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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 585 Documents
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The Role of Neutrophil-to-Lymphocyte Ratio (NLR) as a Predictor of Lymph Node Metastasis in Papillary Thyroid Carcinoma Patients in Cipto Mangunkusumo Hospital Yulian, Erwin Danil; Andrian, Christopher Rico
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1398

Abstract

Background: Pre-treatment inflammatory parameters based on blood tests can serve as prognostic predictors in cancer, one of which is an elevated neutrophil-to-lymphocyte ratio (NLR). However, the role of NLR as a predictor of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) remains controversial. This study was conducted to evaluate the role of NLR as a predictor of LNM in patients with PTC.Method: This cross-sectional analytical study was conducted at RSUPN Dr. Cipto Mangunkusumo from March to September 2024. The research utilized secondary data from the medical records of PTC patients. The receiver operating characteristic (ROC) curve was employed to determine the NLR cut-off value. Bivariate analysis was performed using the Chi-Square test, and multivariate analysis was conducted using multiple logistic regression. A p-value of 0.05 was considered statistically significant.Results: A total of 75 subjects were included in the study. ROC analysis showed an area under the curve (AUC) of 0.656. An NLR cut-off value of 2.34 yielded significant results (p = 0.03; OR = 3.15; 95% CI: 1.22–8.14) with sensitivity and specificity of 64%. Tumor size (p = 0.019), extrathyroidal extension (p 0.001), and papillary thyroid carcinoma variants (p = 0.002) were significantly associated with LNM. Patients with tumor sizes 4 cm had a lower risk of LNM (OR 0.28; 95% CI: 0.11–0.75). After adjusting for confounding variables, multivariate analysis revealed that subjects with high NLR had a 6.17-fold increased risk of LNM (aOR = 6.17; 95% CI: 1.68–22.64). Conclusion: Preoperative NLR in PTC patients is significantly associated with LNM. Tumor size, extrathyroidal extension, and aggressive variants of papillary thyroid carcinoma are significantly associated with LNM and influence the relationship between NLR and LNM.
Dosimetry Audit of IMRT and VMAT External Radiotherapy Techniques: Multi-Institutional Study in East Java Province Maqsuroh, Fiki Hurum; Zahro, Ummu Mar’atu; Dzulfikar, Ahmad Zaki; Harfiyyah, Vivin Fashihatil; Hentihu, Fatimah Kunti; Pawiro, Supriyanto Ardjo
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1258

Abstract

Background: The Multi-Leaf Collimator (MLC) application is utilized in the Linear Accelerator (LINAC) with Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) methods, both of which include advanced methods of administering radiotherapy, which aim to improve dose distribution and increase local tumour control by adjusting the external beam into a shape-specific tumour. Dosimetry audit is a crucial quality assurance procedure in radiotherapy facilities, ensuring patient dosing quality. This study aimed to simulate the dosimetry audit method of IMRT techniques and VMAT with point dose and dose delivery distribution evaluation. Method: The phantom utilized in this study was constructed from acrylic material and featured a C-shaped insert. It comprised a main body and an insert, with the body measuring 15 × 15 × 15 cm and the insert measuring 6 × 6 × 6 cm. The main body was fabricated from polymethyl methacrylate (PMMA) with a density of 1.17 g/cm³, serving as a surrogate for human tissue. The insert, composed of a resin and carbon powder mixture with a density of 1.19 g/cm³, was designed to represent both the organ at risk (OAR) and the planning target volume (PTV) in the study. Phantom images were taken with the center of the CT simulator, then radiation planning was performed with a PTV dose of 4 Gy/2 fractions (D95% 95%, D2% 107%, and Dmax 110%) and a maximum OAR dose of 2.8 Gy. This study was conducted at four radiotherapy centres in East Java province by conducting dosimetry audits on point doses using TLD and dose distribution by evaluating gamma index analysis using EBT3 Film.Results: The results of point dose readings using TLD at all centres and radiation techniques were still within the tolerance limit, namely ± 5%. Apart from that, to evaluate the gamma index using film, at three centres with the 3%/3mm criteria, the gamma passing rate was 90%. Conclusion: This method can be used as a reference in conducting dosimetry audits in radiotherapy using TLD and film
A Scoring System for Patients With Gastro-Intestinal Stromal Tumor Based on Preoperative Abdominal Computed Tomography Scans Findings and Neutrophil-Lymphocyte Ratio as A Predictor for Malignancy Risk Kusnadi, Dana Satria; Putranto, Agi Satria; Wibowo, Taufik Agung; Rahadiani, Nur; Kumalawati, July
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1386

Abstract

Background: The risk of malignancy in Gastrointestinal Stromal Tumors (GISTs) is currently determined based on the National Institute of Health (NIH) and the modified NIH consensus. Abdominal CT scans have been used to determine the characteristics of GIST; the neutrophil-to-lymphocyte ratio (NLR) has also been known to provide prognostic and predictive value in malignancies. In this study, we assessed and developed a scoring system for the malignancy risk of GIST patients based on CT scan findings and preoperative NLR values.Methods: This cross-sectional study was conducted using secondary data. CT scan findings include tumor size, location, shape, growth pattern, margins, contour, calcifications, ulceration, necrosis, organ invasion, vascular enlargement, lymphadenopathy, metastasis, and enhancement pattern. Malignancy risk data using histopathology results were obtained as a standard reference. Inclusion criteria comprised patients diagnosed with GIST through postoperative histopathology and immunohistochemistry, with complete preoperative contrast-enhanced CT scans and hematology test results. Subjects were excluded if they had incomplete data, very small tumors ( 0.5 cm), multiple GISTs or gastric cancer, infections (lung/urinary tract), or trauma at the time of NLR examination. Multivariate analyses were performed to identify predictors of malignancy risk. SPSS version 25 was used for data analysis.Results: A total of 57 subjects were included in the study. A cut-off point of 2.7 was obtained for the NLR value. Bivariate analysis showed that tumor growth patterns (p = 0.003), peritumoral vascular enlargement (p = 0.013), and high NLR values (p = 0.047) were associated with high malignancy risk. Further multivariate analysis showed exophytic growth pattern (p = 0.001, OR = 45.33), mixed growth pattern (p = 0.002, OR = 17.46), and high NLR (p = 0.010, OR = 8.95) as the predictors for malignancy risk. The scoring system using growth pattern and NLR was made with a maximum score of 3. Using a cut-off score of ≥ 2, the scoring system achieved a sensitivity rate of 77.19% and specificity of 81.25%.Conclusions: The malignancy risk of GIST can be assessed by evaluating tumor characteristics through preoperative abdominal CT scans and preoperative NLR value. A score of ≥ 2 based on tumor growth pattern and NLR can help clinicians to assess malignancy risk in GIST patients.
The Difference between Chronic Myeloid Leukemia before and during the COVID-19 Pandemic: A Retrospective Study from Dharmais Cancer Center Tadjoedin, Hilman; Suryana, Kresna Dharma; Hadisantoso, Dwi Wahyunianto; Siregar, Nia Novianti; Djamal, Rizky Syawaluddin; Setiawan, Lyana; Hartono, Bryan Arista; Kunigara, Manika Putri
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1365

Abstract

Background: Chronic myeloid leukemia (CML) is a rare disease, with a global incidence rate ranging from 10 to 15 cases per 1,000,000 population annually, constituting approximately 15% of all adult leukemia. The achievement of complete response in CML patients has been affected by the COVID-19 pandemic. This study aimed to determine differences in characteristics, survival, and complete hematological response (CHR) in CML patients before and after the COVID-19 pandemic at Dharmais Cancer Hospital.Method: A cohort retrospective was conducted using medical records among CML patients diagnosed and treated in 2018 to 2022 in Dharmais Cancer Hospital. Demographic, characteristics, and survival were described. Overall survival was analyzed using Kaplan-Meier and log-rank test, and bivariate analysis was used with the Chi-square and Fisher's exact test. Patients aged 18 years with CML confirmed by bone marrow analysis, and detected fusion of BCR-ABL were included, and multiple malignancies were excluded.Results: The study was conducted on 108 subjects (56 vs. 52, before and during the pandemic, respectively). The demographic characteristics in both periods showed that the majority of subjects were male (59.8% vs. 40.2%), had normal BMI (58.1% vs 41.9%), and had no comorbidities. However, there was a difference in age distribution. The subjects before the pandemic were predominantly over 40 years, while those during the pandemic were 18-39 years. A total of 91/108 subjects survived (49.5% before vs. 50.5% during the pandemic). The median overall survival was 55 vs. 52 months, with a p-value of 0.173. No significant association was found between the study period or history of COVID-19 infection and CHR. However, a significant association was observed between the CML phase and outcomes.Conclusion: No significant differences were observed in demographic or clinical characteristics, overall survival, or CHR among CML patients before and during the COVID-19 pandemic.
Potential Efficacy of Artificial Intelligence in Mammography for Breast Cancer Screening: Current Evidence from Meta-Analysis Amalia, Nurlinah; Nurdiana, Farah; Pradyaputri, Naura Shafa
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1353

Abstract

Background: Artificial intelligence (AI), an advancing field of data science, has been applied in mammography screening for early detection of breast cancer in an effort to enhance screening participants' outcomes. Screening is crucial to halting the spread of breast cancer. These days, mammography is typically used in screenings conducted by radiologists. Therefore, alternative diagnostic methods are needed to provide a diagnostic solution that is efficient in terms of both time and resources. This review aims to evaluate the accuracy of AI applications in radiology, specifically in mammographic image interpretation, to determine whether AI can serve as an evidence-based recommendation for breast cancer screening. Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines. Literature searches were performed across multiple databases, including PubMed, ScienceDirect, and SpringerLink. The inclusion criteria were based on the PICOs framework, focusing on individuals at risk of breast cancer undergoing mammographic screening, where AI was used to interpret the images and compared to a radiologist. Exclusion criteria included studies involving patients with diagnosed breast cancer, non-human studies, non-English, books, paid articles, and review articles. The primary outcomes of interest were the sensitivity and specificity of AI in detecting breast cancer from mammograms. Meta-analysis was conducted using STATA software, while the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was employed to evaluate study qualityResults: A total of 2,412,102 mammograms from twenty-six studies were included in this analysis. The results indicated that AI demonstrated moderate sensitivity [84% (99.92% CI: 99.91 – 99.92)] and specificity [87% (99.97% CI: 99.97 – 99.97)] with a p-value (0.001). Conclusions: These results suggest that AI has potential as a breast cancer diagnosis tool in the future. Radiologists can become more accurate with AI algorithms, which are useful for screening, cutting down on unnecessary recall rates, and reducing effort.
Factors Influencing Chemotherapy Adherence in Patients with Triple-Negative Breast Cancer: A Cross-Sectional Study at the National Cancer Center, Dharmais Hospital, Indonesia Suryana, Kresna Dharma; Girsang, Ermi; Nasution, Sri Lestari Ramadhani; Tadjoedin, Hilman; Anjasari, Melati Salsabila
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1653

Abstract

Background: Triple‑negative breast cancer (TNBC) is an aggressive subtype of breast malignancy with limited targeted therapy options, making adherence to systemic therapy critical for improving survival outcomes. This study aimed to determine the sociodemographic, clinical, and psychosocial factors influencing adherence to systemic therapy among patients with TNBC, especially in resource-constrained settings.Method: A cross-sectional observational study was conducted among 105 female TNBC patients undergoing systemic therapy at the Dharmais Cancer Hospital. Adherence was defined as completion of ≥ 85% of planned systemic therapy cycles without unjustified delay or omission. Data were collected from medical records and structured questionnaires, covering sociodemographic, clinical, and psychosocial characteristics, including psychological distress measured using the Depression Anxiety Stress Scale-10 (DASS-10). Bivariate and multivariate logistic regression analyses were performed to identify factors associated with non-adherence.Results: Median patient age was 48 years (range 25–76), and the majority worked as housewives (58.1%). Most had completed high school education (51.5%), and nearly half earned less than IDR 3 million monthly (48.6%). Clinically, most patients were diagnosed at stage III (40.9%) or IV (38.1%), with comorbidities present in 41.9%, predominantly hypertension (19.1%). While overall adherence to systemic therapy was relatively high, logistic regression analysis identified significant predictors of non-adherence. Comorbid conditions (p 0.01; OR 5.7; 95% CI: 1.94–16.02) and severe levels of anxiety/depression based on DASS-10 scores (p = 0.015; OR 5.65; 95% CI: 1.08–29.42) remained independently associated with lower adherence (p 0.05), underscoring the importance of psychological and clinical support to improve treatment compliance.Conclusion: Comorbid conditions and psychological distress significantly contribute to non-adherence among TNBC patients. Integrating psycho-oncology support and comorbidity management into routine cancer care may enhance treatment adherence and outcomes.
The relevance of family caregiver support to the resilience and spirituality of advanced breast cancer patients through the perspective of religious psychology Sihombing, Sarah Natasya; Ranimpi, Yulius Yusak; Harisantoso, Imanuel Teguh
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1351

Abstract

Introduction: Based on the type of disease, breast cancer is the most common. Individuals who suffer from this disease will experience several changes, including physiological, psychological, social, and spiritual aspects. In the psychological aspect, it can be seen from changes in attitude and behavior, such as depression, anxiety, and emotional instability. Regarding this matter, breast cancer patients who are already in the advanced stage and need help and support from family members to have spirituality and resilience to live well. The research aims to describe and analyze the relevance of family caregiver support for the resilience and spirituality of advanced breast cancer sufferers from the perspective of religious psychology.Method: This research uses qualitative research methods with a case study research design. The data collection technique used in this research was by interviewing the participants involved, namely two women aged 59 years and 60 years who had advanced-stage breast cancer and two family caregivers.Results: The results of the research stated that the support of a family caregiver who always provides support, both spiritually and emotionally, has a great influence on the spirituality and resilience of breast cancer sufferers. This can be seen from the lower level of pain in breast cancer sufferers who have strong resilience and a better ability to overcome the problems faced by breast cancer sufferers who have high spirituality.Conclusion: Support from family caregivers emotionally, practically, and financially provides encouragement and comfort for patients with advanced breast cancer, which reduces anxiety in patients and increases the resilience and spirituality of patients. The resilience of patients with advanced breast cancer can be formed because there is reinforcement that fosters hope for survival and fight from family caregivers.
EORTC QLQ C-30 Quality of Life Assessment in Breast Cancer Patients Undergoing Chemotherapy at Mohammad Hoesin Hospital, Palembang. Plorinda, Vanesha; Qodir, Nur; Liberty, Iche Andriyani; Umar, Mulawan; Ikhsan, Diyaz Syauki
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1549

Abstract

Background: Breast cancer has a high prevalence in Indonesia, with many patients undergoing chemotherapy that impacts their daily lives. Measuring quality of life (QoL) is essential to capture physical, emotional, and social challenges, and the EORTC QLQ-C30 provides a validated tool for this purpose. This study aimed to assess the QoL of breast cancer patients undergoing chemotherapy at RS Mohammad Hoesin Palembang. Methods: This study used a descriptive observational method with a cross-sectional approach. The sample consisted of 106 breast cancer patients undergoing chemotherapy at RS Mohammad Hoesin Palembang, with inclusion criteria of patients ≥ 18 years undergoing chemotherapy and exclusion of those with severe comorbidities or cognitive impairment. Data were collected through interviews using the EORTC QLQ-C30 questionnaire.Results: The study assessed the quality of life of breast cancer patients undergoing chemotherapy at RS Mohammad Hoesin Palembang using the EORTC QLQ-C30. The results showed that the average functional scale score was 78.6 ± 5.85, with the highest in emotional function (84.98 ± 9.27) and the lowest in role function (72.33 ± 18.77). On the symptom scale, the mean score was 57.88 ± 13.91, with constipation being the most reported symptom (74.75 ± 19.14), while insomnia and decreased appetite were the least reported (37.81 ± 11.90). The overall health status score averaged 77.56 ± 11.92. The highlight of this study is that although emotional functioning is relatively well-preserved, role limitations and physical symptoms, particularly constipation, substantially affect patients’ quality of life, underscoring the need for supportive care strategies during chemotherapyConclusions: The quality of life of breast cancer patients undergoing chemotherapy, based on the EORTC QLQ-C30 results, indicates that the functional scale is better than the symptom scale and general health status. Routine and comprehensive quality of life assessments are essential for understanding the impact of treatment and improving the clinical management of patients.
LncRNA in Hepatic Cancer: Diagnosis, Prognosis, and Therapeutic Targeting Abady, Mariam M; Shalaby, Reham A; Bekhet, Marwa
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1395

Abstract

Long non-coding RNAs (lncRNAs) are abundant in the genome and play important regulatory roles. However, classifying and annotating lncRNAs is challenging due to their diverse isoforms, complex functions, and interactions with other genes. Unlike protein-coding genes, lncRNAs exhibit dynamic changes, cell-specific characteristics, and influence various physiological and developmental processes. Dysregulation of lncRNAs is associated with genetic, immunological, metabolic, and tumoral diseases, including liver cancer, a highly lethal malignancy. In liver carcinogenesis, lncRNAs interact with proteins, DNA, and RNA to modulate gene expression, activate oncogenes, or inhibit tumor-suppressor genes. Therapeutic targeting of lncRNAs has emerged as a promising approach for cancer treatment, although clinical trials have shown varying efficacy and toxicity. This review summarizes recent advances on the role of lncRNAs in liver cancer, focusing on their involvement in tumor progression, metastasis, and drug resistance. It highlights their potential as diagnostic, prognostic, and therapeutic targets, discusses key challenges in lncRNA research, and explores emerging strategies for their clinical application in precision medicine.
Factors Associated with the Incidence of Thyroid Carcinoma at Mohammad Hoesin Hospital, Palembang Umar, Mulawan; Ad duri, Ahmad Shahaf; Pariyana, Pariyana; Qodir, Nur; Rasyid, Riana Sari Puspita
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1372

Abstract

Background: Thyroid carcinoma is the most common endocrine malignancy, with its incidence continuously increasing annually. In Indonesia, thyroid cancer represents one of the highest prevalence malignancies, with cases projected to rise each year. This study aims to determine the risk factors associated with the incidence of thyroid carcinoma at Mohammad Hoesin Hospital, Palembang.Method: This study is a case-control observational analytic study using secondary medical record data of thyroid carcinoma patients as a case group and non-carcinoma patients as a control group in the Surgery Department of Mohammad Hoesin Hospital, Palembang, from January 2022 to December 2023, selected by simple random sampling. This study will process and analyze data using univariate analysis methods, bivariate analysis with the Chi-square test, and multivariate analysis with binary logistic regression using SPSS statistical software 29 version.Results: The study included 65 thyroid carcinoma patients as the case group and 65 non-carcinoma patients as the control group. Factors influencing thyroid carcinoma were gender (p 0.001), age (p 0.001), BMI (p 0.001), and history of thyroid disease (p 0.001). Conclusion: This study demonstrated a strong and statistically significant influence of gender, age, BMI, and a history of prior thyroid disease on the likelihood of developing thyroid cancer. These findings underscore the critical importance of these demographic and clinical factors in the risk assessment and screening of individuals for thyroid carcinoma in this population.

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