stoma rekuren pascalaringektomi total. Penatalaksanaan: Pada ketiga kasus ini dilakukanpenutupan defek menggunakan jabir deltopektoral. Kesimpulan: Pada kondisi pemakaian jabir bebasmerupakan kontraindikasi, adanya keterbatasan fasilitas atau dokter ahli serta kondisi sistemik pasien maka jabirdeltopektoral merupakan salah satu alternatif untuk rekonstruksi defek luas pada daerah kepala leher, sebelumatau sesudah radioterapi. Kata kunci : jabir deltopektoral, rekonstruksi, defek kepala leher. ABSTRACT Background: Deltopectoral flap is one of the options for execessive defect caused by tumor ablation andradioterapy in head and neck cancer. Deltopectoral flap is not the main option in head and neck reconstruction,but in some certain condition, it has a better success rate than other flap techniques. Purpose : To presentevidence based case report in order to broaden otolaryngologists’ knowledge about indications and techniquesof deltopectoral flap in reconstruction of defect caused by tumor resection. Cases: We reported 3 cases ofdeltopectoral flap used as a defect closure, one of them was a man 73 years old who had an unknown primarytumor with diabetic status and had undergone radical neck dissection. Two other cases were patients withdefect caused by postlaryngectomy reccurent stoma. Management: We used deltofectoral flap for closing thedefect our patients. Conclusion: In conditions in which the use of free flaps are contraindicated, limitedinstrumentations or experienced surgeons , and poor systemic condition of the patient, deltopectoral flap can beconsidered as an alternative for reconstruction of wide defect of the neck, either pre or post radiotherapy. Keywords : deltopectoral flap, reconstruction , head neck defect.

Nasopharyngeal carcinoma (NPC) is the most prevalent ENT-tumour in Indonesia. We investigated the primary diagnostic value of Epstein-Barr virus (EBV) DNA load and mRNA detection in noninvasive nasopharyngeal (NP) brushings, obtained prospectively from consecutive Indonesian ENT-patients with suspected NPC (N=106) and controls. A subsequent routine NP biopsy was taken for pathological examination and EBER-RISH, yielding 85 confirmed NPC and 21 non-NPC tumour patients. EBV DNA and human DNA load were quantified by real-time PCR. NP brushings from NPC patients contained extremely high EBV DNA loads compared to the 88 non-NPC controls (p

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign hormonal related fibrovascular tumor which originates from superoposterior area of sphenopalatine foramen. Purpose: To determineER-s expression of JNA patient at Cipto Mangunkusumo Hospital. Method: Descriptive study to determine s-estrogen receptor (ER-s) on 27 JNA patients who had been treated at Oncology Division ENT Departement Cipto Mangunkusumo Hospital between 2001-2008 was conducted. Results: ER-s expression of JNA in this study is 100%. Based on ER-s staining intensity, 18.5% gave strong intensity, 29.6% with moderate intensity, and 51.9% with weak intensity. According to positive ER-s cellular, it consist of three groups: less than 25% positive, 25-50% positive, and more than 50% positive, and the result is 3.7%, 3.7%, and 92.6% respectively. Conclusion: Immunohistochemical examination revealed 100% ER-s expression. Keywords: Juvenile nasopharyngeal angiofibroma (JNA), ER-s expression Abstrak : Latar belakang: Angiofibroma nasofaring belia (ANB) adalah suatu tumor fibrovaskular jinak, berasal dari area superoposterior foramen sfenopalatina dan diduga berhubungan erat dengan faktor hormonal. Tujuan: Melihat gambaran ekspresi ER-s pada penderita ANB di RS. Cipto Mangunkusumo. Metode: Penelitian deskriptif untuk melihat gambaran ekspresi reseptor estrogen s (ER-s) pada 27 kasus angiofibroma nasofaring belia (ANB) yang berobat dari tahun 2001 hingga 2008 di Divisi Onkologi Departemen Telinga Hidung Tenggorok RS. Cipto Mangunkusumo. Hasil: Didapati ekspresi ER-s pada ANB sebesar 100%. Berdasarkan intensitas pewarnaan terhadap ER-s didapatkan 18,5% mempunyai intensitas pewarnaan yang kuat, 29,6% intensitas pewarnaannya sedang dan 51,9% memiliki intensitas pewarnaan yang lemah. Tiga koma tujuh persen termasuk kelompok dengan jumlah sel yang positif mengandung ER-s kurang dari 25%, 3,7% termasuk kelompok dengan jumlah sel 25-50%, dan 92,6% termasuk kelompok dengan jumlah sel yang positif mengandung ER-s>50%. Kesimpulan: Hasil pemeriksaan imunohistokimia menunjukkan ekspresi ER-s pada semua kasus (100%). Kata kunci: angiofibroma nasofaring belia (ANB), tumor fibrovaskuler, ekspresi ER-s