Clinical

Postgastrectomy chemoradiation may reactivate HBV infection

Last Updated: 2004-11-11 9:50:20 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The results of a new study show that chronic hepatitis B virus (HBV) carriers are at heightened risk of developing chemoradiation-induced liver disease (CRILD) after postgastrectomy concomitant chemoradiotherapy, probably due to HBV reactivation.

In the November 1st issue of the journal Cancer, a group of clinicians from Taiwan describe 62 patients with gastric/gastroesophageal adenocarcinoma without metastases who underwent gastrectomy and CCRT.

Chemotherapy consisted of one cycle of etoposide, leucovorin, and 5-FU (ELF) followed by five weekly cycles of high-dose 5-FU and leucovorin with conventional radiotherapy (median dose, 45 Gy) followed by three additional cycles of ELF.

A total of eight patients developed CRILD defined as Grade 3-4 liver toxicity after chemotherapy.

According to the team, the incidence of CRILD was significantly higher in chronic HBV carriers than in non-carriers (6 of 11 patients vs 2 of 51 patients; p < 0.001).

"HBV-positive status was the only independent factor associated with CRILD," Dr. Jason Chia-Hsien Cheng from National Taiwan University Hospital in Taipei and colleagues note.

Four of the six HBV carriers who developed CRILD had serologic evidence of viral hepatitis reactivation. Most of them recovered after lamivudine-driven suppression of HBV reactivation.

Based on their experience, Dr. Cheng and colleagues urge close observation of HBV carriers undergoing CCRT "because of the high probability of liver toxicity."

Cancer 2004;101:2126-2133.