Hepatitis B virus reactivation after three-dimensional conformal radiotherapy in patients with hepatitis B virus-related hepatocellular carcinoma.
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.
Kim
Ji Hoon
JH
Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi 411-764, South Korea.
Park
Joong-Won
JW
Kim
Tae Hyun
TH
Koh
Dong Wook
DW
Lee
Woo Jin
WJ
Kim
Chang-Min
CM
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*