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INDONESIA
Indonesian Journal of Cancer
Published by National Cancer Center-Dharmais Cancer Hospital
ISSN : 19783744     EISSN : 23556811     DOI : https://www.doi.org/ 10.33371
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Public Health
Indonesian Journal of Cancer is a peer-reviewed and open-access journal. This journal is published quarterly (in March, June, September, and December) by Dharmais Cancer Hospital - National Cancer Center. Submissions are reviewed under a broad scope of topics relevant to experimental and clinical cancer research. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted acceptance for publication. The journal publishes original research articles, case reports, and review articles under the following categories: cancer management, cancer prevention, cancer etiology, epidemiology, molecular oncology, cancer diagnosis and therapy, tumor pathology, surgical oncology, medical oncology, radiation oncology, interventional radiology, as well as early detection.
Arjuna Subject : Kedokteran - Onkologi
Articles 21 Documents
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Search results for , issue "Vol 18, No 2 (2024): June" : 21 Documents clear
Synergistic Cytotoxicity of 5-Fluorouracil and Epigallocatechin-3-Gallate on Colorectal Cancer Stem Cell Ibrahim, Sugeng; Riwanto, Ignatius; Suharti, Catharina; Putra, Agung; Budijitno, Selamat
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1211

Abstract

Background: Colorectal cancer stem cells (CR-CSCs) derived from the HCT-116 cell line established human colon carcinoma cell line, validated with CD44+/CD133+. The study investigates the synergistic effects of combining epigallocatechin gallate (EGCG) with 5-fluorouracil (5-FU) on CR-CSCs through comprehensive cytotoxicity assessments, aiming to enhance therapeutic outcomes. EGCG is a polyphenol with anti-cancer activity in green tea. Previous studies have reported that the anti-cancer activity of EGCG involves inhibition of proliferation and induction of apoptosis thereby reducing recurrence by as much as 51.6% in patients with colorectal adenoma after polypectomy. The significance lies in optimizing treatment strategies by understanding the potential synergies between conventional chemotherapeutic agents and natural compounds. Given 5-FU's status as a cornerstone in CR-CSCs chemotherapy and EGCG's emergence as a promising natural compound, the study delves into their individual and combined cytotoxicity profiles. Methods: The single and combination assay aimed to determine the cytotoxicity of EGCG and 5-FU, including establishing the half inhibitory concentration (IC50) and combination index (CI) values. CR-CSCs colonies were disassociated, counted, and cultured in 96-well plates. Test solutions of varying concentrations were applied, and subsequent steps involved incubation, media removal, washing, MTT reagent addition, and absorbance measurement. Results: The single cytotoxicity tests established individual IC50 values, revealing 141.26 µM for 5-FU and 464.56 µM for EGCG. Subsequent combination cytotoxicity tests demonstrated a synergistic effect at specific doses, indicated by CI values below 1. Conclusions: These findings highlight the potential for increased cytotoxicity against CR-CSCs when treated with the combination of 5-FU and EGCG.
Transcatheter Arterial Chemo Infusion (TACI) for Squamous Cell Carcinoma of the Tongue: A Case Report Poedjomartono, Bagaswoto; Bangun, Alan Anderson; Frinces, Freshilla Sonia; Indrarto, Erwin Yudhistira Yasanusaraharja; Faiz, Ahmad
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1043

Abstract

Introduction: Cancers of the lip and oral cavity, with the tongue being the most common site, accounted for more than 377,700 cases and more than 177,700 deaths worldwide in 2020. Ninety percent of these oral neoplasms are squamous cell carcinomas (SCC). The main treatments for oral cancers are surgery, radiotherapy, and chemotherapy, either combined or as stand-alone therapies. Transcatheter Arterial Chemo Infusion (TACI) is considered the definitive treatment for locoregionally advanced squamous cell carcinoma of the oral cavity, aiming to preserve function after surgery while maintaining or improving locoregional control and survival rates. This case report presents the qualitative result of TACI on SCC of the tongue. The aim of this case report is to demonstrate the potency of TACI as an alternative palliative therapy for SCC of the tongue. Case Presentation: A 37-year-old man with SCC of the tongue was diagnosed and treated at Dr. Sardjito General Hospital, Yogyakarta in 2021. The patient underwent TACI procedure and subsequent radiotherapy sessions subsequently. The therapeutic response was evaluated by observing the clinical morphology of the lesions. Conclusions: TACI is a minimally invasive technique used in the management of SCC. TACI has shown its potency as an efficient and effective alternative palliative therapy.
Megavoltage CT/MRI-Guided Radiotherapy with Endorectal Balloon Support for Prostate Cancer Patient with Bilateral Hip Prostheses Hama, Yukihiro; Tate, Etsuko
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1203

Abstract

Introduction: Kilovoltage CT-guided radiotherapy for prostate cancer patients with bilateral hip prostheses can be challenging due to metal artifacts. Case Presentation: To compensate for reduced tissue contrast and suppress metal artifacts, a 76-year-old NCCN very high-risk prostate cancer patient underwent megavoltage CT/MRI fusion image-guided radiotherapy with an endorectal balloon. The post-treatment course was uneventful. There were no recurrences or serious side effects 11 years after radiotherapy. Conclusions: Megavoltage CT/MRI-guided radiotherapy with endorectal balloon support may be a viable alternative for a prostate cancer patient with bilateral hip prostheses.
Epidemiological Characteristics and 3-year Overall Survival Outcome of Nasopharyngeal Cancer in Central Java: A Single Institution Retrospective Study Liemiyah, Rikha; Ruspita, Dian Ayu; Naftali, Zulfikar; Muyassaroh, Muyassaroh; Farokah, Farokah
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1083

Abstract

Background: Nasopharyngeal cancer (NPC) has a high incidence and mortality rate in Indonesia, indicating poor survival outcomes. We aimed to evaluate the survival rate of NPC patients and the influence of specific underlying epidemiological characteristics on the overall survival (OS) rate of NPC patients. Methods: We reviewed the medical data from Dr. Kariadi General Hospital's clinical registry system for all newly diagnosed NPC patients between January and December 2018. We retrieved NPC patients' medical record data that met our inclusion/exclusion criteria. The overall survival rate (OS) was estimated using the Kaplan-Meier method. Between-group stratified three-year OS comparisons were conducted using weighted log-rank tests. All statistical analysis was performed in R statistical software. Results: A total of 50  NPC patients were included in the study. Majority of NPC patients were diagnosed in younger age group (58.0%). Male NPC patients dominated this study (74.0%). NPC patients were mostly diagnosed at the advanced stage (76.0%). Nonkeratinizing histology types were frequently found in the study (82.0%). NPC patients achieved a desirable better performance status (78.0%) and had no comorbidities (74.0%). Most NPC patients demonstrated a complete response to therapy (58.0%). The mean follow-up was 26.36 ± 9.5 months and drop-out rate was 18.0%. The three-year OS was 60.8%. Age, sex, stage, histological classification, performance status, comorbidity, therapy response, and therapy drop-out stratified OS did not statistically differ among NPC patients. Conclusions: We found a satisfactory NPC three-year OS. The underlying epidemiological characteristics did not significantly influence the NPC patients' three-year OS.
Enhancing Pediatric Cancer Survival in Indonesia: The Role of CAR T Cell Therapy Azhar, Muhammad Al; Aisyi, Mururul
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1238

Abstract

Pediatric cancer poses a major health challenge globally, especially in low-middle-income countries like Indonesia. The survival rate of pediatric cancer in many high-income countries (HICs) reaches 90%, while it only ranges from 5 to 60% in LMICs. Over 80% of children with cancer live in low-middle-income countries, indicating the urgency to improve the survival rate of pediatric cancer in LMICs [1]. In Indonesia, the prevalence of pediatric cancer was 43.5% in 2020, making it the highest among Southeast Asian countries [2]. According to Dharmais Cancer Hospital (2024), the national cancer referral center for all of Indonesia, the 5-year survival rate of high-risk pediatric acute lymphoblastic leukemia is only 48.8% (unpublished data).One key factor contributing to the low survival rate of pediatric cancer in Indonesia is the lack of effective therapy options, especially for high-risk and relapsed or refractory patients. Several therapeutic approaches, such as immunotherapy, have been widely used in HICs but are still not very popular in Indonesia. CAR (Chimeric Antigen Receptor) T-cell therapy is one of the most promising immunotherapeutic approaches to treat pediatric cancer. Implementing CAR T Cell therapy in Indonesia offers promising prospects for improving the survival rates of pediatric cancer patients.CAR T cell therapy utilizes the body's immune system to specifically target and eliminate cancer cells. This innovative therapy entails extracting a patient's T cells, genetically modifying them to express chimeric antigen receptors specific to tumor-associated antigens, and then reinfusing them into the patient. Once infused, these engineered T cells recognize and eliminate cancer cells bearing the targeted antigen, thereby offering a highly targeted and potentially curative treatment option [3]. This innovative therapy has demonstrated remarkable success in treating certain hematologic malignancies, including pediatric leukemia. The most extensively studied case in childhood patients involves CAR T cells that target CD19, a B cell surface receptor [4].CAR T cell therapy holds great promise for improving survival rates among pediatric cancer patients in Indonesia. Children with refractory or relapsed leukemia, such as B-cell acute lymphoblastic leukemia (B-ALL), who have exhausted standard treatment options, can benefit from CAR T cell therapy. Most relapsed or refractory pediatric cancer patients in Indonesia do not have effective therapy options to treat the disease. CAR T cell therapy emerges as a novel therapy that can significantly improve the survival of this subset of patients. Numerous studies have documented high remission rates (ranging from 70% to 90%) in adults and children diagnosed with refractory B-ALL [4]. A study by Maude et al. [5] reported high remission rates and durable responses in young adults and children with refractory or relapsed B-ALL treated with CAR T cells. Similarly, Park et al. [6] demonstrated long-term remissions and improved survival in pediatric leukemia patients receiving CAR T cell therapy. Several groups also have observed the persistence of CAR T cells and sustained remission lasting over six months in the majority of patients examined [4]. Efforts have been made to implement CAR T cells in Indonesia. Dharmais Cancer Hospital, as a National Cancer Center in Indonesia, has initiated this effort by collaborating with iCarTAB Biomed Inc., a China-based CAR T cell manufacturer with one of its manufacturing sites located in Malaysia. However, this approach involves sending patients' blood samples that have been processed through leukapheresis to Malaysia for CAR T cell manufacturing, followed by the shipment of the manufactured cells back to Indonesia for administration to patients. This process is impractical and incurs intangible costs such as transportation and cryopreservation, ultimately making it more expensive for patients. Regulatory issues related to the shipment of cells across borders in the region and early preparation of patients for CAR T cell therapy soon after relapse before they succumb to treatment-related mortality or relapse-related complications are also challenges that need to be addressed [7]. Reflecting on the abovementioned issue, CAR T cell therapy adoption in Indonesia faces significant challenges. Limited healthcare infrastructure, including specialized facilities for cell therapy manufacturing and administration, poses logistical hurdles. Moreover, cost remains a major barrier, as CAR T cell therapy is often expensive and inaccessible to many patients in Indonesia. Furthermore, the lack of local expertise in cellular immunotherapy may impede the successful implementation of CAR T cell therapy programs.Efforts to address these challenges and maximize the potential of CAR T cell therapy in Indonesia are essential. This requires a multi-faceted approach involving investment in healthcare infrastructure, including establishing specialized centers equipped for CAR T cell therapy manufacturing and administration. Two alternative models have been proposed for manufacturing CAR-T cell therapy: centralized and de-centralized models [8]. In the centralized manufacturing model, point of manufacturing and point of care are located in different geographical areas, while decentralized manufacturing focuses on establishing point of care and manufacturing in close proximity. A decentralized manufacturing model might be the best approach to be implemented in LMICs like Indonesia. Building hospital-based cellular therapy manufacturing reduces the need for transportation and cryopreservation. The decentralized system's geographic proximity improves communication between manufacturing and treatment teams, facilitating the creation of customized products based on a patient's phenotype. This setup also reduces administration time and the risk of delays and mix-ups compared to centralized manufacturing, making hospital-based cellular therapy manufacturing a potentially more cost-effective option [8].In addition, initiatives to reduce the cost of therapy through partnerships with pharmaceutical companies, government subsidies, or philanthropic endeavors can improve affordability and access. Furthermore, capacity-building initiatives aimed at training local healthcare professionals in cellular immunotherapy techniques are essential for ensuring the successful implementation and sustainability of CAR T cell therapy programs in Indonesia. Collaboration between local institutions, international organizations, and industry stakeholders can facilitate knowledge transfer and technology transfer, fostering indigenous expertise in this cutting-edge treatment modality.CAR T cell therapy represents a transformative approach to improving survival rates among pediatric cancer patients in Indonesia. By harnessing the power of immunotherapy, specifically tailored to target cancer cells, CAR T cell therapy offers hope for children with refractory or relapsed leukemia who have limited treatment options. Through continued research, collaboration, and investment in healthcare infrastructure, CAR T cell therapy potentially could greatly improve the prognosis and quality of life for pediatric cancer patients in Indonesia.
Molecular and Host Lifestyle Factors Associated with Persistent Human Papillomavirus Infection and Progression into Cervical Cancer: A Literature Review Yo, Edward Christopher; Nuryanto, Kartiwa Hadi
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1068

Abstract

Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide, especially among low- and middle-income countries. The virus can establish persistent infection in the cervical epithelium, thereby increasing the risk of progression into cervical cancer. Since cervical cancer is one of the leading causes of cancer death among women worldwide, it is important to understand more about persistent HPV infection and potential therapeutic targets to suppress it. This study aims to summarize current insight into various molecular and host lifestyle factors that contribute to persistent HPV infection and ultimately cervical cancer. Methods: This study adopts a literature review design by conducting a journal search through Google Scholar, PubMed, and ScienceDirect. The keywords used included “human papillomavirus”, “persistent infection”, “cervical cancer”, “immune evasion”, and “lifestyle”. Results: Several diverse mechanisms are believed to facilitate persistent HPV infection, which can be classified under molecular and host lifestyle factors. Molecular factors include compartmentalization of HPV replication and gene expression as well as immune evasion, whereas host lifestyle factors include alcohol consumption, smoking, multiple sexual partners, STI coinfection, and certain contraceptive agents. Conclusion: Persistent HPV infection acts as the intermediate phenotype before developing into cervical cancer. Understanding the molecular factors as well as host lifestyle factors underlying it can lead to more specific therapeutic options as well as better prevention and education programs. Future research is needed to better clarify the exact mechanisms underlying persistent infection. 
The Epstein-Barr Virus (EBV) DNA Test as a Predictor of The Course of Nasopharyngeal Cancer Maharani, Putri; Kodrat, Henry
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1120

Abstract

Background: Nasopharyngeal cancer (NPC) incidence has been largely found in Southern China and Southeast Asia and was associated with Epstein-Barr Virus (EBV). Some advanced-stage NPC may still rise to local recurrence or distant metastasis and higher plasma EBV DNA was still found in locally advanced nasopharyngeal cancer (LA-NPC) at 1 month or even 3 years after completing radiotherapy (RT). Even though EBV DNA has not been widely used in clinical practice, it could be an important value for determining treatment outcomes and risk of disease relapse.Methods: This review article gathered studies from the PubMed database from 2021 to 2022. Using various searching terms 434 articles were found and were narrowed down to 7 according to the inclusion criteria. The individual review was made for each article and endpoints such as overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and local recurrence-free survival (LRFS) were drawn.Results: Overall subjects for these studies ranged up to 2,354 LA-NPC patients (median of 1,073   subjects). All studies observed the pre-treatment and post-treatment EBV DNA and only two studies observed post-neoadjuvant chemotherapy (post-NAc). EBV DNA currently is the most reliable biomarker available for clinical purposes and its versatility can be useful, especially to value prognosis and to determine the course of treatment.Conclusions: Apart from survival outcomes, pre-treatment EBV DNA is considered good for predicting the overall prognosis. Meanwhile, post-induction chemotherapy (post-IC) or post-NAc EBV DNA is suitable for adjuvant therapy indicators, especially in LA-NPC. Even though the cut-off value for the tests was still varied across laboratories (ranging from 1,500 to 4,000), post-NAc and post-treatment might have some benefit to help predict any locoregional recurrence and distant metastasis, considering pre-treatment will not change the therapeutic course completely.
Prevalence of Sinonasal Cancer in Dr. Sardjito General Hospital Yogyakarta in The Period between January 2017 and December 2022 Indrasari, Sagung Rai; Herdini, Camelia; Yudistira, Danu; Mary, Cynthia
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1087

Abstract

Background: Sinonasal cancer is considered a rare disease and data concerning the disease in Indonesia still requires extensive research. This study aimed to describe the factors that contribute to the incidence and outcome of sinonasal cancer. Methods: This was a descriptive study conducted at the Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Sardjito General Hospital Yogyakarta between January 2017 and December 2022. Data regarding histopathological type, sex, age, location of tumor, presence of metabolic syndrome, staging, treatment, overall survival, and cancer recurrence were extracted from the patient’s medical records. All patients diagnosed with sinonasal cancer within the period were included in the study. Results: A total of 117 patients were included in this study ranging from 11 to 85 years of age and averaging 54,5 years. Most patients were diagnosed within the age range of 51 – 60 years. SCC was found to be the most common and it was more prevalent in males than in females. More patients were found to have suprastructure tumors. Most patients were not recorded to have metabolic syndrome. The majority of patients were diagnosed in the late stage of sinonasal cancer and overall survival for most cases was death. More patients received 2 or less therapy, followed by patients who received all 3 types of treatment. Recurrency was found in only 1,7% of all cases. Conclusion: Several conditions can affect the incidence and outcome of sinonasal cancer which include sex, age of diagnosis, presence of risk factors (e.g. metabolic syndrome), location of tumor, staging, treatment, recurrence, and the histopathological type.
Profile of Primary Brain Tumor Patients Who Received Radiotherapy at Hasan Sadikin General Hospital Bandung in 2020-2021 Rahmawaty, Siti Fira; Kusumadjati, Adji; Utama, Marhendra Satria
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1006

Abstract

Background: A brain tumor is a tumor that is most known for its dangerous progressivity. Brain tumor is classified into primary and metastatic types. One of the management for primary brain tumors is radiotherapy. This study aims to elucidate the medical profiles and Karnofsky Performance Status (KPS) of patients with primary brain tumors with radiotherapy in Hasan Sadikin General Hospital based on a hospital-based cancer registry (HCBR) in 2020-2021.Methods: This study was conducted with a descriptive method. The sampling technique was total sampling using 22 medical records of primary brain tumor patients with radiotherapy from the year 2020-2021 which were registered in HCBR at the Radiotherapy Department, Hasan Sadikin General Hospital.Results: Primary brain tumor patients with radiotherapy were mostly from the 25-34 years age group (27.3%), male gender (68.2%), with a regional origin of West Priangan (45.5%), the chief complaint was headache (45.5%), with topography presence of overlapping lesion in the brain (ICD-O code C71.8) (27.3%), histopathological type is predominantly astrocytic tumors (22.7%), majority of patients underwent subtotal resection (59.1%), adjuvant radiation therapy was mostly indicated (40.9%), with all patients using Linac external beam radiotherapy (EBRT) radiation device. Almost all patients can finish radiotherapy (95.5%). The waiting time for radiotherapy is mostly 5-6 weeks (31.8%).Conclusions: Primary brain tumor infects more men than women, with a predominant age group of 25-34 years old. Histopathological findings are mostly of the astrocystic tumor type with most chief complain being headaches. The most common treatment is subtotal resection followed by radiotherapy using EBRT Linac with a positive one-year-postradiotherapy prognosis.
Supraventricular Tachycardia Induced by Cisplatin in a Patient with Breast Cancer: A Case Report Laksono, Sidhi; Kusharsamita, Hillary
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1066

Abstract

Introduction: Cisplatin is one of the most extensively used chemotherapeutic agents for treating many malignancies. Cisplatin chemotherapy, on the other hand, is linked to cardiotoxicity, which may vary from silent arrhythmias to heart failure to sudden cardiac death. In this article, we describe a case of supraventricular tachycardia induced by cisplatin in a breast cancer patient. Case Presentation: Our patient had no history of heart disease and had SVT during cisplatin administration. This condition resolved when the infusion was stopped and amiodarone was administered intravenously. The electrolyte levels were within the usual range. No abnormalities were detected on her echocardiography imaging. Primary cardiotoxicity from cisplatin was subsequently determined to be this patient's root cause of SVT. The patient also had an excellent response to the subsequent cycles of treatment. Conclusions: It is important to note that cisplatin therapy is associated with cardiac toxicity. Arrhythmias such as SVT have been associated with chemotherapy drugs. Hence the ECG has to be closely monitored during cisplatin administration. In addition, An ECG and echocardiogram should be done regularly to rule out the possibility of a secondary form of chemotherapy-induced arrhythmia. 

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