Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Three Cases of Radiation-Induced Hepatitis B Virus Reactivation after Hepatic Tomotherapy: Case Report

간암의 토모테라피 후 발생한 B형 간염 바이러스 재활성화 3예: 증례보고

  • Kong, Moon-Kyoo (Department of Radiation Oncology, Kyung Hee University College of Medicine) ;
  • Hong, Seong-Eon (Department of Radiation Oncology, Kyung Hee University College of Medicine) ;
  • Kim, Byung-Ho (Department of Internal Medicine, Kyung Hee University College of Medicine) ;
  • Choi, Jin-Hyun (Department of Radiation Oncology, Kyung Hee University College of Medicine)
  • 공문규 (경희대학교 의과대학 방사선종양학교실) ;
  • 홍성언 (경희대학교 의과대학 방사선종양학교실) ;
  • 김병호 (경희대학교 의과대학 내과학교실) ;
  • 최진현 (경희대학교 의과대학 방사선종양학교실)
  • Received : 2010.12.08
  • Accepted : 2011.02.23
  • Published : 2011.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Radiation-induced liver disease (RILD) has been characterized as a veno-occlusive disease with anicteric elevation of alkaline phosphatase (ALP). However, some RILD patients present with elevated transaminase levels rather than with anicteric elevation of ALP, and these findings are common in the Asia-Pacific region where hepatitis B virus (HBV) infection is associated with 70~90% of hepatocelluar carcinoma (HCC) cases. In addition, the development of RILD is more common in patients with hepatitis B virus-related HCC. These findings indicate that susceptibility to RILD might be different in HBV carriers and non-carriers, and moreover, RILD in patients with HBV-related HCC might be associated with another unique pathogenesis such as HBV reactivation. However, HBV reactivation after hepatic irradiation has been reported in only a few studies. This study reports three cases of HBV reactivation alter hepatic tomotherapy for management of HCC.

방사선간염은 대개 황달을 동반하지 않은 알칼리인산 분해효소(alkaline phophatase)의 상승을 특징으로 보인다. 하지만, 방사선간염 환자의 일부에서는 아미노전달효소(transaminase)의 상승을 특징적인 소견으로 보이고, 이러한 소견은 특히 간암 환자의 70~90%가 B형 간염 바이러스 보균자인 아시아 지역에서 흔하게 관찰된다. 또한 B형 간염 바이러스 보균자인 간암 환자를 방사선으로 치료했을 때 방사선간염이 더 흔하게 발생한다. 이런 사실들은 B형 간염 바이러스 보균자에서 방사선간염의 발생 기전이 비보균자에서의 그것과 다를 수 있다는 것을 시사하고, B형 간염 바이러스 보균자에서 발생하는 방사선간염의 발생기전은 B형 간염 바이러스의 재활성화와 연관이 있을 것으로 추측된다. 하지만, 현재 간암의 방사선치료 후 B형 간염 바이러스의 재활성화에 대한 연구는 미미한 수준이다. 이에 저자들은 간암 환자의 토모테라피 후 발생한 B형 간염 바이러스 재활성화 3예를 보고하고자 한다.

Keywords

References

  1. Dawson LA, McGinn CJ, Normolle D, et al. Escalated focal liver radiation and concurrent hepatic artery fluorode-oxyuridine for unresectable intrahepatic malignancies. J Clin Oncol 2000;18:2210-2218 https://doi.org/10.1200/JCO.2000.18.11.2210
  2. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21:109-122
  3. Cheng JC, Wu JK, Huang CM, et al. Radiation-induced liver disease after three-dimensional conformal radiotherapy for patients with hepatocellular carcinoma: dosimetric analysis and implication. Int J Radiat Oncol Biol Phys 2002;54:156-162
  4. Cheng JC, Wu JK, Lee PC, et al. Biologic susceptibility of hepatocellular carcinoma patients treated with radiotherapy to radiation-induced liver disease. Int J Radiat Oncol Biol Phys 2004;60:1502-1509 https://doi.org/10.1016/j.ijrobp.2004.05.048
  5. Furuse J, Ishii H, Nagase M, Kawashima M, Ogino T, Yoshino M. Adverse hepatic events caused by radiotherapy for advanced hepatocellular carcinoma. J Gastroenterol Hepatol 2005;20:1512-1518 https://doi.org/10.1111/j.1440-1746.2005.03916.x
  6. Lawrence TS, Robertson JM, Anscher MS, Jirtle RL, Ensminger WD, Fajardo LF. Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys 1995;31:1237-1248 https://doi.org/10.1016/0360-3016(94)00418-K
  7. Cheng JC, Wu JK, Huang CM, et al. Radiation-induced liver disease after radiotherapy for hepatocellular carcinoma: clinical manifestation and dosimetric description. Radiother Oncol 2002;63:41-45 https://doi.org/10.1016/S0167-8140(02)00061-0
  8. Kim JH, Park JW, Kim TH, Koh DW, Lee WJ, Kim CM. Hepatitis B virus reactivation after three-dimensional conformal radiotherapy in patients with hepatitis B virus-related hepato-cellular carcinoma. Int J Radiat Oncol Biol Phys 2007;69:813-819 https://doi.org/10.1016/j.ijrobp.2007.04.005
  9. Yeo W, Chan PK, Zhong S, et al. 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 https://doi.org/10.1002/1096-9071(200011)62:3<299::AID-JMV1>3.0.CO;2-0
  10. Chan TM, Fang GX, Tang CS, Cheng IK, Lai KN, Ho SK. Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients. Hepatology 2002;36:1246-1252 https://doi.org/10.1053/jhep.2002.36156
  11. 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 https://doi.org/10.1016/j.jhep.2004.05.014
  12. Kim B. Hepatitis B virus reactivation after partial hepatic irradiation alone: a case report. J Korean Soc Ther Radiol Oncol 2010;28:106-110 https://doi.org/10.3857/jkstro.2010.28.2.106
  13. Liang SX, Zhu XD, Xu ZY, et al. Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance. Int J Radiat Oncol Biol Phys 2006;65:426-434 https://doi.org/10.1016/j.ijrobp.2005.12.031
  14. Chou CH, Chen PJ, Jeng YM, Cheng AL, Huang LR, Cheng JC. Synergistic effect of radiation and interleukin-6 on hepatitis B virus reactivation in liver through STAT3 signaling pathway. Int J Radiat Oncol Biol Phys 2009;75:1545-1552 https://doi.org/10.1016/j.ijrobp.2008.12.072
  15. Jang JW, Choi JY, Bae SH, et al. A randomized controlled study of preemptive lamivudine in patients receiving transarterial chemo-lipiodolization. Hepatology 2006;43:233-240 https://doi.org/10.1002/hep.21024
  16. Yeo W, Johnson PJ. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology 2006;43:209-220 https://doi.org/10.1002/hep.21051
  17. Hoofnagle JH, Dusheiko GM, Schafer DF, et al. Reactivation of chronic hepatitis B virus infection by cancer chemotherapy. Ann Intern Med 1982;96:447-449 https://doi.org/10.7326/0003-4819-96-4-447
  18. Cheng AL, Hsiung CA, Su IJ, et al. Steroid-free chemotherapy decreases risk of hepatitis B virus (HBV) reactivation in HBV-carriers with lymphoma. Hepatology 2003;37:1320-1328 https://doi.org/10.1053/jhep.2003.50220
  19. Yeo W, Chan PK, Ho WM, et al. Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy. J Clin Oncol 2004;22:927-934 https://doi.org/10.1200/JCO.2004.05.161
  20. Idilman R, Arat M, Soydan E, et al. Lamivudine prophylaxis for prevention of chemotherapy-induced hepatitis B virus reactivation in hepatitis B virus carriers with malignancies. J Viral Hepat 2004;11:141-147 https://doi.org/10.1046/j.1365-2893.2003.00479.x