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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 611 Documents
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Fibrovascular Polyps of the Hypopharynx: A Case Report Herdini, Camelia; Wirata, I Komang Praba Edi; Indrasari, Sagung Rai; Yudistira, Danu; Alamanda, Monik
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1352

Abstract

Introduction: Fibrovascular polyps are very rare, non-cancerous growths in the hypopharynx, though they can occur anywhere in the pharynx. Surgical excision is the definitive treatment to alleviate the patient's symptoms with an excellent outcome. This case report aims to share knowledge about the clinical presentation and treatment of this rare condition. Case Presentation: A 45-year-old man complained primarily of recurrent sore throat and frequent choking episodes, particularly during sleep. He also felt a mass in his deep throat, which he felt in his mouth just before swallowing, particularly when he vomited. A pedunculated mass originating from the lateral hypopharyngeal wall is detected during physical examination. After the mass was completely resected, he received proton pump inhibitors (PPI) and postoperative antibiotics.Conclusion: For fibrovascular polyps, definitive surgical excision is the preferred treatment. It is recognized that with total resection, malignant transformation and disease recurrence are relatively rare.
Future Prospects and Challenges of Hyperthermic Intraperitoneal Chemotherapy in Indonesia Pratama, Muhamad Airel; Ihsan, Syarifaha; Linangkung, Arum
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1321

Abstract

Background: Peritoneal carcinomatosis (PC) is a condition characterized by the spread of cancer to the peritoneum, often indicating advanced disease and poor prognosis. Traditionally viewed as a terminal illness, PC typically shows limited response to systemic chemotherapy, prompting a shift towards local-regional management through cytoreductive surgery (CRS) followed by heated intraperitoneal chemotherapy (HIPEC). This study aims to evaluate the potential of introducing HIPEC as a treatment for PC in Indonesia.Methods: A Literature search was conducted in June 2024 by using PubMed as the main electronic database. General terms related to the search, such as “hyperthermic intraperitoneal chemotherapy OR HIPEC”, “peritoneal carcinomatosis OR PC”, “cancer”, and “Indonesia” were used in screening. We included clinical trials that focused on HIPEC for the treatment of PC, comprehensive review articles that discuss HIPEC and its application, as well as studies that provided cost analysis of implementing HIPEC. Two reviewers (MA and SI) were involved in screening and full-text reviews. A meeting was held daily to standardize the reviewers’ understanding. Discussion with one reviewer (AL) was done to analyze results and come up with a suitable discussion.Results: Numerous trials demonstrate the significant benefits of CRS and HIPEC for patients with PC of various origins. Several guidelines outline specific criteria for HIPEC eligibility to ensure optimal outcomes, while others consider the procedure as experimental. Despite its effectiveness, its high costs act as its main challenge, particularly regarding reimbursement policies. CRS-HIPEC, however, remains cost-effective when considering life-years gained compared to standard chemotherapy. Conclusions: While international studies have demonstrated the effectiveness of CRS-HIPEC in treating peritoneal carcinomatosis, the application of this treatment in Indonesia remains largely untested. This study highlights the need for further research on the feasibility, clinical outcomes, and infrastructure requirements for implementing HIPEC in Indonesia. To effectively implement HIPEC in Indonesia, it is essential to consider a few factors, including but not limited to reimbursement policies, adoption of eligibility guidelines, and establishing multidisciplinary standards.
Adrenocortical Carcinoma with Infiltrated and Ruptured Inferior Vena Cava in Adult Woman Maligan, Deden Jinar Wahyudi; Maulana, Akhada; Danurdoro, Aria; Santosa, Hilda; Kumaladewi, Baiq Ratna
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1355

Abstract

Introduction: Adrenocortical carcinoma (ACC) is a malignant tumor that develops in the adrenal cortex. This case involves a rare, aggressive disease that demands specialized knowledge and optimal treatment for a favorable prognosis. This study aims to present the case of a woman with a right-sided ACC extending into the inferior vena cava (IVC), managed through radical resection and IVC repair.Case Presentation: A 50-year-old female presented with a complaint of a lump in the upper right abdomen, which she noticed three months ago. Abdominal computed tomography (CT) scan with contrast revealed a solid, inhomogeneous mass in the right suprarenal region measuring 12 cm x 11 cm. However, three days before the scheduled operation, the patient was brought to the emergency department with complaints of weakness and muscle weakness throughout the body. During the surgery, an adrenalectomy on the right side revealed a tumor infiltrating the IVC, causing venous rupture. The histological examination of the right adrenal tissue revealed ACC, infiltration of tumor cells beyond the capsule, lymphovascular infiltration, and no evidence of tumor cell infiltration into the kidney tissue. The treatment approach for this ACC case involved a complete surgical resection with open adrenalectomy and vena reconstruction. Postoperative results indicated improved patient condition, including symptom relief and favorable biochemical evaluation after surgery.Conclusion: Our patient had a right-sided ACC with local vascular infiltration into the IVC.
Comparison of USG and CT Scan Findings in Late Stage Ovarian Cancer in Dr. Cipto Mangunkusomo National Referral Hospital Sugianto, Sugianto; Purwoto, Gatot; Nuranna, Laila; Putra, Andi Darma; Nuryanto, Kartiwa Hadi; Shelly, Vannesa
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1369

Abstract

Background: Ovarian cancer remains a leading cause of gynecological cancer mortality due to its typically late-stage diagnosis. Current diagnostic methods include ultrasonography (USG) and computed tomography (CT), with CT generally favored for its higher sensitivity and specificity. However, CT's limited availability in resource-poor settings raises the need to assess USG’s diagnostic viability in detecting advanced ovarian malignancies. This study aims to compare the diagnostic accuracy of USG and CT in detecting adnexal masses, ascites, lymph node involvement, omental cake, and distant metastasis in advanced-stage ovarian cancer.Method: A cross-sectional comparative study was conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from January 2021 to December 2023. The study included 70 patients with histologically confirmed advanced ovarian cancer (FIGO stages III and IV) who underwent both USG and CT before surgical intervention. Diagnostic performance measures, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for each modality, using surgical findings as the gold standard. Statistical analysis was performed using SPSS software, with significance set at p 0.05.Results: Both imaging methods demonstrated high specificity (100%) and PPV for adnexal mass detection, indicating reliability in confirming positive cases. However, CT showed superior sensitivity and accuracy across most parameters, particularly for ascites (sensitivity: 93.94%), lymph node involvement (56%), and distant metastases (36.67%). In comparison, USG had lower sensitivity, especially for distant metastases (6.67%), but maintained high specificity. These findings suggest that while USG is effective for initial assessment, CT is preferred for detailed staging.Conclusion: This study confirms CT’s superiority over USG in comprehensive ovarian cancer staging, particularly for detecting metastatic indicators. However, USG’s accessibility and affordability support its role as an initial diagnostic tool, especially in resource-limited settings. A multimodal approach, integrating USG for preliminary screening with CT for confirmation, may optimize diagnostic outcomes. Further research should focus on enhancing USG’s sensitivity to bridge the diagnostic gap in underserved regions.
Differences in Tissue Factor Positive Microparticle (Tf+Mps) Levels in Breast Cancer Patients Before and After Chemotherapy Adnyana, I Wayan Losen; Rahayu Srikandi, Ni Made 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.v19i4.1392

Abstract

Background: Cancer-associated thrombosis is a well-known phenomenon that leads to significant patient morbidity and mortality. Malignancy increases the risk of thrombosis, and chemotherapy further elevates this risk. The pathophysiological mechanisms underlying this process are still poorly understood. High levels of tissue factor positive microparticle (TF+MPs) are a risk factor for thrombosis, with levels increasing in patients with cancer. This study aims to find the impact of chemotherapy on TF+MPs levels in breast cancer patients before and after chemotherapy. Method: This longitudinal observational analytic study involved breast cancer patients undergoing chemotherapy at Prof. Dr. I.G.N.G. Ngoerah General Hospital (RSUP), Denpasar, from March to August 2024, in patients above 18 years of age. TF+MPs levels were measured using the Enzyme-linked Immunosorbent Assay (ELISA) method. A paired T-test analyzed the differences in TF+MPs levels in breast cancer before and after chemotherapy.Results: A total of 31 breast cancer cases undergoing chemotherapy were studied. The average age of breast cancer patients was 51.16 ± 6.93 years. No Special Type breast cancer (61.3%) was the dominant type found. Stage III was predominantly observed in breast cancer patients (38.8%), and poorly differentiated grading had a high percentage in breast cancer cases (51.8%). The median body mass index (BMI) of breast cancer patients was 24.3 (18.0-39.7) kg/m². The levels of TF+MPs showed a significant difference in breast cancer patients before chemotherapy, measured at 0.42 ± 0.17 pg/mL, and after undergoing chemotherapy, measured at 0.66 ± 0.28 pg/mL. This represents an increase in TF+MPs levels of 0.24±0.28 pg/mL as observed in a paired t-test (p 0.001).Conclusion: This study demonstrates that chemotherapy significantly increases the levels of TF+MPs in breast cancer patients. Further study is warranted to investigate the clinical implications of monitoring TF+MPs for thromboprophylaxis strategies
Risk Factors and Infection Patterns of Febrile Neutropenia after Induction Chemotherapy in Patients with Acute Myeloid Leukemia Pratiwi, Made Sindy Astri; Agustini, Made Priska Arya; Rena, Ni Made Renny Anggreni; Bakta, I Made
Indonesian Journal of Cancer Vol 20, No 1 (2026): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i1.1495

Abstract

Background: Febrile neutropenia (FN) is a serious cause of mortality in acute myeloid leukemia (AML), with a mortality rate of 10-30%. FN often occurs after receiving induction chemotherapy in AML. Patients with FN are susceptible to various infections, but the pathogens are often unknown. It is important to predict FN and identify the specific pathogen of infection. This study aims to identify risk factors and infection patterns of FN after induction chemotherapy in AML patients.Methods: This research was a retrospective cohort study located at Prof. I.G.N.G Ngoerah General Hospital, Bali. The samples were AML patients aged ≥ 18 years treated with induction chemotherapy, cytarabine plus daunorubicin, from 2018 to 2022. The risk factors assessed were age, gender, body mass index, ECOG status, comorbidity, and pre-treatment blood count. The patients who had FN would be assessed for the incidence of infection through microbiological examination.Results: This study included 92 patients aged 19 to 76 years old. As many as 68 patients (73.9%) had FN. A multivariate analysis showed ECOG status (p = 0.004; OR 6.680; 95% CI 1.830 – 24.385), comorbidity (p = 0.010; OR 7.394; 95% CI 1.628 – 33.575), and haemoglobin level ≤ 8 g/dL (p = 0.015; OR 6.043; 95% CI 1.449 – 33.265) as significant risk factors. The most common site of infection was the respiratory tract (63.75%), followed by genitourinary (15%) and skin (8.75%). Most specimens were obtained from sputum (35%), blood (26.25%), and urine (15%). Streptococcus sp., Staphylococcus sp., and Escherichia coli were the top three most common pathogens found. Conclusions: ECOG status, comorbidity, and low haemoglobin level were associated with FN after induction chemotherapy of AML. Patients with FN are susceptible to various infections. The identification of risk factors and infections of FN will facilitate consideration of further treatment in AML.
The Relationship of Immunohistochemical Expression of BRAFV600E with Clinical Features and Histopathological Subtypes in Papillary Thyroid Carcinoma (PTC) Masriana, Masriana; Betty, Betty; Delyuzar, Delyuzar; Alferraly, Ibnu; Dahlan, Nadjib
Indonesian Journal of Cancer Vol 20, No 1 (2026): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i1.1434

Abstract

Background: Papillary thyroid carcinoma (PTC) is an indolent thyroid malignancy with clinicopathological features that play a role in prognosis. BRAFV600E mutations in PTC are associated with poor prognosis, and BRAFV600E immunohistochemical staining exhibits high specificity and sensitivity. This study aims to determine the association between BRAFV600E immunohistochemical expression and clinical features and histopathological subtypes in PTC.Method: This analytical observational study utilizes a cross-sectional approach, conducted from March to December 2024 at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Sumatera Utara, and affiliated hospitals. A total of 35 PTC samples were selected and continued with BRAFV600E immunohistochemical staining. Clinicopathological data, including age, gender, tumor size, lymph nodes, metastasis, lymphovascular invasion, disease stage, and PTC subtype, were collected. Statistical analysis was performed using Somers'd (ordinal-ordinal) and Eta (nominal-ordinal) correlation test in SPSS.Results: PTC was most prevalent among females and the age group under 45 years. Predominant clinical features included tumor sizes exceeding 4 cm (T3), an absence of lymph node involvement (N0), and no detectable metastasis (M0). The classic subtype emerged as the most frequent histopathological variant, typically presenting without lymphovascular invasion (LVI) and diagnosed at Stage I. While most parameters showed no significant statistical association with BRAFV600E expression (p 0.05), a significant relationship was identified specifically regarding the cancer stage (p 0.05).Conclusion: There are no significant associations observed between BRAFV600E immunohistochemical expression and the majority of clinicopathological factors. However, a significant relationship with disease stage was identified. These findings suggest that BRAFV600E expression may have potential value as an indicator of disease stage in PTC.
Integrating Molecular, Digital, and Morphological Insights: The Unavoidable Future of Oncologic Diagnostics Hasibuan, Arie Widiansyah; Delyuzar, Delyuzar
Indonesian Journal of Cancer Vol 20, No 1 (2026): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i1.1620

Abstract

The remarkable progress of Anatomical Pathology over recent decades has fundamentally reshaped the landscape of oncologic diagnostics. From the early era when microscopic interpretation of routine hematoxylin-eosin (HE) stained sections formed the diagnostic cornerstone, the discipline has evolved into a complex hub of integrated biological data. This journey began with mastery of histopathological and cytological morphology and expanded to the use of histochemical and immunohistochemical stains, enabling precise visualization of specific proteins. The transformation continued as molecular technologies became routinely implemented in major laboratories, extending diagnostic capacity far beyond the limits of the optical microscope [1]. Advances in molecular techniques have opened a new dimension in cancer understanding. Polymerase chain reaction (PCR), real-time quantitative PCR, and reverse transcription PCR enable highly sensitive detection of gene mutations or transcripts, including EGFR mutations in pulmonary adenocarcinoma and BCR-ABL fusion transcripts in leukemia. Fluorescence in situ hybridization (FISH) adds the ability to visualize gene amplification or chromosomal rearrangements directly within cell nuclei, for example, to confirm HER2 amplification in breast carcinoma or ALK rearrangements in lung carcinoma. The most dramatic leap has come with next-generation sequencing (NGS), which uses massively parallel sequencing. It can interrogate hundreds to thousands of genes simultaneously. Targeted gene panels, whole-exome sequencing, and even whole-genome sequencing facilitate identification of driver mutations, copy number variations, and gene fusions in a single analysis. Tumor mutational burden and microsatellite instability status have now been recognized as critical biomarkers in selecting patients for immunotherapy. Moreover, transcriptomics, proteomics, and metabolomics, collectively referred to as “omics”, provide comprehensive insight into the interplay of genes, proteins, and metabolites that govern tumor biology and allow detection of germline mutations for familial risk assessment. The emergence of liquid biopsy, through analysis of circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs), adds the ability to dynamically monitor the development of resistance mutations and therapeutic response without invasive procedures [1,2]. At the same time, digital technologies and artificial intelligence (AI) are revolutionizing the practice of pathology. Digital pathology using whole slide imaging (WSI) replaces glass slides with high-resolution digital files that can be stored, shared, and algorithmically analyzed. Deep-learning algorithms are now capable of highlighting tumor areas, quantifying proliferation indices such as Ki-67, and even predicting genetic mutations directly from HE images. Integration of AI not only accelerates diagnosis and reduces interobserver variability but also transforms histomorphologic images into quantitative data that can be correlated with clinical outcomes. These developments reposition the pathologist from a mere “slide reader” to an integrator of biological information combining morphology, molecular data, and digital analytics [2–5,7]. Despite the force of these innovations, morphology remains an irreplaceable foundation. Evaluation of tissue architecture in histopathology and cytology, and the recognition of growth patterns, continue to provide essential biological context that cannot be fully supplanted by genomic data. Histologic grading systems such as Nottingham for breast carcinoma and Gleason for prostate carcinoma remain critical determinants of risk stratification and therapeutic planning. Assessment of surgical margins, selection of representative tumor areas for further molecular analysis, and correlation with radiologic findings require the pathologist’s expertise as curator of tissue. Without quality control anchored in microscopic evaluation, molecular results risk being misleading [1]. Thus, the prediction that “pathologists will abandon the microscope” is only literally true because optical devices may be replaced by WSI monitors. It does not signify abandonment of morphological analysis itself [3–5]. This paradigm shift carries broad implications for every branch of oncology. Medical oncologists rely on molecular findings to guide targeted therapy; surgeons require accurate information to determine resection margins; and genetic counselors assess familial risk based on germline alterations. The concept of “integrated diagnosis” emphasized in the 5th edition of the World Health Organization classification of tumors provides the modern framework: the final diagnosis synthesizes morphology, immunohistochemistry, and molecular data into a single comprehensive report [1]. Contemporary cancer therapy decisions from the selection of tyrosine kinase inhibitors to checkpoint inhibitor immunotherapy can only be reached through such multidimensional interpretation [2]. Adoption of these advanced technologies demands robust infrastructure, significant financial investment, and personnel with bioinformatics expertise. Disparities between major referral centers and regional hospitals must be addressed so that progress does not widen gaps in cancer care. Issues of genomic data privacy, clinical validation of analytic pipelines, and legal responsibility for AI-assisted decisions require careful attention. Governments, educational institutions, and hospitals must invest in molecular pathology and bioinformatics curricula and prepare appropriate regulatory frameworks [7]. Anatomical Pathology is now entering an era in which the role of the pathologist has shifted from mere microscopic examiner to architect of integrated cancer biology data. The strengths of NGS, FISH, advanced PCR, omics, and liquid biopsy have opened new perspectives on cancer pathogenesis, precision therapy, and dynamic disease monitoring. Yet these advances do not diminish the role of morphology; rather, they reinforce its status as the foundation upon which molecular analysis and AI applications depend [1-5,7]. All oncology stakeholders must work together to build infrastructure and collaborative networks so that cancer services in Indonesia are fully prepared for the era of precision diagnostics, where molecular, digital, and morphological integration becomes the gold standard of modern cancer management.
The Role of Tumor-Infiltrating Lymphocytes in Ovarian Cancer Prognosis: A Systematic Review on Immune Subtypes and Spatial Distribution Kusumastuti, Sanindita; Hellyanti, Tantri; Kodariah, Ria
Indonesian Journal of Cancer Vol 20, No 1 (2026): March
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i1.1433

Abstract

Background: Tumor-infiltrating lymphocytes (TILs) are key components of the immune microenvironment in ovarian cancer, influencing disease progression and clinical outcomes. However, the prognostic significance of different TIL subtypes, including CD8+, CD4+, FOXP3+ regulatory T cells, and CD20+ B cells, remains inconsistent across studies. This systematic review aims to synthesize current evidence on the prognostic roles of these immune subtypes, with a focus on their spatial distribution within the tumor microenvironment and associations with overall survival (OS) and progression-free survival (PFS) in ovarian cancer. Methods: A systematic search was conducted using the PRISMA 2020 guideline protocol and was registered under PROSPERO with registration number CRD42025638744. Several databases, including PubMed, Scopus, and Google Scholar, were included to obtain articles, using keywords related to ovarian cancer, TILs, immune subtypes, and prognosis. Studies published in peer-reviewed journals without time restrictions were included. Selection criteria focused on studies that reported the density and localization of TIL subtypes and their association with clinical outcomes.Results: Fifteen studies met the inclusion criteria, involving 7,982 ovarian cancer patients. CD8+ TILs, together with CD20+ B cells and memory T cells, were consistently associated with better clinical outcomes, particularly when localized within intraepithelial regions. CD4+ T cells exhibited diverse prognostic effects depending on their polarization, where FOXP3+ regulatory T cells were linked to poor prognosis due to their immunosuppressive functions. The spatial distribution of TILs was a critical determinant of their prognostic value, with intraepithelial TILs showing stronger anti-tumor activity than stromal TILs. Variability in detection methods, cut-off values, and tissue sampling contributed to inconsistencies across studies.Conclusion: While TILs phenotypes may predict clinical outcome in ovarian cancer patient, their spatial distribution must be taken into consideration to sharpen analysis. To establish a more reliable prognostic marker, methodologies using standardized TIL thresholds should be implemented, hence the need for further studies.
Periorbital Necrotizing Fasciitis in Lung Adenocarcinoma Patient Receiving Afatinib: A Case Report Kusumawardani, Ida Ayu Jasminarti Dwi; Tan, Leviani; Indraswari, Putu Gita; Yuliawati, Putu; Wiradana, A.A. Gde Agung Anom Arie
Indonesian Journal of Cancer Vol 20, No 1 (2026): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i1.1417

Abstract

Background: Afatinib is a second-generation Tyrosine Kinase Inhibitor (TKI) approved by the Food and Drug Administration (FDA) as first-line therapy for advanced Non-small cell lung cancer (NSCLC) with distant organ metastasis. However, afatinib has been reported to cause several side effects. Here, we report a case of periorbital necrotizing fasciitis, potentially associated with afatinib use, presenting as a grade 3 side effect in a 59-year-old woman with stage IVB lung adenocarcinoma. This is the first literature reporting afatinib-related periorbital necrotizing fasciitis, a rare sight-threatening infection.Case Presentation: A 59-year-old female patient came to the Emergency Room with a protruding left eye, which is accompanied by redness, purulent discharge, and a blackish wound around the left eye area for the last 5 days. The patient had been diagnosed with stage IVB lung adenocarcinoma (T4N3M1c) six months ago. Previously, she underwent chemotherapy with a combination of Gemcitabine and Carboplatin. The patient then underwent 20 cycles of radiotherapy followed by immunotherapy using afatinib. The patient was then admitted with suspected necrotizing fasciitis of the left periorbital area due to side effects of afatinib. She was given ceftriaxone 2 grams every 24 hours intravenously (IV), analgesics IV, methylprednisolone IV, gentamicin eye drops, and regular wound care. After several days of treatment, the patient had significant improvement. Afatinib therapy was temporarily stopped. Re-evaluation at one month showed significant improvement in the patient's left periorbital area. Afatinib therapy was then continued at a lower dose of 30 mg every 24 hours.Conclusions: Good education and caution are still needed for patients who were given afatinib. More studies on the side effects of afatinib are needed to identify predisposing factors and establish a consensus on the management of afatinib-induced periorbital necrotizing fasciitis in NSCLC patients.

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