CHARACTERISTICS OF RECURRENCE NASOPHARYNGEAL CARCINOMA IN HASAN SADIKIN HOSPITAL PERIOD 2017-2019

Introduction: Nasopharyngeal carcinoma is a malignancy that occurs in the squamous epithelium in the nasopharynx region. Recurrent Nasopharyngeal carcinoma is defined as tumor recurrence after the complete remission. Patients with recurrent NPC always experience local, regional, or both failure, with or without distant metastases and can damage surrounding tissue.. Methods: This research method was a retrospective descriptive based on medical record data in patients with recurrent nasopharyngeal carcinoma at ORL-HNS outpatient ward subdivision of Head Neck Surgery, RSHS, Bandung from 2017 to 2019. Result: In RSHS Bandung, there was 1727 patient NPC period 2017-2019. There was 135 recurrent nasopharyngeal carcinoma patients (7,8 %) consist of 96 male and 39 female, aged over 40 years as many as 107 patients. More patients were found in T3-T4 (56%), N2-N3(56%), M0 (91%), stage III-IV (75%). The duration of the patient experienced a relapse after initial therapy for more than 24 months (52%). Conclusion: Characteristics of recurrent nasopharyngeal carcinoma most of them come with stage III-IV, T3-T4 without distant metastases, with a recurrence within less than 24 months. There was 7,8% recurrent nasopharyngeal carcinoma patients Keywords: Charactherisic, Nasopharyngeal Carcinoma, Recurrence

CORRELATION BETWEEN NUCLEUS FACTOR KAPPA B AND MICROVESSEL DENSITY IN NASOPHARYNGEAL CARCINOMA

Introduction: Nasopharyngeal carcinoma (NPC) is an aggressive head and neck cancer, mostly associated with EBV infection. Nuclear factor kappa B (NF-κB) is transcription factors that act as a tumor promoter, especially in inflammation-associated cancer. It also attracts angiogenesis. Microvessel Density (MVD) is widely used as an index for tumor angiogenesis. There have been no studies found about the correlation of NF-κB and MVD expression in NPC. Objective: The aim of this study is to investigate the correlation of NF-κB and MVD expression that may affect targeted therapies in NPC patients Methods: A total of 30 paraffin blocks of NPC patients biopsies were assessed immunohistochemically for NF-κB expression and MVD. Data were analyzed using the Spearman's nonparametric test to assess the correlation between NF-κB expression and MVD. Results: Positive NF-κB expression was found in 22 (73.33%) patients and negative in 8 (26.67%) patients. High MVD expression in 17 (56.67%) patients and low MVD expression in 13 (43.33%) patients. There was no significant correlation found between NF-κB and MVD. Conclusion: This study has not confirmed any correlation between NF-κB and MVD. Further research needs to be done to get a better assessment on nuclear proliferation rates and tumor-related angiogenesis in NPC.

CORRELATION OF KI67 LEVEL TO METASTATIC EVENTS IN NASOPHARYNGEAL CARCINOMA

Introduction Nasopharyngeal carcinoma (KNF) is a malignant squamous cell tumor occurring in the nasopharyngeal epithelial region where the cuboid epithelium is transformed into squamous cells. One of the typical signs of malignancy is uncontrolled cell proliferation. K67 is an immunohistochemical (IHC) test to assess cell proliferation activity. Increased Ki67 expression is associated with increased mitotic activity in cell proliferation. Objective To determine the correlation of ki67 expression to regional and distant metastases events of nasopharyngeal carcinoma at KNF in Dr. Mohammad Hoesin Palembang. Methods This cross-sectional study was conducted on 31 subjects of KNF patients who had been diagnosed in Oncology Division of Department of Ear Nose and Throat Head Neck Surgery, then performed immunohistochemistry inspection of KI67 in Department of Anatomical Pathology of Dr. Mohammad Hoesin Palembang. The subjects were collected consecutive sampling from October to December 2017 and performed other tests for staging such as computer tomography, chest x ray and abdominal ultrasound. Results In the Ki67 level correlation analysis of the incidence of metastasis in nasopharyngeal carcinoma, the correlation coefficient was 0.98 with very strong correlation strength and the positive correlation was not statistically significant (p=0.599). However, in Ki67 level correlation analysis of histopathology result of nasopharyngeal carcinoma was found correlation coefficient of 0.385 and positive correlation which was statistically significant (p=0.032). Conclusion Ki67 levels of metastatic occurrence in nasopharyngeal carcinoma have no statistically significant correlation. However, Ki67 level on histopathological results of nasopharyngeal carcinoma and Ki67 immunoreactivity with primary tumor has a statistically significant correlation.

EFFECT OF SEA CUCUMBER OIL AND HONEY IN POST RADIOTHERAPY NASOPHARYNGEAL CARCINOMA PATIENTS

Introduction: Nasopharyngeal carcinoma is one of the most commonly found cases of head and neck malignancy. The most common side effects of radiotherapy is skin damaged. Until now, there is no standard therapy that has been given to post radiotherapy patient in Hasan Sadikin Hospital. Sea cucumber and honey can accelerate the healing process of the wound caused by radiotherapy. Objective: This study was conducted to compare the effects of the use topical sea cucumber oil and honey in patient with nasopharyngeal carcinoma post radiotherapy. Method: The study was conducted at Radiotherapy Clinic in Hasan Sadikin Hospital from may until September 2015 with patients who experienced skin damaged level two or more based on the criteria of Radiation Therapy Oncology Group (RTOG). This was an experimental study. Subjects were selected consecutively between the two groups: sea cucumber oil group and honey group. The draft analysis was done using Randomized Controlled Trial (RCT). Result: 30 patients were divided equally into two groups, sea cucumber group and honey group. Most of the nasopharyngeal carcinoma patients were >45 years old, the ratio man to woman was 2-3:1, with the BMI was <18.5. All subjects in this study experienced recovery rate up to level 1 (p=1.0), after one week of treatment. In the 2nd week after treatment all patients in the sea cucumber group achieved recovery up to level 0, and in the honey group as much as 2 patients only experienced the recovery rate to level 0, while the remaining 13 subjects remained at level 1 (p=0.0001). It was found that the wound healing process occurs better in sea cucumber oil group than the honey group (p=0.0001). Conclusion: Sea cucumber oil accelerates the healing process of the skin tissue damaged in patients with nasopharyngeal carcinoma after radiotherapy, faster than with honey.

CASE REPORT: NASOPHARYNGEAL CARCINOMA IN PREGNANCY

Introduction: Nasopharyngeal carcinoma in pregnancy is a rare case, a dilemma in its management. This condition has a significant negative effect on pregnancy, given risk of premature birth, fetal defects and abortion. Case Report: 23-year-old woman with 13 weeks gestation age comes with swelling in both necks accompanied by nosebleeds. On nasoendoscopic examination, there was a mass at nasopharynx. Histopathological examination results a nasopharyngeal squamous cell carcinoma. Conclusion: The management of nasopharyngeal carcinoma in pregnancy is very complex, need for extensive multidisciplinary approach with experienced doctors in their respective fields

NASOPHARYNGEAL CARCINOMA IN PANYABUNGAN DISTRICT HOSPITAL

Introduction: Nasopharyngeal carcinoma is the most common malignancy found in the head and neck area. Non-specific initial symptoms and hidden locations often make it difficult to diagnose early nasopharyngeal carcinoma. The limitations of tools and human resources in the district are a problem in enforcing and finding patients with nasopharyngeal carcinoma in this situation. Objective: The purpose of this study is to observe the prevalence of nasopharyngeal carcinoma in Departement of Otorhinolaryngology-Head and Neck Surgery Panyabungan District Hospital. Method: This study collecting data from medical record of Nasopharyngeal carcinoma (NPC) at Panyabungan District Hospital. Result: The distribution of NPC patients during January-December 2018 there were 10 patients. NPC base on gender male 50% and female 50%. NPC based on age groups in 46-55 years is 40%, 56-65 years old is 20% and 16-25 years, 26-35 years, 36-45 years, and 66-75 years each of 10%. NPC patients based of clinical appearance is limadenophaty colli is 100%, epistaxis 80%, Nasal congesty 70%.ear fulness 40% and diplopia 30%. NPC based on histophatologycal types is WHO type I 10%, WHO type II 50% and WHO type III 40%. Conclusion: Nasopharyngeal carcinoma is a malignant tumor originating from the nasopharyngeal epithelium. The patient NPC were diagnosed at an advanced stage. All of patients showed enlargement of neck limph nodes and some showed diplopia.

CORRELATION BETWEEN S100 PROTEIN EXPRESSION WITH CLINICAL STAGING NASOPHARYNGEAL CARCINOMA TYPE III

Introduction: Nasopharyngeal carcinoma is the most found head and neck cancer, which originated from a nasopharyngeal epithelial cell, and predilection site commonly at rosen muller fossa. S100 protein inflammatory mediators are involved in the regulation of cellular processes including inflammation and malignancy. S100 protein plays a central role in the proliferation, regulation of cell apoptosis and metastasis causing continuing growth of cancer cells through activation of STAT3 by IL-6, NF-κB, ROS. Objective: This study aimed to determine the correlation between S100 protein expression levels to the clinical stage of NPC WHO type III. Method: This research is a cross-sectional analytic study. This study was held in the Anatomical Pathology Department of Hasan Sadikin Hospital from August until October 2015. The study was conducted using 29 pieces of secondary data, medical records and paraffin blocks anatomical pathology of NPC patients were examined S100 protein immunohistochemistry. Result: This study was performed from 29 subjects (18 males and 9 females). There was a strong positive correlation between histoscore S100 protein expression with clinical staging p<0.05. There is a significant correlation between S100 protein expression with the clinical stage of NPC WHO type III using double regression analysis (F=15.676, p=0.000). Conclusion: There were significant correlation S100 protein expression levels to clinical stage nasopharyngeal carcinoma WHO type III.

NASOPHARYNGEAL CARCINOMA WITH INTRACRANIAL INVOLVED

Introduction: Nasopharyngeal carcinoma (NPC) is an aggressive carcinoma come from postnasal space. Histology type of nasopharyngeal cell carcinoma and the staging that affect with management therapy. Nasopharyngeal carcinoma can be controlled by implementing evidence-based strategies of cancer and management of patients. Case report: Reported a case in 47-year-old man, diagnosis squamous cell carcinoma of nasopharynx with intracranial involvement. Conclusion: Histology type of nasopharyngeal carcinoma and the staging determined the modality of therapy and nasopharyngeal carcinoma prognosis

THE EFFECT OF GINKGO BILOBA AGAINST OTOTOXIC HEARING LOSS ON ADVANCED STAGE UNDIFFERENTIATED NASOPHARYNGEAL CARCINOMA RECEIVING CISPLATIN CHEMOTHERAPY

Introduction: Undifferentiated nasopharyngeal carcinoma is the most common malignant tumor in nasopharynx, in which most patients come to a hospital in advanced stage. Cisplatin is one of the most effective widely used chemotherapy drugs for advanced stage undifferentiated nasopharyngeal carcinoma. Although it provides a successful outcome against cancer, there is serious side effect namely ototoxic hearing loss. Ginkgo biloba is a powerful antioxidant which may prevent ototoxic hearing loss. Objective: The study aims to determine the effect of ginkgo biloba against ototoxic hearing loss on advanced stage undifferentiated nasopharyngeal carcinoma receiving cisplatin chemotherapy. Methods: This study was double blind Randomized Control Trial with pre-post test design, was conducted in 22 patients with advanced stage undifferentiated nasopharyngeal carcinoma receiving cisplatin chemotherapy at the Department of Otorhinolaryngology Head and Neck Surgery dr. Moewardi Hospital Surakarta between June 1st and October 1st 2019. The subjects were allocated into control (plasebo) and treatment (80 mg Ginkgo biloba extract) groups. Hearing function was examined with pure tone audiometry, tympanometry and Distortion Product Otoacoustic Emission before and after the first, the second and the third cisplatin chemotherapy. The results of the examination of the two groups were tested using Friedman and Chi Square test. P value of <0.05 was considered significant. Results: The study subjects were mostly male (63.6%), with the age range of 40-59 years (90.9%). The baseline characteristics of the study subjects were homogeneous (p>0.05). There was a significant difference in the incidence of ototoxic hearing loss between control and treatment group after getting the second and the third chemotherapy (p=0.043 and p=0.033, respectively). Conclusion: There is a significant effect of ginkgo biloba in term of preventing ototoxic hearing loss on advanced stage undifferentiated nasopharyngeal carcinoma patients receiving cisplatin chemotherapy.

RECURRENT NASOPHARYNGEAL CARCINOMA: PROBLEM AND MANAGEMENT

Introduction: Treatment results for nasopharyngeal carcinoma (NPC) have been improved, but there were still some patients who developed localized persistent or local recurrent. Local recurrence still represents a major cause of mortality and morbidity also management still challenging issues. Case Report: A 27-year-old woman presented with bilateral conductive hearing loss, dysphagia, rhinorrhoea, epistaxis, and cranial nerve palsy after chemo radiation for NPC. The results of nasopharyngoscopy, CT scan, and PET scan were not found a mass in the nasopharynx. The result of nasopharyngeal biopsy result was undifferentiated carcinoma. Patient diagnosed with recurrent NPC and planned for re-radiotherapy. Conclusion: After complete treatment for NPC we must immediately ensure recurrence and choose the next appropriate treatment.