| Objective To investigate the efficiency, toxicity and survival in patients with primary liver carcinoma treated by three-dimensional conformal radiotherapy (3DCRT). To investigate the risk factors for hepatitis B virus (HBV) reactivation in primary liver carcinoma after 3DCRT. To determine whether preemptive lamivudine reduces 3DCRT-induced hepatitis B reactivation in Patients with primary liver carcinoma.Methods All 103 patients with primary liver carcinoma were treated by 3DCRT in conventional fractionation radiotherapy receivd 2.0Gy per fraction,5 fractions per week with the total dose of 50～65Gy/5～7 w. The planning target volume was covered with 90% isodose curve, using 6 MV X-ray. Clinic data of sixty-nine HBsAg-positive patients with primary liver carcinoma were studied retrospectively. Before 3DCRT, all patients underwent baseline examination, including complete blood cell counts, liver function tests, renal function tests, AFP levels, hepatitis B surface antigen, antibody to hepatitis B surface antigen, hepatitis B e antigen, antibody to hepatitis B e antigen, serum HBV DNA quantification. They were followed up during and for 12 weeks after 3DCRT. Complete blood cell counts were performed biweekly. Liver function tests, renal function tests, AFP levels, hepatitis B surface antigen, antibody to hepatitis B surface antigen, hepatitis B e antigen, Antibody to hepatitis B e antigen, serum HBV DNA quantification were monitored monthly or more frequently if necessary.110 patients who underwent 3DCRT with primary liver carcinoma were enrolled in the study. A total of 41 patients who received lamivudine 100mg daily from the start of 3DCRT to 8 weeks after 3DCRT were assigned as treatment group. 69 patients who did not received lamivudine therapy in the course of 3DCRT as control group.Results Of the 103 cases, complete response (CR) rate was 9.7%; PR,45.6%; the overall response rate (CR+PR),55.3%. The 1-,2-,3-year survival rate was 69.3%, 45.3%,37.4%, respectively. Cox analysis showed that HBsAg status, tumor sizes, portal vein tumor thrombosis and T grade of TNM were the major factors affecting survival in primary liver carcinoma patients. A total of 17 patients developed RILD, the rate 16.5%. HBVDNA serum levels of 22 (21.4%) patients who were HBsAg positive continue to rise exponentially during 12 weeks after radiotherapy.17 patients had their liver function from moderate to severe damage, and 3 died. During the study,12 (17.4%) of 69 patients developed RILD,17(24.6%) HBV reactivation, and 15(21.7%) developed hepatitis due to HBV reactivation. With univariate analysis of factors, a baseline HBV DNA level of more than 105 copies/mL was the only independent predictor of HBV reactivation after 3DCRT. During the study, in the control group, CR rate was 7.2%(5/69); PR,42.0%(29/69); the overall response rate (CR+PR),49.2%. In the treatment group, CR rate was 7.3%(3/41); PR,39.0% (16/41); the overall response rate (CR+PR),46.3%. The difference of the overall response rate between two groups was not statistically significant (P>0.05). The rate of RILD for the control group and the treatment group was 17.4%(12of 69) and 14.6 %(6 of 41), respectively (P>0.05). The cumulative rate of HBV reactivation and hepatitis due to HBV reactivation was significantly greater in control group (2.4%and 2.4%) than in treatment group (24.6%and 21.7%).Conclusions 3DCRT may be considered as an effective and feasible approach to treat primary liver carcinoma with good response. In patients with primary liver carcinoma undergoing 3DCRT, HBV reactivation and consequent hepatitis due to HBV reactivation should be considered in the differential diagnosis of RILD. The prognosis of patients with hepatitis due to HBV reactivation was poor, even if they were treated with antiviral therapy actively. The Preemptive antiviral therapy might be considered in primary liver carcinoma patients with an HBV DNA level of more than 105copies/mL. Preemptive lamivudine therapy for patients with primary liver carcinoma who were underwent 3DCRT might reduce the risk for HBV reactivation and hepatitis due to HBV reactivation. Further studies are needed to confirm the value of this approach.
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