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Tumor regio pineal bertanggungjawab pada lebih kurang 0,5% dari semua tumor sistem saraf pusat pada dewasa, 1% pada dewasa muda, dan 2,7% pada anak-anak. Karena tindakan operasi dan biopsi dikaitkan dengan tingkat mortalitas dan morbiditas yang tinggi, banyak institusi kesehatan menggunakan radioterapi lokal tumor dengan dosis 2000 cGy sebagai radiasi ex juvantibus. Jika tumor cukup radioresponsif, maka tumor dianggap sebagai germinoma, dan selanjutnya dilakukan radiasi kraniospinal (dosis total 3000 cGy). Tetapi jika tumor relatif radioresistan, maka radiasi dilanjutkan pada lokal tumor atau operasi reseksi tumor kemudian disarankan pada beberapa kasus. Seorang anak laki-laki, usia 12 tahun dirujuk ke Departemen Radioterapi RSCM paska pemasangan VP shunt. Riwayat parestesia di kedua tangan sejak 2 bulan sebelum shunting, yang dirasakan memberat. Gejala klinis dan CT kepala menunjukkan perbaikan paska pemasangan shunting. Massa didiagnosa banding sebagai germinoma atau pineoblastoma. Saat pemeriksaan awal di Departemen Radioterapi, pasien tanpa keluhan dengan KPS 100%. Pemeriksaan neurologi tidak ditemukan kelainan objektif, dengan hasil pemeriksaan endokrinologi dalam batas normal. Hasil pemeriksaan MRI kepala 2 bulan kemudian menunjukkan pembesaranvolume tumor 2 kali ukuran sebelumnya. Tetap tidak ditemukan kelainan secara klinis. Dilakukan radiasi ex juvantibus pada lokal tumor, sebanyak 10 fraksi dengan total dosis 2000 cGy. Didapatkan pengecilan volume tumor yang signifikan berdasarkan MRI evaluasi (regresi 95%). Tumor pineal tersebut dianggap sebagai suatu jenis Germinoma, dan selanjutnya dilakukan radiasi kraniospinal. Kata kunci : tumor region pineal, radioterapi ex juvantibus, germinoma, kraniospinal Pineal tumor covered less than 0.5 % from the total of central nervous system tumor in adults, 1% in young adult, and 2.7% in children. Surgery and biopsy are associated with high incidence of morbidity and mortality, thus many institutions applied local irradiation with the total dose of 2000 cGy as radiation ex juvantibus. If the tumor is radiosensitive, the tumor is classified as germinoma or pineoblastoma, in which craniospinal irradiation will be done with total dose of 3000 cGy. On the other hand, if the tumor is categorised as radioresistant, irradiation will be applied only to local tumor, or in some cases, resection is recommended. A 12 year old boy, referred to Radiotherapy Department Cipto Mangunkusumo Hospital post VP Shunt, with the history of paresthesis on both upper extremities since 2 months prior to VP shunt. Signs, symptoms, and CT scan showed an improvement post VP shunt. The tumor was diagnosed as germinoma or pineoblastoma. During anamnesis and physical examination, the patient has no complaint with the karnofsky scale of 100%. There were no abnormalities in neurological and endocrinology examination. Latest MRI examination performed 2 months after, showed a double fold increase in tumor volume. Irradiation ex juvantibus on the local tumor was delivered in 10 fraction with total dose of...

Introduction:Metastatic brain disease is still a major contributor to cancer treatment failure. Various treatments have improved in the recent decades, which allow for better control of brain metastatic lesions. Various prognostic scoring tools have been developed and used worldwide to stratify patients with brain metastases to determine who will benefit most from aggressive treatment. The three most commonly used prognostic scoring tools are recursive partitioning analysis (RPA), basic score for brain metastases (BSBM) and graded prognostic assessment (GPA). The aim of this study is to validate these scoring tools using an Indonesian cancer patient population.Method:A retrospective analysis of all patients presenting with brain metastases from January 2012 until December 2014, through using hospital medical records, was conducted. All patients receiving whole brain radiotherapy during this period were included in this study. A follow-up with a telephone call was carried out to determine the patient’s health and survival status. Uncontactable patients were excluded from the analysis. Survival analysis was carried out by stratifying patients based on the three prognostic scoring systems.Result:A total of 80 patients were eligible to be included in the study, with 18 excluded due to being uncontactable. The remaining 62 patients’ data were analysed and stratified with all three scoring systems. The RPA was found to confer better stratification than BSBM and GPA in our study population.Conclusion:GPA was non-prognostic in our study population and BSBM was less prognostic, especially in the middle group, class 1 and class 2. Those BSBM class 1 and class 2 did not provide good prognostic stratification in our study population, whereas RPA was proven to be the best in stratifying patients’ prognosis with brain metastases in our study population.