title: Hepatitis B virus reactivation after three-dimensional conformal radiotherapy in patients with hepatitis B virus-related hepatocellular carcinoma.
abstract: OBJECTIVE
  To investigate whether three-dimensional conformal radiotherapy (3D-CRT) influences hepatitis B virus (HBV) reactivation and chronic hepatitis B (CHB) exacerbation in patients with HBV-related hepatocellular carcinoma (HCC).
  
  
  METHODS
  Of the 48 HCC patients with HBV who underwent 3D-CRT to the liver, 16 underwent lamivudine therapy before and during 3D-CRT (Group 1) and 32 did not receive antiviral therapy before 3D-CRT (Group 2). To analyze spontaneous HBV reactivation, we included a control group of 43 HCC patients who did not receive any specific treatment for HCC or CHB.
  
  
  RESULTS
  The cumulative rate of radiation-induced liver disease for Groups 1 and 2 was 12.5% (2 of 16) and 21.8% (7 of 32), respectively (p > 0.05). The cumulative rate of HBV reactivation was significantly greater in Group 2 (21.8%, 7 of 32) than in Group 1 (0%, 0/16) or the control group (2.3%, 1 of 43; p < 0.05 each). The cumulative rate of CHB exacerbation, however, did not differ significantly between Groups 2 (12.5%, 4 of 32) and 1 (0%, 0 of 16) or the control group (2.3%, 1 of 43; p > 0.05 each). The CHB exacerbations in the 4 Group 2 patients had radiation-induced liver disease features but were differentiated by serum HBV DNA changes. Two of these patients required antiviral therapy and effectively recovered with lamivudine therapy.
  
  
  CONCLUSIONS
  In patients with HBV-related HCC undergoing 3D-CRT, HBV reactivation and consequent CHB exacerbation should be considered in the differential diagnosis of radiation-induced liver disease, and antiviral therapy might be considered for the prevention of liver function deterioration after RT.
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi 411-764, South Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Koh
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Kim
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy / Q000821:virology*; D016022:Case-Control Studies; D005260:Female; D006515:Hepatitis B virus / Q000502:physiology / Q000528:radiation effects*; D019694:Hepatitis B, Chronic / Q000821:virology*; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal; D014775:Virus Activation / Q000502:physiology* / Q000528:radiation effects*