It has been suggested that hepatitis B e antigen (HBeAg) seroconversion after lamivudine therapy is durable in Caucasians with chronic hepatitis B (CHB). However, little is known whether it is also durable in endemic areas of hepatitis B virus (HBV) infection. We evaluated the posttreatment durability of lamivudine-induced HBeAg seroconversion and the predictive factors for relapse in Korean patients with CHB. We retrospectively analyzed 98 HBeAg-positive patients with CHB who were treated with lamivudine between August 1996 and December 1997. Lamivudine was given at a dose of 150 mg per day. After HBeAg seroconversion, lamivudine was continued for an additional 2 to 4 months, and posttreatment monitoring continued for up to 24 months. HBeAg seroconversion was achieved in 34 of the 98 patients (34.7%). The mean duration of treatment in these seroconverters was 9.3 ؎ 3.0 months. During the follow-up period, the cumulative relapse rates at 1 year and 2 years posttreatment were 37.5% and 49.2%, respectively. Although interferon alfa (IFN-␣) has been accepted as an effective therapy in chronic hepatitis B (CHB), [1][2][3][4][5][6] it is known to be less effective in Asian patients because of the immune tolerance secondary to perinatal infection. [7][8][9] In addition, it has potential dose-limiting side effects and is inconvenient because of prolonged subcutaneous injection. 10 Lamivudine is an oral nucleoside analogue that inhibits reverse transcription by causing chain termination of nascent viral DNA in hepatitis B virus (HBV) infection. 11,12 Despite its effectiveness in suppressing HBV replication and safety, [13][14][15][16] the optimum duration of lamivudine therapy is not yet determined. From the experience of IFN-␣ 2,5,6 and lamivudine therapy in Western patients, 15,16 hepatitis B e antigen (HBeAg) seroconversion, defined as undetectable HBeAg/ HBV DNA and appearance of anti-HBe, can be regarded as an appropriate parameter for cessation of lamivudine.Although Dienstag et al. 15,16 reported that lamivudine-induced HBeAg seroconversion was durable and lamivudine could be stopped after HBeAg loss or seroconversion, the posttreatment follow-up duration in those studies ranged from only 4 to 12 months and the sample size was too small. To our knowledge, there is no long-term posttreatment follow-up study of patients who achieved lamivudine-induced HBeAg seroconversion. Furthermore, it is also unknown whether lamivudine-induced HBeAg seroconversion can be durable posttreatment in endemic areas such as Korea, where most HBV infection is considered to be transmitted vertically. 17,18 The aim of this study was to evaluate the posttreatment durability of lamivudine-induced HBeAg seroconversion in this endemic area and the predictive factors for relapse after cessation of lamivudine. PATIENTS AND METHODSPatients. We retrospectively analyzed 98 consecutive patients (77 men and 21 women; mean age, 34.9 Ϯ 9.4 years) with HBeAg-positive CHB who were treated with lamivudine between August 1996 and December 1997. Table 1 s...

BackgroundEven with early stage hepatocellular carcinoma (HCC), patients are often ineligible for surgical resection, transplantation, or local ablation due to advanced cirrhosis, donor shortage, or difficult location. Stereotactic body radiation therapy (SBRT) has been established as a standard treatment option for patients with stage I lung cancer, who are not eligible for surgery, and may be a promising alternative treatment for patients with small HCC who are not eligible for curative treatment.Materials and MethodsA registry database of 93 patients who were treated with SBRT for HCC between 2007 and 2009 was analyzed. A dose of 10-20 Gy per fraction was given over 3-4 consecutive days, resulting in a total dose of 30-60 Gy. The tumor response was determined using dynamic computed tomography or magnetic resonance imaging, which was performed 3 months after completion of SBRT.ResultsThe median follow-up period was 25.6 months. Median size of tumors was 2 cm (range: 1-6 cm). Overall patients’ survival rates at 1 and 3 years were 86.0% and 53.8%, respectively. Complete and partial tumor response were achieved in 15.5% and 45.7% of patients, respectively. Local recurrence-free survival rate was 92.1% at 3 years. Most local failures were found in patients with HCCs > 3 cm, and local control rate at 3 years was 76.3% in patients with HCC > 3 cm, 93.3% in patients with tumors between 2.1-3 cm, and 100% in patients with tumors ≤ 2 cm, respectively. Out-of-field intrahepatic recurrence-free survival rates at 1 and 3 years were 51.9% and 32.4%, respectively. Grade ≥ 3 hepatic toxicity was observed in 6 (6.5%).ConclusionsSBRT was effective in local control of small HCC. SBRT may be a promising alternative treatment for patients with small HCC which is unsuitable for other curative therapy.