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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.

PDF file - 53K

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.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, vascular, tumour primarily occuring in adolescent males. Juvenile nasopharyngeal angiofibroma is normally unilateral, originating from the sphenopalatine artery. Two separate masses arising from both sides are exceedingly rare. We report a case of a 29-year-old male presented with increasing nasal obstruction, recurrent epistaxis, and a mass on his left buccal. Computed tomography and magnetic resonance imaging revealed non-contiguous tumours on the right nasopharynx and on the left buccal. Angiography showed independent vascular supplies from each side with no bilateral supply noted. Preoperative embolization on both vascular supplies was done, followed by surgical removal of the tumours with no major complication. Histopathological examination showed both are JNA. No major complications were noted. This case discusses how suspecting bilateral juvenile angiofibroma in a patient with two non-contiguous masses in head and neck region is recommended. Proper diagnosis of bilateral JNA can lead to better management and results.

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.