Cancer pain is one of the most common, feared, debilitating, and often undertreated symptoms among cancer patients. It needs attention since it has a significant impact on the quality of life (QoL) of the patients. Also, since cancer has emerged as a major health problem in developing countries, there is a need to strengthen preventive strategies for effective cancer pain management and provide comfort to cancer patients. Nonetheless, various barriers limit developing countries toward optimal cancer pain management. To bridge the gap between adequate pain management and burden of cancer pain in developing countries, a comprehensive understanding of the limitations faced and the prevalence of cancer pain should be addressed. The aim of this literature review is to provide a deeper understanding on the factors associated with cancer pain as well as barriers toward optimal cancer pain management in developing countries. Some of the barriers addressed were administrative, judicial, economic, and professional barriers. Also, estimates on the prevalence of cancer pain and detrimental effects of pain on the QoL of cancer patients have been addressed. In summary, pain, which is one of the most debilitating symptoms of cancer, remains uncontrolled and undertreated in developing countries. It has a profound impact on the patient’s QoL and can have physical, psychological, and social consequences; therefore, it needs to be managed urgently and appropriately. Most importantly, optimal treatment of cancer pain should be highlighted as a priority in developing countries and concerted efforts should be made to eliminate different barriers discussed in this review for effective and humane care.

PURPOSE In 2016, there were 1,308,061 cases of cancer being treated in Indonesia, with 2.2 trillion rupiahs spent, amounting to $486,960,633 in US dollars (purchasing power parity 2016). The high burden of cancers in Indonesia requires a valid data collection to inform future cancer-related policies. The purpose of this study is to report cancer epidemiological data from 2008 to 2012 based on Hospital-Based Cancer Registry (HBCR) data from Cipto Mangunkusumo Hospital, Indonesia. METHODS This was a descriptive study with cross-sectional design. Data were collected from Cipto Mangunkusumo Hospital HBCR 2008-2012. Demographical, diagnostic, stages of cancer, and histopathological types of cancer data were extracted. RESULTS After screening, 18,216 cases were included. A total of 12,438 patients were older than 39 years of age (68.3%), with a female-to-male ratio of 9:5. Most patients have cancers at advanced stages (stages III and IV, 10.2%). The most common sites of cancer were cervix uteri (2,878 cases, 15.8%), breast (2,459 cases, 13.5%), hematopoietic and reticuloendothelial systems (1,422 cases, 7.8%), nasopharynx (1,338 cases, 7.4%), and lymph nodes (1,104 cases, 6.1%). CONCLUSION From this HBCR, cancer incidence in female was almost twice the incidence in male, largely because of the burden of cervical and breast cancers. The cervix uteri as one of the top five cancer sites based on this HBCR, 2008-2012, are still approximately consistent with Global Cancer Incidence, Mortality and Prevalence 2018, which portrayed that Indonesia has been severely afflicted by cervical cancer cases more than any other Association of Southeast Asian Nations countries. The HBCR could serve as a robust database of epidemiological data for cancer cases in Indonesia.

Brain tumors are challenging to handle and cause severe mortality and morbidity. The primary therapy for brain tumors, a combination of radiotherapy, chemotherapy (i.e temozolomide), and corticosteroids, is considered inadequate to improve patients' clinical conditions and associated with many adverse effects. There is an urgent need for new compounds or repurposing of existing therapies, which could improve brain tumor patients' prognosis. Metformin, commonly used for type 2 diabetes medication, has been examined for its protective action in cancer, reducing cancer risk and cancer-related mortality. However, its effect on cancer is still in rigorous debate. This study examines recent studies on the effects of metformin in primary brain tumor patients through systematic reviews. The literature search was performed on PubMed, ScienceDirect, and SpringerLink databases for articles published between 2013 and 2020. We selected clinical studies comparing the therapeutic outcomes of brain tumor therapy with and without metformin. The clinical benefits of the drug were assessed through the overall survival (OS) and progression-free survival (PFS) of brain tumor patients. Those studies demonstrated that the combination of metformin with temozolomide given post-radiotherapy resulted in better OS and PFS . Nonetheless, the efficacy and safety of metformin need further clinical testing in the wider population.

Primary brain tumour remains one of the most disabling and lethal disease. Data from International Agency for Research on Cancer 2018 shows incidence of primary brain and CNS tumour worldwide of approximately 296,851. At the same year, The Global Cancer Atlas showed that 5,354 people in Indonesia were diagnosed with primary brain tumour. Glioma represents 27% of all tumours and 80% of all malignant tumours (Ostrom et al., 2015). Glioblastoma accounts for the majority of gliomas (55,1%), and combined glioblastoma and astrocytomas account for about 75% of all gliomas. Glioblastoma is an incurable tumour, and poor prognosis continue to prevail despite substantial treatment (Gorlia et al., 2012). In literature, age of patients, performance status, IDH (isocitrate dehydrogenase) mutation, MGMT

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FACTORS INFLUENCING PERFORMANCE STATUS IN PATIENTS WITH INTRACRANIAL TUMOR AT CIPTO MANGUNKUSUMO GENERAL HOSPITALABSTRACTIntroduction: Patients diagnosed with malignancy have a long course of illness from diagnosis to treatment. Assessment of performance status (PS) is essential to give an overview of therapeutic readiness and patient’s prognosis. Karnofsky Performance Scale is a PS assessment used widely in neurooncology patients. This instrument can assess functional impairment among patients. To this date, clinical factors in admission time that influences KPS in hospitalized intracranial tumor has not been researched.Aim: To get an overview of KPS in hospitalized intracranial  patients in Cipto Mangunkusumo General Hospital and to investigate factors that influence.Methods: The design of this research was cohort retrospective. The research was done in Cipto Mangunkusumo General Hospital using secondary data in 2015-2016. The subjects of the research were patients with intracranial tumors. Demographic, clinical status in admission, pathological anatomy, and performance status data were acquired. The data were processed and presented descriptively and analytically. Independent predictors investigated using multivariate logistic regression.Results: There were 68 subjects obtained in this research. As much as 35 (51.5%) subject had primary intracranial tumor. As much as 58 (85.2%) subjects aged <60 years old. As much as 51 (76.5%) subjects had supratentorial tumor. Majority of subjects (70%) had KPS score <70. Subjects with primary tumor had more cranial nerve palsy (p=0.021) and hemiparesis (p=0.038). Decreased consciousness increased the risk of KPS score <70 by 5.2x in the time of admission.Discussion: Majority of subjects had KPS score <70. Decreased consciousness in the time of admission is an independent predictive factor that lowers KPS.Keywords: Karnofsky Performance Scale, intracranial tumor, neurooncology, risk factorsABSTRAKPendahuluan: Pasien keganasan memiliki perjalanan penyakit yang panjang mulai dari diagnosis hingga tata laksana. Kondisi pasien dapat sangat beragam, sehingga penting dilakukan pengkajian status performa untuk memberikan gambaran kesiapan terapi dan prognosisnya. Instrumen yang paling sering digunakan secara standar internasional adalah Karnofsky Performance Scale (KPS). Sejauh ini belum diketahui penggunaan KPS pada pasien tumor intrakranial, mengingat performa pasien yang tidak hanya disebabkan oleh keganasannya, namun juga kecacatan akibat dari lesinya.Tujuan: Mendapatkan gambaran KPS pasien tumor intrakranial serta faktor-faktor yang memengaruhinya.Metode: Penelitian kohort retrospektif terhadap pasien tumor intrakranial yang dirawat di RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada tahun 2015-2016. Dilakukan pencatatan karakteristik demografik pasien, faktor klinis saat admisi, patologi anatomi, dan KPS. Data disajikan secara deskriptif dan analitik, faktor prediktor independen diinvestigasi menggunakan analisis multivariat regresi logistik.Hasil: Didapatkan 68 subjek dalam penelitian ini dengan proporsi tumor primer dan sekunder sebanyak 33 dan 35 orang. Subjek perempuan lebih banyak pada kelompok tumor primer dan lebih sedikit pada tumor sekunder. Mayoritas subjek berusia <60 tahun (85,2%), lokasi tumor di supratentorial (76,5%), dan KPS masuk <70 (69,2%). Subjek dengan penurunan kesadaran saat masuk perawatan akan cenderung memiliki KPS <70 (p=0,005) dibanding faktor-faktor klinis lainnya dengan risiko 5,2x menyebabkan status performa yang rendah tersebut saat admisi.Diskusi: Sebagian besar subjek memiliki nilai KPS <70. Penurunan kesadaran saat admisi merupakan faktor prediktif independen penurunan KPS.Kata kunci: Faktor risiko, Karnofsky Performance Scale, neuroonkologi, tumor intrakranial

Background Adipose derived stromal vascular fraction (SVF) contains a heterogeneous population of mononuclear cells, progenitor cells and about 1–10% are mesenchymal stromal cells. These cells are an ideal candidate for regenerative medicine for peripheral neuropathy. Leprosy is a disabling disorder with neuropathy, usually with consequences of permanent disability of the extremities. We conducted a preliminary study to evaluate the cell yield, its characteristics and clinical outcomes after SVF injections in four leprosy patients. Methods Four post leprosy patients were recruited and evaluated for sensory testing (warm detection, cold detection, vibration, pain and sensation) on the ulnar area of the hand. Liposuction was done and adipose tissue was processed into SVF with a closed system and injected to the ulnar area of the hand at the dorsal and palmar side. Evaluation of sensory testing was done after 3 days, 1 week, 1 month and 3 months following SVF injection. SVF was also characterized using flow cytometry, cell counting, sterility and presence of mycobacteria. Results The results showed that leprosy patients had a low count of mesenchymal cells and a high amount of CD34/CD45 positive cells. One patient was positive for mycobacteria from his adipose tissue and SVF. Sensory examination after SVF injection showed an improvement in temperature and pain sensation in the palmar and superficial branch. Meanwhile, touch sensation improved on the dorsal branch, and there was no improvement for vibration in all patients. Conclusions The results showed that SVF had a potential to improve sensory loss in leprosy patients.

Abstractsiii102 NEURO-ONCOLOGY • MAY 2017 C677T, 58.8% [45.2-71.3] were either heterozygous or homozygous for A1298C, and 25.5% [15.5-38.9] were compound heterozygotes. Peak methotrexate levels were 656.0 [579.6-730.4] in patients with a mutation and 513. 43 [376.3-605.5] in non-mutated patients (p=0.11). Serum methotrexate levels >0.05 on day 6 only occurred in patients with a mutation (34.1%, p=0.06). Any grade 2 or greater toxicity occurred in 42.9% of non-mutated and 84.1% of mutated patients (p=0.031). Grade 3 toxicities were only observed in patients with at least one mutation: 14.8% [5.92-32.5] and 23.3% [11.8-40.9] in C677T and A1298C mutations respectively. There was no statistically significant difference between the two mutations (p=0.51). We hypothesized that overall survival might be longer in patients with MTHFR SNPs, but in our cohort that difference was not statistically significant: 730 days in the mutated vs. 284 days in the non-mutated patients (p=0.4). The frequency of MTHFR SNPs was dramatically greater in our lymphoma cohort than in the general population (~33% for C766T and 24-40% for A1298C mutations) raising the possibility that these mutations are themselves associated with CNS lymphomas. CONCLUSIONS: MTHFR mutations are associated with an increased frequency of toxicity and prolonged need for leucovorin rescue. Larger patient series may disclose a survival advantage for patients with MTHFR mutations. These mutations may be associated with the occurrence of CNS lymphoma. Central nervous system invasion of multiple myeloma is a rare extramedullary form of the disease, presenting as intraparenchymal lesions, leptomeningeal disease, or via direct dural invasion. Survival of leptomeningeal myelomatosis in historical series is considered to be extremely poor, but seems to be improving in the era of novel therapy, namely proteosome inhibitors and immunomodulatory class drugs. Here we present the case of a 48 year-old male with isolated central nervous system relapse of multiple myeloma who had multiple rapidly progressive intraparenchymal myeloma lesions, cauda equina lesions, as well as leptomeningeal myelomatosis that developed years after complete response to autologous stem cell transplant. This patient's central nervous system disease progressed following systemic high-dose methotrexate, but demonstrated a durable partial response to proton beam craniospinal irradiation combined with immunomodulatory chemotherapy using pomalidomide plus dexamethasone. Little is known about the use of proton radiation therapy in the treatment of plasma cell neoplasms as compared to other hematologic malignancies (such as leukemia), nor about its efficacy, with no published reports to our knowledge. Finally, we review the current literature regarding treatment of both intraparenchymal and leptomeningeal myelomatosis. P14.02 PROTON RADIATION THERAPY COMBINED WITH IMMUNOMODULATORY DRUGS FOR CENTRAL NERVOUS P14.03 MENINGES METASTASES IN BREAST CANCER-ONE CENTER STUDY EXPERIENCE OF CONCOMITANT THERAPY INTRA...