The Effects of Hepatic Artery Chemotherapy on Viral Hepatitis in Patients With Hepatocellular Carcinoma

Abstract

Transcatheter arterial chemoembolization (TACE) or arterial Yttrium-90 (90Y) microspheres are used to treat unresectable hepatocellular carcinoma (HCC), but little is known about their effects on viral hepatitis. The aim of this study was to determine their effect on viral hepatitis in patients with HCC. We carried out a retrospective review of patients treated for HCC. Worsening of viral hepatitis was determined by serum chemistry and viral loads where available. Fifty-two patients treated with TACE were followed for a mean of 22.0 months. Thirty-nine patients (75%) had decreased/stable tumor. Two of the 39 (5%) patients with decreased/stable tumor burden had a sustained increase in bilirubin. None had a sustained ALT elevation or significant increase in viral load after TACE. Twenty-four patients treated with 90Y microspheres were followed for a mean of 12.0 months. Twenty-two of these had a decreased/stable tumor burden and no patient had a significant elevation of ALT. However, 7 of the 22 had a sustained bilirubin elevation. We conclude that neither TACE nor 90Y treatment was associated with worsening viral hepatitis in this group of HCC patients. The presence of chronic viral hepatitis with normal bilirubin should not exclude the use of these therapies in patients with unresectable HCC.

Changes in hepatitis B virus DNA levels and liver function after transcatheter arterial chemoembolization of hepatocellular carcinoma

“…Some case reports also showed that TACE represents a major risk factor for HBV reactivation in HBV‐related HCC patients 10,19,20 . However, different or even controversial results were observed in other reports 11–14 . A prospective study showed that a single session of TACE had little effect on the incidence of HBV reactivation, and usually the HBV reactivated patients recovered spontaneously 11 .…”

Comparison of transcatheter arterial chemoembolization and microsphere embolization for treatment of unresectable hepatocellular carcinoma: a meta-analysis

“…A total of thirteen studies (Salem et al 2011;Carr et al 2010;Kooby et al 2009;Lewandowski et al 2009;Lee et al 2008;Hou et al 2006;Kirchhoff et al 2006;Ahmad et al 2005;Cao et al 2005a, b;Liu et al 2005;Du et al 2002;Hao et al 2000) were included in our analysis criteria, which included 597 and 1,233 HCC patients for treatment with microsphere embolization and chemoembolization, respectively (Table 1). Of these published studies, ten had comparison data on response rate and 1-year survival rate, three had overall survival (OS), and two had time to progression.…”

“…Thus, if these two subgroups were combined, the statistically significant difference was only marginal (RR 1.04 vs. 1.41, interaction P = 0.075). Data on ten studies were available for response rate analyses in 396 and 1,033 patients treated with microsphere embolization or chemoembolization, respectively (Carr et al 2010;Kooby et al 2009;Lewandowski et al 2009;Lee et al 2008;Hou et al 2006;Kirchhoff et al 2006;Ahmad et al 2005;Cao et al 2005a, b;Du et al 2002;Hao et al 2000). Overall, 231 (58.3%) and 570 (55.2%) patients who underwent microsphere embolization or chemoembolization showed complete or partial responses.…”

Role of lamivudine with transarterial chemoembolization in the survival of patients with hepatocellular carcinoma

“…found that there was no significantly increase of serum HBV‐DNA level in 52 HCC patients undergoing TACE. Another previous study found that TACE decreased HBV‐DNA level in primary liver cancer patients, especially for those with preoperative HBV‐DNA level of ≥ 1 × 10 5 /mL, and those with postoperative AFP decline. According to the EASL (2012) clinical guideline: Management of chronic hepatitis B virus infection , for HBeAg‐positive patients, treatment should be considered if the HBV‐DNA is > 20 000 IU/mL with ALT ≥ 2 ULN.…”

“…reported 69 cases of HCC with HBV infection that a single TACE would not increase serum HBV‐DNA level. Ahmad J et al . found that there was no significantly increase of serum HBV‐DNA level in 52 HCC patients undergoing TACE.…”