Kim Ji Hoon, Park Joong-Won, Kim Tae Hyun, Koh Dong Wook, Lee Woo Jin, Kim Chang-Min
Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi 411-764, South Korea.
Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):813-9. doi: 10.1016/j.ijrobp.2007.04.005. Epub 2007 May 24.
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).
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.
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.
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.
探讨三维适形放疗（3D-CRT）是否会影响乙型肝炎病毒（HBV）相关肝细胞癌（HCC）患者的HBV再激活及慢性乙型肝炎（CHB）病情加重。
48例接受肝脏3D-CRT的HBV相关HCC患者中，16例在3D-CRT前及治疗期间接受拉米夫定治疗（第1组），32例在3D-CRT前未接受抗病毒治疗（第2组）。为分析自发性HBV再激活情况，纳入43例未接受HCC或CHB任何特异性治疗的HCC患者作为对照组。
第1组和第2组放射性肝病的累积发生率分别为12.5%（16例中的2例）和21.8%（32例中的7例）（p>0.05）。第2组HBV再激活的累积发生率（21.8%，32例中的7例）显著高于第1组（0%，16例中的0例）或对照组（2.3%，43例中的1例；每组p<0.05）。然而，第2组（12.5%，32例中的4例）与第1组（0%，16例中的0例）或对照组（2.3%，43例中的1例）CHB病情加重的累积发生率差异无统计学意义（每组p>0.05）。第2组的4例CHB病情加重患者具有放射性肝病特征，但通过血清HBV DNA变化可鉴别。其中2例患者需要抗病毒治疗，并通过拉米夫定治疗有效康复。
在接受3D-CRT的HBV相关HCC患者中，HBV再激活及随之而来的CHB病情加重应在放射性肝病鉴别诊断中予以考虑，且可考虑采用抗病毒治疗预防放疗后肝功能恶化。
