{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:38:43Z","timestamp":1790206723494,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2004,9,23]],"date-time":"2004-09-23T00:00:00Z","timestamp":1095897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2004,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Postgastrectomy patients undergoing chemoradiation risk chemoradiation\u2010induced liver disease (CRILD). The objectives of this study were to investigate dosimetric implications and assess biologic susceptibility to CRILD in these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Sixty\u2010two patients with Stage IB\u2013IV gastric\/gastroesophageal adenocarcinoma without metastases underwent radical total\/subtotal gastrectomy; regional lymph node dissection; and postoperative, adjuvant, concomitant chemoradiotherapy (CCRT). Among these, 8 patients developed CRILD (defined as Grade 3\u20134 liver toxicity), and 11 patients were chronic hepatitis B virus (HBV) carriers (HBV+). Chemotherapy consisted of 1 cycle of etoposide, leucovorin, and 5\u2010fluorouracil (ELF); followed by 5 weekly high doses of 5\u2010fluorouracil (2000\u20132600 mg\/m<jats:sup>2<\/jats:sup>) and leucovorin concurrent with radiotherapy (median dose, 45 grays [Gy] to the tumor bed\/regional lymphatics); followed by 3 cycles of ELF separated by a 21\u2010day interval. Patients were followed for \u2265 4 months after CCRT. Patient\u2010related and dosimetric factors were correlated with CRILD.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>HBV+ status was the only independent factor associated with CRILD. HBV+ patients had a higher CRILD incidence (6 of 11 patients vs. 2 of 51 patients; <jats:italic>P<\/jats:italic> &lt; 0.001). HBV\u2010negative patients with CRILD were recipients of a higher mean liver dose (MLD) (23.8 Gy vs. 15.2 Gy; <jats:italic>P<\/jats:italic> = 0.009) and a higher volume fraction of liver that received &gt; 30 Gy (36.5% vs. 19.7%; <jats:italic>P<\/jats:italic> = 0.009) compared with noncarriers without CRILD, but no MLD difference was found between HBV+ patients with or without CRILD. Moreover, in four of six carriers with CRILD, HBV infection was reactivated during CRILD. Two of the toxicities were fatal.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>HBV carriers had a higher incidence of CRILD after postgastrectomy CCRT, probably related to HBV reactivation. Dosimetric parameters modulated the risk of CRILD in noncarriers, but not in carriers. These factors deserve attention in CRILD\/HBV+ patients, and the underlying pathogenesis warrants investigation. Cancer 2004. \u00a9 2004 American Cancer Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.20591","type":"journal-article","created":{"date-parts":[[2004,9,23]],"date-time":"2004-09-23T14:06:31Z","timestamp":1095948391000},"page":"2126-2133","source":"Crossref","is-referenced-by-count":23,"title":["Unexpectedly frequent hepatitis B reactivation by chemoradiation in postgastrectomy patients"],"prefix":"10.1002","volume":"101","author":[{"given":"Jason Chia\u2010Hsien","family":"Cheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei\u2010Ching","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella Y.","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010Tse","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Jer\u2010Min Jian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juei\u2010Low","family":"Sung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2004,10,18]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2388(199909)17:2<132::AID-SSU8>3.0.CO;2-E"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010187"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(01)02646-3"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(92)90651-W"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)02846-8"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)02915-2"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/1096-9071(200011)62:3<299::AID-JMV1>3.0.CO;2-0"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(99)00559-3"},{"key":"e_1_2_5_10_2","first-page":"513","article-title":"Complication 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