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All Journal The International Journal of Medical Science and Health Research The Indonesian Journal of General Medicine
Nova Agusta Isdiarto
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Postoperative External Beam Radiotherapy and Radioactive Iodine versus Radioactive Iodine Alone In Differentiated Thyroid Cancer-Systematic Review And Meta-Analysis Maren Irgiwi Fadlilah; Nova Agusta Isdiarto; Arundito Widikusumo
The International Journal of Medical Science and Health Research Vol. 12 No. 4 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ahd9ss16

Abstract

Introduction: Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, with an increasing incidence globally. Radioactive iodine therapy (RAI) is the standard adjuvant treatment after thyroidectomy, but the role of postoperative external beam radiotherapy (EBRT) remains controversial, with conflicting evidence regarding its efficacy in improving local-regional control and overall survival. Objective: This study aimed to evaluate the effectiveness of combining EBRT with RAI compared with RAI alone in improving local-regional control and disease-free survival in adult patients with DTC. Methods: A systematic review and meta-analysis were performed based on PRISMA guidelines. A literature search was performed using PubMed, Science Direct, and Google Scholar, focusing on studies published after 2005. Inclusion criteria included patients with DTC who received EBRT and RAI versus RAI alone. Data were analyzed using Review Manager (RevMan) version 5.4 with a random effects model to calculate effect sizes and assess heterogeneity. Results: Of the 12,000 articles identified, three studies with a total of 606 participants met the inclusion criteria. Meta-analysis showed that EBRT had no significant impact on overall survival or distant metastasis rate (RR = 0.59; 95% CI: 0.14–2.54; p = 0.48; I² = 92%), but has potential benefit in local-regional control, especially in high-risk patients with unresectable tumors or poor RAI uptake. Discussion: The role of EBRT in the management of DTC remains controversial due to the retrospective nature of most studies and variations in treatment protocols. Although it may improve local-regional control, its impact on survival is inconclusive. The potential for increased morbidity and the lack of prospective trials highlight the need for further research to identify subgroups of patients who may benefit most from EBRT. Conclusion: This meta-analysis suggests that EBRT does not provide significant clinical implications compared with RAI alone. Further studies with standard treatment regimens are needed to clarify the role of EBRT in DTC management.
Radiotherapy in Malignant Melanoma of the Nasal Cavity: A Rare Case Re-Irradiation Using Volumetric-Modulated Arc Therapy (VMAT) and Brachytherapy Maren Irgiwi Fadlilah; Nova Agusta Isdiarto; Arundito Widikusumo
The Indonesian Journal of General Medicine Vol. 28 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/djykgh08

Abstract

Background: Malignant mucosal melanoma of the nasal cavity is a rare tumor with agressive characteristic and poor prognosis. Modern radiotherapy modalities such as Intensity-Modulated Radiotherapy (IMRT), VMAT, and brachytherapy offer the potential of the improvement of local control in tumor that historically known as radioresistant. The aim of this case report is to discuss malignant melanoma of the nasal cavity and the impact of radiotherapy, with a focus on re-irradiation using VMAT and brachytherapy in this diasase. Case description and Discussion: A man, 61 years old was diagnosed with malignant melanoma of the nasal cavity based on imaging and histopathology result. The patient underwent four cycles of chemotherapy, followed by external beam radiotherapy using IMRT technique with total dose 70 Gy/35 fractions. Post-treatment evaluation revealed residual mass, leading to re-irradiation using VMAT at 50 Gy/25 fractions, followed by Ir-192 brachytherapy at 16 Gy/4 fractions using a nasopharyngeal applicator. The cumulative total BED administered exceeded >160 Gy. Side effects on organs at risk were minimal, and post-treatment nasal bleeding and nasal congestion symptoms did not recur. Conclusion: A Multimodal approach combining IMRT, re-irradiation of VMAT, and brachytherapy demonstrates promising clinical outcomes in cases of malignant melanoma of the nasal cavity. The administration of a high cumulative Biological Effective Dose (BED) enables optimal tumor control without increasing toxicity to surrounding organs. This strategy is worth considering in the management of inoperable or locally recurrent head and neck mucosal melanoma.
Co-Authors Arundito Widikusumo Maren Irgiwi Fadlilah