Analysis of hepatitis B virus reactivation induced by precise radiotherapy in patients with primary liver cancer
HUANG We, LU Yan-da, ZHANG Wei, ZHANG Jian, ZHOU Tao, LI Hong-sheng, LI Bao-sheng, YU Jin-ming.
Department of Radiation Oncology Ⅵ, Shandong Cancer Hospital, Shandong′s Key Laboratory of Radiation Oncology, Ji′nan 250117, China Corresponding author:LI Bao-sheng
Objective To investigate the clinical features of hepatitis B virus (HBV) reactivation after precise radiotherapy in patients with primary liver cancer (PLC) and analyze the risk factors for HBV reactivation. Methods A retrospective analysis was performed on the clinical data of 69 hepatitis B surface antigen (HBsAg)-positive patients with PLC, some of whom had HBV reactivation after precise radiotherapy. Before radiotherapy, all patients underwent baseline examinations, including blood routine, liver function test, renal function test, and quantifications of serum alpha-fetoprotein (AFP), serum HBV markers, and serum HBV DNA. During radiotherapy and within 12 weeks after radiotherapy, blood routine was performed biweekly, and liver function test, renal function test, and quantifications of serum AFP, serum HBV markers, and serum HBV DNA were performed once every four weeks. Logistic regression analysis was used to evaluate the association of the indices with HBV reactivation. Results Of the 69 patients, 12(17%) had radiation-induced liver disease, 17(25%) had HBV reactivation, and 15(22%) developed hepatitis due to HBV reactivation. The logistic regression analysis showed that baseline serum HBV DNA level was the risk factor for HBV reactivation after precise radiotherapy. Conclusions HBV reactivation may occur after precise radiotherapy in patients with PLC, and baseline serum HBV DNA level is the independent risk factor for HBV reactivation. The patients who develop hepatitis due to HBV reactivation have poor prognosis even if they receive antiviral therapy in time.
HUANG We,LU Yan-da,ZHANG Wei et al. Analysis of hepatitis B virus reactivation induced by precise radiotherapy in patients with primary liver cancer[J]. Chinese Journal of Radiation Oncology, 2013, 22(3): 193-196.
[1] Lok ASF, Lai CL, Wu PC, et al. Hepatitis B virus infection in Chinese families in Hong Kong. Am J Epidemiol,1987,126:492-499. [2] Yeo W, Lam KC, Zee B, et al. Hepatitis B reactivation in patients with hepatocellular carcinoma undergoing systemic chemotherapy. Ann Oncol,2004,15:1661-1666. [3] 杨秉辉.原发性肝癌//中国抗癌协会.新编常见恶性肿瘤诊治规范.北京:中国协和医科大学出版社,1999:389-479. [4] Lawrence TS, Ten Haken RK, Kessler ML, et al. The use of 3-D dose volume analysis to predict radiation hepatitis. Int J Radiat Oncol Biol Phys,1992,23:781-788. [5] Trotti A, Byhardt R, Stetz J, et al. Common toxicity criteria:version 2.0. an improved reference for grading the acute effects of cancer treatment:impact on radiotherapy. Int J Radiat Oncol Biol Phys,2000,47:13-47. [6] Yeo W, Chan PK, Zhong S, et a1. Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy:a prospective study of 626 patients with identification of risk factors. J Med Virol,2000,62:299-307. [7] Jeong WJ, Jong YC, Si HB, et a1. A Randomized controlled study of preemptive lamivudine in patients receiving transarterial chemo-lipiodolization. Hepatology,2006,43:233-240. [8] Yeo W, Johnson PJ. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology,2006,43:209-220. [9] Tamori A, Nishiguchi S, Tanaka M, et al. Lamivudine therapy for hepatitis B virus reactivation in a patient receiving intra-arterial chemotherapy for advanced hepatocellular carcinoma. Hepatol Res,2003,26:77-80. [10] Jang JW, Choi JY, Bae SH, et al. Transarterial chemolipiodolization can reactivate hepatitis B virus replication in patients with hepatocellular carcinoma. J Hepatol,2004,41:427-435. [11] Kim JH, Park JW, Kim TH, et al. Hepatitis B reactivation after three-dimensional conformal radiotherapy in patients with hepatitis B virus-related hepatocellular carcinoma. Int J Radiat Oncol Biol Phys,2007,69:813-819. [12] 吴晓安,章志勇,洪节约,等.三维适形放疗治疗86例肝癌的临床疗效分析.实用癌症杂志,2007,22:373-375. [13] Lok ASF, Liang RHS, Chiu EKW, et al. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology,1991,100:182-188. [14] Yeo W, Zhong S, Chan PKS, et al. Sequence variations of precore/core and precore promoter regions of hepatitis B virus in patients with or without viral reactivation during cytotoxic chemotherapy. J Viral Hep,2000,7:448-458. [15] Chou CH, Chen PJ, Lee PH, et al. Radiation-Induced hepatitis B virus reactivation in live mediated bystander effect from irradiated endothelial cells. Clin Cancer Res,2007,13:851-857. [16] Keeffe EB, Dieterich DT, Han SH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States an update. Clin Gastroenterol Hepato,2006,4:936.
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