Virologic Impact of Radiotherapy in Hepatitis C Virus-Infected Patients With Hepatocellular Carcinoma.

Abstract

Hepatitis B virus (HBV) reactivation had been reported following radiotherapy in patients with hepatocellular carcinoma (HCC) along with limited data focused on patients infected with hepatitis C virus (HCV). Herein, we aimed to examine the virologic impact of radiotherapy in HCV-infected patients with HCC. In this case-control study, we identified all patients with unresectable HCC who received radiotherapy directed to the liver at MD Anderson from March 2009 through November 2018. Cases were defined as patients with HCV infection; controls were defined as patients without HCV infection. The case to control ratio was 1:3, and the subjects were matched by age, radiation dose, and fractionation or biologically effective dose of the radiation to the normal liver (α/β=2.5) and tumor (α/β=10). Thirty-two patients were studied, including 8 cases and 24 controls. No HCV reactivation was observed among the cases. Hepatitis flare was observed in 2 (25%) of 8 cases and 2 (8%) of 24 controls (p=0.25). The peak alanine aminotransferase level within 6 months after radiotherapy did not differ significantly between the cases and controls. Radiotherapy completion rates were similar in the two groups. This is the first report analyzing changes in HCV RNA levels after radiation for HCV-associated HCC. Our results suggest that the effects of radiotherapy on the liver function of HCV-infected patients with HCC do not differ from the HCV-uninfected patients. Therefore, it may not be necessary to monitor for HCV replication in HCV-infected patients receiving radiotherapy for HCC or to incorporate a biological variable based on HCV infection status in mathematical models of liver dose-volume constraints that predict radiation-induced liver disease.