Background: Currently, endoscopic thyroidectomy techniques continue to evolve in response to the growing demand for better cosmetic outcomes. To date, transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) remains the only technique that leaves no visible external scar. However, this approach has certain limitations. The primary objective of this report is to present our initial experience with an alternative to TOETVA, namely the Transoral Endoscopic Thyroidectomy via Submental approach (TOETSA), in 38 patients at a single center. Method: We performed the TOETSA procedure on 38 patients who met the inclusion criteria between January 2020 and Desember 2023. The procedure was successfully completed in 36 cases, while conversion to open thyroidectomy was required in 2 cases. Unlike conventional TOETSA, in which all instruments are introduced transorally, this approach utilizes two instruments inserted via the vestibular access and one instrument introduced through the submental crease. Results: Among the 38 TOETSA procedures completed successfully, all specimens were extracted intact, with a mean maximum nodule size of 4.01 +/- 0.80 cm (range: 2.50-6.40 cm). The mean operative time, which included procedures on large tumors and simultaneous training of novice surgeons, was 186.82 +/- 19,46 (range: 147-226 Minutes). No life-threatening or permanent postoperative complications were observed. Cosmetic satisfaction after 6 months of follow-up was also favorable. However, a comprehensive assessment of oncologic safety could not yet be performed, as most patients were only monitored for 8.6 months in average. Conclusion: TOETSA offers favorable therapeutic and cosmetic outcomes with low complication rates, even in larger specimens. Oncological safety should remain the main consideration in technique selection. TOETSA is also feasible as a training platform for novice surgeons.

Objective: This study aimed to analyze the status of human papillomavirus (HPV) infection status and p53 expression in Indonesian patients with oral squamous cell carcinoma (OSCC) and their relationship with patient survival. Methods: This retrospective cohort study was conducted in Indonesia's main referral hospital with 74 patients diagnosed with OSCC between January 2014 and December 2018. Polymerase chain reaction followed by hybridization was performed to detect HPV genotypes in tumor tissues. The expression of p53 was assessed by immunohistochemistry. Clinicopathological data were collected and patients were followed up for a minimum of 36 months from the month of diagnosis. Statistical tests and survival analyses were also performed. Results: HPV infection was identified in 52 (70.3 %) patients, mostly out-panel genotypes of HPV followed by HPV35. There were no differences in the clinicopathological characteristics between HPV-positive and HPVnegative patients. Positive p53 expression was observed in 47 (63.5 %) patients. The p53-negative patients were significantly younger than the p53-positive patients. No difference in 3-year overall survival was observed between patients with OSCC stratified by HPV infection status and p53 expression. Univariate and multivariate analyses showed that HPV infection status and p53 expression did not correlate with survival. Conclusion: HPV infection and p53 expression were not suitable as prognostic markers for survival in our patients due to the lack of significant associations.

Context:Salivary gland cancer (SGC) is a rare and heterogeneous malignancy characterized by diverse clinicopathological features. In Indonesia, limited data exist regarding survival outcomes and associated prognostic factors.Aims:The aim of this study was to determine the 3-year overall survival (OS) rate of SGC patients and to evaluate the association between clinicopathological factors and survival outcomes.Settings and Design:A retrospective cohort study was conducted at Cipto Mangunkusumo General Hospital, a national referral hospital in Indonesia.Materials and Methods:Data from 32 SGC patients registered between 2019 and 2021 were analyzed. Clinicopathological and survival data were collected from medical records and supplemented with telephone interviews.Statistical Analysis:Survival was estimated using the Kaplan-Meier method. The association between variables and survival was analyzed using Cox proportional hazards regression.Results:The 3-year OS rate for SGC patients was 67.9%. The most frequent histologies were adenoid cystic carcinoma and mucoepidermoid carcinoma (31.3% each), with a majority of patients (78.1%) presenting at an advanced stage. No clinicopathological factors were found to be statistically significant predictors of survival. However, lymphovascular invasion (LVI) showed a trend toward being a negative prognostic factor (hazard ratios = 3.24; P = 0.201).Conclusions:The 3-year OS for SGC patients in this cohort was 67.9%. While no factors reached statistical significance, LVI may be an important prognostic marker. Larger, multicenter studies are needed to confirm these findings.

OBJECTIVE:This study was designed to determine the role of BRAF V600E and TERT mutations in the incidence of neck lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). METHODS:This was a cross-sectional study, involving PTC patients at Dr. Cipto Mangunkusumo Hospital, Jakarta. Data were obtained retrospectively based on medical records, except for BRAF V600E and TERT promoter mutations. Tumor tissue specimens of PTC's patients were transferred to the Integrated Laboratory of Faculty of Medicine, Universitas Indonesia. BRAF gene multiplication was performed with KOD One PCR Master Mix (Toyobo KMM-201), while TERT gene multiplication was performed with PCR Master Mix. Data analysis was performed with SPSS version 20. The data were analyzed using univariate and bivariate analysis with the Chi-Square test. RESULT:42 PTC patients were included in the study; 19 (45%) had BRAF mutation, 20 (48%) had TERT mutation, and 20 (48%) had LN metastases. BRAF V600E mutation was associated with LN metastasis [p<0.001, OR = 25.33 (95% CI 4.92 - 130.34)], while TERT mutation was not. Patients with BRAF+ and TERT- mutations were 18.00 times (95% CI 2.01 - 161.05) more likely to develop LN metastasis than patients with BRAF- and TERT-. Furthermore, the presence of TERT mutation along with BRAF mutation increased the risk to 60.00 (95% CI 4.72 - 763.04) higher than patients with BRAF- and TERT-. CONCLUSION:BRAF mutation was associated with LN metastasis in PTC patients, but not TERT mutations. However, the presence of TERT mutation in PTC's patients with BRAF mutation increased the risk of LN metastasis.

Aim : To determine the incidence of lymph node metastasis in breast cancer of young women and its relationship with clinicopathologic factors. Methods : The study used an analytic observational design and a cross-sectional approach. Bivariate analysis was performed with Fisher's exact probability test to determine the association of clinicopathologic factors with lymph node metastasis. Results: N1 lymph node metastases could be found in most of the young women breast cancer patients at 42.9%, followed by N3 and N2 at 11.4% and 8.6%, respectively. On the other hand, 37.1% of patients showed no lymph node metastasis. Fisher's exact probability test showed that of the six clinicopathological factors, only tumour size was associated with lymph node metastasis with a p-value of 0.031. Conclusion : The incidence rate of lymph node metastasis in breast cancer of young women was 42.9% for N1, 11.4% for N3, and 8.6% for N2. There was a significant association between tumour size and lymph node metastasis.

IntroductionGraves' disease (GD) is the most common cause of hyperthyroidism in children and adolescents. Data regarding pediatric GD in Indonesia are limited and pose challenges to diagnosing and treating the patients. In many aspects the clinical presentation of GD in children and adolescents resembles that of the adult population. There are three treatments for pediatric GD: anti-thyroid drugs, radioiodine ablation, and thyroidectomy. Although surgery is gaining acceptance as the definitive first-line treatment for children with GD, several studies examining pediatric populations have shown high complication rates. This study aims to describe a series of pediatric GD cases from a tertiary care center over an eight-year period.Presentation of CasesRetrospective data of five patients with hyperthyroidism diagnosed with GD between 2014 and 2022 were reviewed. Clinical presentation, diagnosis, therapies, and short-term postoperative outcomes of GD were analyzed. All five GD patients presented with neck lumps. Low TSH levels and elevated FT4 levels were found in all patients preoperatively. Total thyroidectomy was performed in all patients, while one patient had lymphadenectomy concurrently. Histopathologic examination confirmed a diagnosis of GD in all patients. All patients in this study experienced postoperative complications such as hoarseness, while only three patients had hypocalcemia as a complication.DiscussionTotal thyroidectomy in pediatric patients remains challenging. The euthyroid condition in patient prior to surgery is recommended to avoid the risk of thyroid storm during surgery, but a few studies have revealed that there is no difference in outcomes for hyperthyroid individuals. Close postoperative surveillance for complications of total thyroidectomy is necessary.ConclusionsResults of this study showed that pediatric GD patients had the same symptoms of hyperthyroidism as adults with all patients complained of neck lumps. Total thyroidectomy is the definitive therapy for GD in pediatrics as well as in adults. The minority of patients will experience transient and benign morbidities, with hoarseness of the voice being the most common transient postoperative morbidity. In performing total thyroidectomy, meticulous surgery and good anatomical recognition are required to avoid postoperative complications. So that, follow-up of post-total thyroidectomy in pediatric GD patients needs to be done.

Background: Neoadjuvant chemotherapy (NAC) is a crucial component in the management of tongue-based locally advanced squamous cell carcinoma (LASCC) due to its ability to decrease tumor mass and facilitate free tissue transplantation. The utilization of adjuvant radiation and chemotherapy has been observed to decelerate the progression of post-operative tumor growth. Probability of free flap failure is elevated. Post-operative complications and the long-term functional outcomes of speaking, salivation, and swallowing determine the quality of free flaps. Methods: A retrospective review of tongue LASCC patients who underwent NAC followed by glossectomy and free tissue transfer from 2015 to 2018. Tongue functional outcomes of speaking, swallowing, and salivation were assessed using FACE-Q scale in 3 times follow-up period. Result: This study included 7 patients who underwent tongue reconstruction. Treatment modalities were based on tumor presentation, with 4 patients (57.1%) receiving Taxane, 5-Fluorouracil, and Paclitaxel/Doclitaxel (TPF), and 3 patients (42.1%) receiving Paclitaxel and 5-Fluorouracil (PF). Tongue reconstruction utilized the radial forearm free flap in 5 patients (71.4%) and the anterolateral thigh free flap in 2 patients (28.6%). Intraoperatively, NAC had no impact on the integrity of small and reliable donor vessels. Three patients died from tumor metastases after the second follow-up assessment, while one patient was lost to follow-up. The study found no significant association between chemotherapy dosage and free flap vitality (P = 0.629). FACE-Q assessments revealed moderate to low scores in speaking, eating, and drinking outcomes. Conclusion: Tongue reconstruction after NAC in LASCC patients remains a challenging procedure for surgeons. While the consideration of surgical difficulties due to damage of the donor vessels demands a more structured pre-operative plan. No correlation between the exposure of NAC or AR to free flap complication as well as functional outcome.

Introduction: Most thyroid malignancy is papillary thyroid carcinoma (PTC). However, lymph node metastases occur in 30-40% of PTC patients. Biomarkers to predict cervical lymph node metastases have now begun to be widely varied, such as matrix metalloproteinase (MMP) and vascular endothelial growth factor (VEGF). There has not been any diagnostic agreement on MMP-9 and VEGF-C as predictors of lymph node metastasis in PTC. Hence, this study aims to determine the association of MMP-9 and VEGF-C to cervical lymph node metastases in PTC patients. Methods: A cross-sectional study was conducted at Cipto Mangunkusumo General Hospital, Jakarta. Patients diagnosed with PTC based on histopathological examination were included in this study. Patients with distant metastases were excluded from the study. The expression of MMP-9 and VEGF-C was investigated at the Anatomical Pathology Laboratory. Results: Sixty-two patients were included in this study, 80.6% female and 19.4% male. The MMP-9 expression was higher in the metastatic group (p<0.001). The same results were also found in VEGF-C expression, where the median expression of this marker in the metastatic group was higher than in the non-metastatic group (p<0.001). We found a significant positive correlation between the MMP-9 and VEGF-C expressions (correlation coefficient of 0.618). Conclusions: There is a significant relationship between the expression of MMP-9 and VEGFC with cervical lymph node metastases in PTC patients. The MMP-9 and VEGF-C expression was higher in the metastatic group. The increased MMP-9 expression is also positively correlated with increased VEGF-C expression.

Introduction The prevalence of thyroid carcinoma (TC) among pediatric and adolescent populations is infrequent, yet its global occurrence is escalating. Insufficient information pertaining to TC in the pediatric populace of Indonesia presents issues in the identification and management of patients with this condition. The objective of this study is to provide a detailed account of a collection of pediatric TC cases that were recorded at a tertiary care center throughout an extended interval of eight years. Presentation of Cases The present study conducted a retrospective data analysis of ten patients who received a diagnosis of TC during the period spanning from 2014 to 2022. The present study focused on analyzing the clinical manifestation, diagnostic measures, treatment modalities, and immediate postoperative consequences of TC. All patients diagnosed with thyroid cancer exhibited the presence of neck lump. Nine patients underwent total thyroidectomy, while one patient underwent isthmolobectomy. The histopathologic evaluation confirmed the diagnosis of thyroid cancer in every individual. There were a significant number of patients, up to 50%, who encountered complications after undergoing surgery. Two patients reported the hoarseness of voice, whereas two other patients experienced the signs of hypocalcemia. Only one patient exhibited both these symptoms simultaneously. Discussion The implementation of total thyroidectomy as a surgical intervention in pediatric patients poses a notable challenge. Postoperative monitoring for potential complications following surgery for total thyroidectomy is imperative. Conclusions The current study provides evidence that the utilization of total thyroidectomy in combination with lymph node dissection as indicated in patients with lymph node metastases in pediatric patients with thyroid carcinoma leads to a significant reduction in the probability of recurrence of lymph node enlargement. During the performance of surgical procedures, meticulous observation plays a key role in mitigating the risk of postoperative complications, such as hypoparathyroidism, hypocalcemia, and injury to the recurrent laryngeal nerve. Thus, it is imperative to conduct follow-up procedures for post-surgical interventions among pediatric patients diagnosed with TC.

Background: Benign thyroid nodules are the most common thyroid disorders in the world.Ninety percent of thyroid nodule cases found in the hospital are benign nodules.In the case of benign thyroid nodules, it is difficult to determine the appropriate balance between the risks and benefits of surgical therapy as a curative approach, whereas an approach with suppressive therapy reports unsatisfactory results and requires a long treatment time.Another alternative therapy for benign thyroid nodules is radiofrequency ablation (RFA) therapy, which is used for benign thyroid nodules with clear and solitary nodule margins.Although several studies have shown that RFA is a safe technique, there are some associated complications, which are minor.Therefore, reviewing the literatures is critical to evaluate the effectiveness of RFA in reducing the size of benign thyroid nodules and the complications that occur.Methods: This study aims to conduct a literature review on RFA therapy for benign thyroid nodules.Literature searching was conducted on PubMed, Scopus, and ScienceDirect.Result: Based on a review of 27 literature, RFA can effectively reduce the size of benign thyroid nodules by up to 80% within 6 -12 months of initial therapy.After the RFA procedure, it was reported that 83% of patients had no complications and 16.1% of patients experienced mild-moderate complications that were reversible.Conclusion: RFA can effectively reduce the size of benign thyroid nodules, and RFA has a good safety profile in treating benign thyroid nodules.

Introduction: Axillary lymph node involvement is an important aspect of breast cancer diagnosis in determining treatment and predicting distant metastasis. Lymph node metastasis is associated with higher recurrence and survival rates. Lymph node status is a significant prognostic factor and is widely used. Several factors affect lymph node metastasis, including tumor size, grade, and invasive ductal histological type. FGF2, a lymphangiogenesis factor, influences the occurrence of lymph node metastasis. The present study aimed to determine the association between FGF2 expression and axillary lymph node metastasis in early-stage breast cancer and evaluate the association between FGF2 expression and clinicopathologic factors. Methods: A cross-sectional design was used to evaluate the expression of FGF2 in 47 early-stage breast cancer patients who underwent either a mastectomy or breast-conserving surgery procedure at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from January 2014 to December 2018. FGF2 expression was examined by immunohistochemistry. Results: FGF2 expression was significantly correlated with axillary lymph node metastasis incidence [p = 0.044, odds ratio 4.22 (95% CI 0.983-18.1)]. Higher FGF2 expression was significantly correlated with the grade, subtype, estrogen receptor (ER) status, and progesterone receptor (PR) status of the tumor (p = 0.017, p = 0.031, p = 0.002, p = 0.013, respectively). Conclusions: Increased FGF2 expression and tumor size significantly correlated with axillary lymph node metastasis. The tumor's grade, intrinsic subtype, ER and PR status were significantly correlated with increased FGF2 expression. Our study indicated that FGF2 expression might aid in determining the presence of axillary lymph node metastasis.

Background: Artificial intelligence (AI) is recognized to have tremendous potential to revolutionize breast cancer management through mammography. However, the extent of its impact on radiologists with different levels of experience remains largely unexplored. Therefore, this study aimed to comprehensively show how AI could assist radiologists of varying expertise including breast and non-breast radiologists, as well as senior residents, in performing mammogram interpretation.Methods: This retrospective study analyzed eligible mammograms from Cipto Mangunkusumo Hospital between January 2017 and March 2021. Mammographic readings were conducted independently by two breast radiologists, two from other subspecialties, and three senior residents, all blinded to clinical information. AI standalone performance, as well as radiologists with and without AI assistance, was measured. Results: The results showed that a total of 886 eligible mammograms were analyzed. AI standalone performance, assessed using ROC curve analysis, yielded an AUC of 0.946 (95% CI, 0.925–0.967) with sensitivity and specificity of 90.1% and 93.6%, respectively. AI assistance significantly improved the sensitivity and specificity of all radiologists, regardless of experience level, with a median increase of 19.4% (IQR, 10.4–33.5%) and 12.1% (IQR, 5.2–16.2%), respectively. Moreover, there was a trend toward a higher increase with AI assistance in dense compared to fatty breasts.Conclusions: AI proved to be a highly effective diagnostic supplement for radiologists across varying experience levels, specifically in non-breast radiologists, offering the potential to add even greater value in cases of dense breast tissue. The results were derived from a national referral tertiary hospital that generally received many breast cancer cases referred from other hospitals for further treatment. Therefore, further studies incorporating different levels of hospitals were needed.

Introduction. The strategy for treating limb soft tissue sarcoma (STS) is challenging due to delayed diagnosis and the non-specific clinical picture, leading to the mortality of nearly 50% of newly diagnosed patients. Various therapeutic modalities have been applied to increase the survival of patients with extremity soft tissue sarcoma. However, clinicopathological factors can influence the survival rate and thus affect the effectiveness of therapy. This study aims to determine the numbers and factors influencing overall survival five years after treatment for patients with soft tissue sarcoma of the extremities at Dr. Cipto Mangunkusumo General Hospital (CMGH) in 2011-2015.

INTRODUCTION:Thyroid cancer is the third most common cancer that occurs in children and adolescents. Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy. Although the mortality rate of thyroid malignancy in children is usually low, the disease recurrence is higher in children with more severe clinical presentation than in adults. This study aimed to determine the demographic and clinicopathological characteristics and outcome of pediatric and adolescent patients with thyroid malignancy in Indonesia.METHODS:The retrospective study included all patients diagnosed with thyroid carcinoma aged <20 years, from January 1, 2015, to December 31, 2019. Twenty-nine subjects fulfilled the inclusion and exclusion criteria. We retrieved baseline characteristics, pathology features, TSH and fT4 status, radioactive iodine therapy data, and patients' outcomes. Then, data were analyzed using the chi-square or Fisher's exact method.RESULTS:We identified 29 eligible subjects, including 3 boys and 26 girls. The most common type of thyroid carcinoma was PTC (96.5%), and follicular type (31%) was the predominant variant of PTC. Lymph node involvement occurred in 24% of patients, while distant metastasis occurred in 17.2% of patients with PTC. Twenty-four (82.7%) patients had stage 1 disease. Disease recurrence was recorded in 31% of patients during the study period with a median follow-up time of 24 months.CONCLUSION:PTC is the most frequent type of thyroid carcinoma among children and adolescents. This malignancy has a low mortality rate, but the recurrence rate remains high among younger patients than adults even during a short-term follow-up analysis. Distant metastasis and lymph node involvement are commonly found in this age group.

Abstract Background Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy in Asia. Most patients in Cipto Mangunkusumo Hospital have been diagnosed with an advanced stage. There had not been any survival study for OSCC in Indonesia. This study aimed to investigate the survival rate and prognostic factors of OSCC in Cipto Mangunkusumo Hospital. Methods A retrospective cohort study was conducted on OSCC patients diagnosed and treated in Cipto Mangunkusumo Hospital from 2014 to 2018. Data regarding age, gender, site of the primary lesion, clinical stage of the disease, tumor differentiation, invasion, and surgical margins were collected. The main outcomes measured were overall survival (OS) and disease-specific survival (DSS). The predictors of survival were then determined. Result 169 patients were included. The majority of patients were male (51.5%) and above 50 years old (55.6%). The most prevalent tumor site was the tongue (72.8%) followed by buccal mucosa (13%). The majority (82.2%) of patients had advanced (clinical stage IV) disease at diagnosis. A smaller majority of patients had a well-differentiated tumor (60.4%) and a low-grade tumor (53.8%). The worst one-year and two-year overall survival rates were found in the stage IV group (53.5% and 37.5%, respectively). The disease-specific survival rate was 66.9%. Conclusion The one-year and two-year overall survival rates of OSCC in Cipto Mangunkusumo Hospital were 58.6% and 43.1%. Moreover, clinical stage, tumor size, and lymph node involvement were the most significant prognostic factors for OSCC.

Introduction: Parathyroid carcinoma (PC) is a rare malignancy that accounts for 1 % of cases of hyperparathy-roidism. Data regarding PC in Indonesia are scarce, which poses challenges to diagnosis and treatment. This study aims to describe a series of PC cases from a tertiary health care center over 12 years.Presentation of cases: Retrospective data of six patients with hyperparathyroidism diagnosed with PC between 2008 and 2020 were reviewed. Clinical presentation, diagnosis, management, and short-term outcomes of PC were analyzed. All six PC patients were diagnosed postoperatively. Four of the patients presented with symp-tomatic hypercalcemia, and two presented with neck swelling. Elevated serum parathyroid hormone was observed in five patients. Only two patients had imaging results corresponding to PC characteristics. Ipsilateral parathyroidectomies were performed on 5 patients where invasion and metastasis are not evident. Four frozen section samples suggested PC, and two suggested parathyroid adenoma. Further histopathologic examination confirmed a diagnosis of PC in all patients. No metastasis to the adjacent lymph nodes or distant target organs was found during surgery.Discussion: Preoperative diagnosis of PC remains challenging. Suspicion of PC is appropriate in the presence of severe hypercalcemia, elevated parathyroid hormone level, and a mass observed either during imaging or intraoperatively.Conclusion: Ipsilateral parathyroidectomy seems to be feasible compared to total resection in order to preserve function and structure. Incomplete excision may lead to an increased risk of recurrence, emphasizing the importance of routinely following up on PC cases.

INTRODUCTION AND IMPORTANCE:Thyroid hemiagenesis (TH) is a rare congenital anomaly where one lobe fails to develop, especially more frequently occurs on the left lobe. The exact mechanisms for thyroid morphogenesis remain unclear. In this paper, we report a rare case of right lobe TH associated with Hurthle cell carcinoma. CASE PRESENTATION:A 59 years old woman was admitted with a neck lump increasing in size in the last 20 years. There were no symptoms of hyperthyroidism and hypothyroidism. There was a palpable, painless 5 cm mass in the middle of the neck. Initial thyroid ultrasonography (USG) revealed an enlarged left lobe, with hypoechoic lesion with cystic component and calcification (TIRADS 4). However, the right lobe was non-visualized. Fine needle aspiration biopsy result tendency was a malignancy. Hence, isthmolobectomy was conducted. Pathology result was Hurthle cell carcinoma. On the ninth month, USG revealed fibrotic tissue in the right thyroid bed and bilateral lymphadenopathy. Due to discrepancy, the patient was planned for a neck exploration surgery and a right lobe incision. Intraoperatively, the right thyroid was absent. Intraoperative USG also confirmed no right thyroid lobe. DISCUSSION:Thyroid hemiagenesis can be visualized by using USG due to its practicality and cost effectiveness reasons. Follow up evaluations consisted of systematic monitoring of thyroid morphology and hormonal functions should follow the diagnosis of TH. Neck exploration surgery might need to be performed to clarify any discrepancy and confirm the diagnosis. CONCLUSION:TH can be recognized through supporting examination; however, discrepancy may occur.

CONTEXT: Chemoresistance is a major issue in patients with locally advanced oral squamous cell carcinoma (OSCC). In this study, we evaluated the effectiveness of melatonin in conjunction with neoadjuvant chemotherapy (NC) on hypoxia-inducible factor-1α (HIF-1α) expression and clinical response in locally advanced OSCC patients. AIMS: To study the effects of melatonin on HIF-1α expression and its effect on the clinical response of patients with locally advanced OSCC. SETTINGS AND DESIGN: A randomized controlled trial was conducted, wherein patients were recruited from several hospitals in Jakarta, Indonesia. Patients were randomized into two groups using computerized block randomization. SUBJECTS AND METHODS: Both groups were given NC, with treatment group receiving melatonin. Outcomes measured in this study were HIF-1α expression from tissue samples and clinical response based on the RECIST 1.1 criteria. Twenty-five patients completed the study protocol and were included in the data analysis. STATISTICAL ANALYSIS USED: Shapiro–Wilk test was used to test the data normality. For data with normal distribution, we conducted an independent t-test to compare between the two groups. Data with abnormal distribution were analyzed using Mann–Whitney U-test. The mean difference between the two groups was analyzed using Shapiro–Wilk normality test. RESULTS: Our study showed a significant decrease in HIF-1α expression in the melatonin group compared to the placebo group (P < 0.05, relative risk 3.08). However, the degree of reduction of HIF-1α expression in the melatonin group did not differ significantly (P = 0.301). CONCLUSIONS: Our study showed that melatonin administered at 20 mg/day could reduce the expression of HIF-1α and residual tumor percentage, but did not affect the clinical response in OSCC patients.

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.