PLoS One. 2018 Jul 30;13(7):e0201316. doi: 10.1371/journal.pone.0201316. eCollection 2018.
Hepatitis B virus reactivation after radiotherapy for hepatocellular carcinoma and efficacy of antiviral treatment: A multicenter study.
Jun BG1, Kim YD1, Kim SG2, Kim YS2, Jeong SW3, Jang JY3, Lee SH4, Kim HS4, Kang SH5, Kim MY5, Baik SK5, Lee M6, Kim TS6, Choi DH6, Choi SH7, Suk KT7, Kim DJ7, Cheon GJ1.
Author information
1
Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea.
2
Department of Internal Medicine, Soonchunhyang University College of Medicine Bucheon Hospital, Bucheon, South Korea.
3
Department of Internal Medicine, Soonchunhyang University College of Medicine Seoul Hospital, Seoul, South Korea.
4
Department of Internal Medicine, Soonchunhyang University College of Medicine Cheonan Hospital, Cheonan, South Korea.
5
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
6
Department of Internal medicine, Kangwon National University Hospital, Chuncheon, South Korea.
7
Department of Internal Medicine Hallym University College of Medicine, Chuncheon, South Korea.
Abstract
Convincing data that support routine use of preventive therapy against hepatitis B virus (HBV) reactivation in radiotherapy (RT) for hepatocellular carcinoma (HCC) are lacking. The aim of this study was to investigate the incidence, clinical significance, and risk factors of HBV reactivation after RT. Medical records of 133 HBsAg (+) HCC patients who received radiotherapy from March 2009 to February 2016 were reviewed. Patients were divided into two groups: 1) non-antiviral group, those who did not receive antiviral therapy before RT (n = 27); and antiviral group (those who underwent antiviral therapy before RT) (n = 106). Factors related to HBV reactivation in HCC patients were evaluated. 17 (12.7%) of 133 patients developed HBV reactivation after RT. Patients in the antiviral group had significantly lower rates of HBV reactivation than those in the non-antiviral group (7.5% vs. 33.3%, p<0.001). HBV related hepatitis was also lower in the antiviral group (3.8% vs. 14.8%, p = 0.031). In multivariate analysis, absence of antiviral treatment (OR: 8.339, 95% CI: 2.532-27.470, p<0.001) and combined treatment of RT with transarterial chemoembolizatoin (TACE) (OR: 5.313, 95% CI: 1.548-18.232, p = 0.008) were risk factors for HBV reactivation. HBV reactivation can occur after radiotherapy. Combination treatment of RT with TACE and non-antiviral treatment are major risk factors for HBV reactivation during or after RT. Therefore, preventive antiviral therapy should be recommended for patients with HCC who are scheduled to receive RT.