Objective To evaluate the effectiveness of a nasopharyngeal carcinoma (NPC) awareness programme on the short-term and long-term improvement of knowledge and referral of patients with NPC by primary healthcare centres (PHCCs) staff in Indonesia. Design The NPC awareness programme consisted of 12 symposia including a Train-The-Trainer component, containing lectures about early symptoms and risk factors of NPC, practical examination and the referral system for NPC suspects. Before and after training participants completed a questionnaire. The Indonesian Doctors Association accredited all activities. Participants 1 representative general practitioner (GP) from each PHCC attended an NPC awareness symposium. On the basis of the Train-The-Trainer principle, GPs received training material and were obligated to train their colleagues in the PHCC. Results 703 GPs attended the symposia and trained 1349 staff members: 314 other GPs, 685 nurses and 350 midwives. After the training, respondents’ average score regarding the knowledge of NPC symptoms increased from 47 points (of the 100) to 74 points (p<0.001); this increase was similar between symposium and Train-The-Trainer component (p=0.88). At 1½ years after the training, this knowledge remained significantly increased at 59 points (p<0.001). Conclusions The initial results of this NPC awareness programme indicate that the programme effectively increases NPC knowledge in the short and long term and therefore should be continued. Effects of the improved knowledge on the stage at diagnoses of the patients with NPC will still need to be scrutinised. This awareness programme can serve as a blueprint for other cancer types in Indonesia and for other developing countries.
Nasopharyngeal carcinoma (NPC) is the most common head and neck malignancy in Indonesia. Overall, it ranksfourth in males and sixth in females as the most prevalent type of cancer in that country. The data show that in the year 2011, NPC incidence was considered to be intermediate (6.2/100,000 population per year). Through histopathologic examination, about 70 to 80% of these cases were found to be type III according to the WHO ciassificaton. NPC carries an excellent prognosis if treated early, but most patients presented with stage III to IV disease, which negatively affected the cure rate and increased the mortality rate. Epstein-Barr virus (EBV) IgA serology has been established as an effective markerfor NPC. Therefore, biologic markers, DNA, and/ or antibody-based diagnosis is needed to decrease NPC cases. A screeningprogram needs tobedeveloped that will identifypeople at high risk of NPC and those who are in theearly stage ofthedisease. In thisstudy, 20samples were collected from posttherapy patients. An otolaryngologic examination, histopathologyofnasopharyngeal tissue, and blood testing for serologic markers were performed. IgA anti-EBNA1 + VCA-pl Senzyme-linked immunosorbent assay showedpositive impactas a toolfor confirming the diagnosis ofNPC, but itstillhastobecombinedwithother specific diagnostic tools for post-therapy monitoringand for determining prognosis.
Table of contentsA1 Hope and despair in the current treatment of nasopharyngeal cancerIB TanI1 NPC international incidence and risk factorsEllen T ChangI2 Familial nasopharyngeal carcinoma and the use of biomarkersChien-Jen Chen, Wan-Lun Hsu, Yin-Chu ChienI3 Genetic susceptibility risk factors for sporadic and familial NPC: recent findingsAllan HildesheimI5 Genetic and environmental risk factors for nasopharyngeal cancer in Southeast AsiaJames D McKay, Valerie Gaborieau, Mohamed Arifin Bin Kaderi, Dewajani Purnomosari, Catherine Voegele, Florence LeCalvez-Kelm, Graham Byrnes, Paul Brennan, Beena DeviI6 Characterization of the NPC methylome identifies aberrant epigenetic disruption of key signaling pathways and EBV-induced gene methylationLi L, Zhang Y, Fan Y, Sun K, Du Z, Sun H, Chan AT, Tsao SW, Zeng YX, Tao QI7 Tumor exosomes and translational research in NPCPierre Busson, Claire Lhuillier, Olivier Morales, Dhafer Mrizak, Aurore Gelin, Nikiforos Kapetanakis, Nadira DelhemI8 Host manipulations of the Epstein-Barr virus EBNA1 proteinSheila Mansouri, Jennifer Cao, Anup Vaidya, and Lori FrappierI9 Somatic genetic changes in EBV-associated nasopharyngeal carcinomaLo Kwok WaiI10 Preliminary screening results for nasopharyngeal carcinoma with ELISA-based EBV antibodies in Southern ChinaSui-Hong Chen, Jin-lin Du, Ming-Fang Ji, Qi-Hong Huang, Qing Liu, Su-Mei CaoI11 EBV array platform to screen for EBV antibodies associated with NPC and other EBV-associated disordersDenise L. Doolan, Anna Coghill, Jason Mulvenna, Carla Proietti, Lea Lekieffre, Jeffrey Bethony, and Allan HildesheimI12 The nasopharyngeal carcinoma awareness program in IndonesiaRenske Fles, Sagung Rai Indrasari, Camelia Herdini, Santi Martini, Atoillah Isfandiari, Achmad Rhomdoni, Marlinda Adham, Ika Mayangsari, Erik van Werkhoven, Maarten Wildeman, Bambang Hariwiyanto, Bambang Hermani, Widodo Ario Kentjono, Sofia Mubarika Haryana, Marjanka Schmidt, IB TanI13 Current advances and future direction in nasopharyngeal cancer managementBrian O’SullivanI14 Management of juvenile nasopharyngeal cancerEnis OzyarI15 Global pattern of nasopharyngeal cancer: correlation of outcome with access to radiotherapyAnne WM LeeI16 The predictive/prognostic biomarker for nasopharyngeal carcinomaMu-Sheng ZengI17 Effect of HLA and KIR polymorphism on NPC riskXiaojiang Gao, Minzhong Tang, Pat Martin, Yi Zeng, Mary CarringtonI18 Exploring the Association between Potentially Neutralizing Antibodies against EBV Infection and Nasopharyngeal CarcinomaAnna E Coghill, Wei Bu, Hanh Nguyen, Wan-Lun Hsu, Kelly J Yu, Pei-Jen Lou, Cheng-Ping Wang, Chien-Jen Chen, Allan Hildesheim, Jeffrey I CohenI19 Advances in MR imaging in NPCAnn D KingO1 Epstein-Barr virus seromarkers and risk of nasopharyngeal carcinoma: the gene-environment interaction study on nasopharyngeal carcinoma in TaiwanYin-Chu Chien, Wan-Lun Hsu, Kelly J Yu, Tseng-Cheng Chen, Ching-Yuan Lin, Yung-An Tsou, Yi-Shing Leu, Li-Jen Laio, Yen-Liang Chang, Cheng-Ping Wang, Chun-Hun Hua, Ming-Shiang Wu, Chu-Hsing Kate Hsiao, Jehn-Chuan ...
Nasopharyngeal carcinoma (NPC) is ranked 6th of malignant tumors in Indonesia. To analyze the correlation of dose and duration of cisplatin exposure with cytotoxic effects on nasopharyngeal carcinoma stem cells. The biopsy NPC tissue was cultured and processed to obtain NPC stem cells to be treated with cisplatin different doses and durations (24 and 48 h). The number of dead cells after exposure will be calculated using a hemocytometer. Death stem cell density of NPC at exposure of 2 lg/ml cisplatin dose was 81.37%, while the smallest death cell density a dose of 0.05 lg/ml after a 72-h observation was 21.3%. The coefficient correlation 0.827 and value p = 0.000 (p \ 0.05). The analysis of the correlation between cisplatin exposure duration and death cell was also significant with the correlation coefficient-0.357 and the value p = 0.001 (p \ 0.05). There was a correlation between the increased dose of cisplatin with the cytotoxicity effects on NPC stem cell.
Latar belakang: Pada penderita Karsinoma Nasofaring (KNF) masih sering ditemukan kekambuhan meskipun sudah mendapat terapi yang lengkap. Penelitian terbaru membuktikan bahwa kekambuhan disebabkan oleh sel punca KNF yang resisten terhadap radioterapi. Mekanisme resistensi sel punca kanker terhadap radioterapi diduga karena hambatan terhadap apoptosis dan atau memicu proliferasi. Hambatan terhadap apoptosis disebabkan oleh penurunan protein p53 (wild type), selain over-ekspresiHsp70. Tujuan: Menjelaskan mekanisme resistensi sel punca KNF terhadap radioterapi berdasarkan profil ekspresi protein p53(wild type)dan Hsp70. Metode: Penelitian true experimental dengan menggunakan rancangan randomisasi kelompok kontrol sebelum dan sesudah tes. Kultur sel punca KNF dibagi menjadi dua kelompok, masing-masing 16 sampel. Pada kelompok perlakuan diberikan paparan radioterapi dengan dosis 1,5 Gy menggunakan pesawat Linac, lalu diinkubasi selama 24 jam. Sebelum dan sesudah perlakuan pada kedua kelompok diperiksa ekspresi p53 (wild type) dan Hsp70. Pemeriksaan menggunakan metode flowcytometry. Hasil: Ekspresi p53 (wild type) antara kelompok perlakuan dan kontrol terdapatperbedaan yang tidak bermakna dengan p=0,576 (p≥0,05). Ekspresi Hsp70, antara kelompok perlakuan dan kontrol terdapat perbedaan yang tidak bermakna dengan p=0,172 (p≥0,05). Kesimpulan: Tidak terdapatperubahan ekspresi p53 (wild type) dan Hsp70 pada sel punca KNF yang resisten terhadap radioterapi.Kata kunci : Sel punca KNF, p53 (wild type), Hsp70, karsinoma nasofaring ABSTRACTBackground: Recurrences are frequently occurred in nasopharyngeal carcinoma (NPC) patients, eventhough they had received complete therapy. Recent studies have proved that those recurrences were caused by NPC cancer stem cells that resistant to radiotherapy. Mechanisms of resistance of cancer stem cells to radiotherapy is assumed due to the block of apoptosis and or proliferation inducing. The block of apoptosis was caused by the decrease of p53 (wild type) expression, in addition to Hsp70 over expression. Objective: To find out the mechanism of NPC stem cells that resistant to radiotherapy based on profiles of protein p53 (wild type) and Hsp70 expression. Methods: Using true experimental study by randomizedpre and post test control group design. The cultured NPC stem cells were divided into two groups, with 16 samples each. The treatment group had 1,5Gy dose of radiotherapy exposure with Linac device, then incubated for 24 hours. Both groups were examined for p53 (wild type) and Hsp70 expressions before and after treatment. The examinations were conducted by flowcytometry method. Result: The P53 (wild type) expression between the treatment and control group showed insignificant difference with p=0.576(p≥0.05). The Hsp70 expression between treatment and control group showed insignificant difference with p=0.172 (p≥0.05). Conclusion: There were no changes of p53 (wild type) and Hsp70 expressions on NPC stem cells that resistant to radiotherapyKeywords: NPC stem cells, p53 (wild type), Hsp70, nasopharyngeal carcinoma
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