JOURNAL OF HEPATOLOGY shown in Table 3 is also very similar despite the above-mentioned differences in the proportion of patients treated in a lobar fashion. In summary, we totally agree with Garin et al. that better dosimetry models for therapeutic planning will be welcomed and their development is warranted, but we respectfully disagree that they are crucial, since the currently used methods result in significant clinical activity with an acceptable incidence of liver toxicity. Most importantly, we cannot find any scientific basis to sustain that glass microspheres have substantial benefits over resin microspheres or vice versa. What the available evidence shows is that radioembolization is indeed a very consistent therapeutic procedure irrespective of the device used and the type of tumor treated, and that future efforts should be dedicated to improve their performance and to find the precise role it may play in the evolving treatment paradigm of primary and secondary liver tumors.
Conflict of interest BS, MI and JIB have received lecture fees, and BS and JIB have consulted for Sirtex Medical.
[4] Lau WY, Leung WT, Ho S, Leung NW, Chan M, Lin J, et al. Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study. Br J Cancer 1994;70:994–999. [5] Garin E, Lenoir L, Rolland Y, Edeline J, Mesbah H, Laffont S, et al. Dosimetry based on 99mTc-macroaggregated albumin SPECT/CT accurately predicts tumor response and survival in hepatocellular carcinoma patients treated with 90Y-loaded glass microspheres: preliminary results. J Nucl Med 2012;53:255–263. [6] Mazzaferro V, Sposito C, Bhoori S, Romito R, Chiesa C, Morosi C, et al. Yttrium 90 radioembolization for intermediate-advanced hepatocarcinoma: a phase II study. Hepatology 2012. Aug 22. http://dx.doi.org/10.1002/hep.26014 [Epub ahead of print]. [7] Kao YH, Hock Tan AE, Burgmans MC, Irani FG, Khoo LS, Gong Lo RH, et al. Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling for safe and effective 90Y radioembolization. J Nucl Med 2012;53:559–566. [8] Chiesa C, Maccauro M, Romito R, Spreafico C, Pellizzari S, Negri A, et al. Need, feasibility and convenience of dosimetric treatment planning in liver selective internal radiation therapy with (90)Y microspheres: the experience of the National Tumor Institute of Milan. Q J Nucl Med Mol Imaging 2011;55:168–197. [9] Dancey JE, Shepherd FA, Paul K, Sniderman KW, Houle S, Gabrys J, et al. Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Ymicrospheres. J Nucl Med 2000;41:1673–1681. [10] Naymagon S, Warner RRP, Patel K, Harpaz N, Machac J, Weintraub JL, et al. Gastroduodenal ulceration associated with radioembolization for the treatment of hepatic tumors: an institutional experience and review of the literature. Dig Dis Sci 2010;55:2450–2458.
⇑
References [1] Sangro B, Iñarrairaegui M, Bilbao JI. Radioembolization for hepatocellular carcinoma. J Hepatol 2012;56:464–473. [2] Jiang M, Fischman A, Nowakowski FS. Segmental perfusion differences on paired Tc-99m Macroaggregated Albumin (MAA) hepatic perfusion imaging and yttrium-90 (Y-90) Bremsstrahlung imaging studies in SIR-sphere radioembolization: associations with angiography. J Nucl Med Radiat Ther 2012;3:122. http://dx.doi.org/10.4172/2155-9619.1000122. [3] Strigari L, Sciuto R, Rea S, Carpanese L, Pizzi G, Soriani A, et al. Efficacy and toxicity related to treatment of hepatocellular carcinoma with 90Y-SIR spheres: radiobiologic considerations. J Nucl Med 2010;51:1377–1385.
Bruno Sangro Mercedes Iñarrairaegui Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Spain ⇑Corresponding author. E-mail address:
[email protected] Jose I. Bilbao Interventional Radiology, Clinica Universidad de Navarra, Pamplona, Spain
Identification of chronic hepatitis B To the Editor: One paper with impressive findings recently published in The Journal of Hepatology by Veldhuijzen et al., reported that on-site testing could increase the detecting rate of hepatitis B for high-risk persons [1]. We would like to comment that Veldhuijzen et al.’s paper highlights the concept that only those who know they are infected with hepatitis B could have the chance to receive antiviral treatment. Likewise, Hsu et al.’s study showed that using electronic health records among primary care providers could significantly increase the screening rate of hepatitis B for high-risk persons [2]. Li et al. reported that those having a family physician and having better knowledge of hepatitis B could be associated with increased screening rates of hepatitis B [3]. These studies provide valuable evidence that hepatitis B screening recommended by primary care providers could increase the detecting rate of hepatitis B. Taiwan is the first country in the world to a commence national hepatitis B immunization program for newborns.
Initially, hepatitis B vaccine was only given to newborns whose mothers were hepatitis B carriers since July 1984. Two years later, universal immunization has been extended to all newborns from 1986 to date [4]. Since the prevalence of hepatitis B carriers was around 14.7–19.5% in Taiwan before universal immunization [5,6], and the current CDC guidelines already recommend screening of all subjects born in countries with hepatitis B prevalence P2% [7], based on cost-benefit effect, we would like to suggest that migrants who were born in Taiwan before 1986 should be recommended for hepatitis B screening.
Conflict of interest The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
Journal of Hepatology 2013 vol. 58 j 1053–1061
1057
Letters to the Editor References [1] Veldhuijzen IK, Wolter R, Rijckborst V, Mostert M, Voeten HA, Cheung Y, et al. Identification and treatment of chronic hepatitis B in Chinese migrants: results of a project offering on-site testing in Rotterdam. The Netherlands J Hepatol 2012;57:1171–1176. [2] Hsu L, Bowlus CL, Stewart SL, Nguyen TT, Dang J, Chan B, et al. Electronic messages increase Hepatitis B screening in at-risk Asian American patients: a randomized, controlled trial. Dig Dis Sci 2012:1–8, [online paper]. [3] Li D, Tang T, Patterson M, Ho M, Heathcote J, Shah H. The impact of hepatitis B knowledge and stigma on screening in Canadian Chinese persons. Can J Gastroenterol 2012;26:597–602. [4] Huang K, Lin S. Nationwide vaccination: a success story in Taiwan. Vaccine 2000;18:S35–S38. [5] Wu JS, Chen CH, Chiang YH, Lee YC, Lee MH, Ko YC, et al. Hepatitis B virus infection in Taiwan with reference to anti-HBc versus HBsAg and anti-HBs. Taiwan Yi Xue Hui Za Zhi 1980;79:760–767. [6] Lai SW, Lin T, Liao KF, Lai HC, Liu CS, Lin CC. Seroepidemiology of hepatitis B and hepatitis C virus infections in people receiving health checkups – a hospital-based study. Ann Acad Med Singapore 2009;38:1106. [7] Centers for Disease Control and Prevention. Hepatitis B Information for Health Professionals. http://www.cdc.gov/hepatitis/Settings/index.htm [cited in 2012 November].
Shih-Wei Lai School of Medicine, China Medical University, Taichung, Taiwan Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
⇑
Kuan-Fu Liao Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan Department of Health Care Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan ⇑Corresponding author. Address: Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan E-mail address:
[email protected]
Reply to: ‘‘Identification of chronic hepatitis B’’ To the Editor: We appreciate the letter to the editor regarding our paper on the results of a project offering on-site hepatitis B testing to Chinese migrants in Rotterdam [1]. To take Lai and Liao’s suggestion to screen persons born in Taiwan before 1986 further, we would like to recommend offering screening to all persons born in hepatitis B endemic countries before the introduction of universal vaccination. Additionally, Lai and Liao rightly observe that primary care providers could play an important role in the detection of chronic hepatitis B infections. To achieve a substantial increase in the number of identified patients with chronic hepatitis B, we feel efforts should be targeted at several healthcare settings. Hwang et al. studied ten thousand patients receiving chemotherapy and found that only 17% were screened for hepatitis B [2]. This shows that besides improving screening rates through outreach programmes and interventions aimed at primary care, room for improvement also exists in the hospital setting.
References [1] Veldhuijzen IK, Wolter R, Rijckborst V, Mostert M, Voeten HA, Cheung Y, et al. Identification and treatment of chronic hepatitis B in Chinese migrants: results of a project offering on-site testing in Rotterdam, The Netherlands. J Hepatol 2012;57:1171–1176. [2] Hwang JP, Fisch MJ, Zhang H, Kallen MA, Routbort MJ, Lal LS, et al. Low rates of hepatitis B virus screening at the onset of chemotherapy. J Oncol Pract 2012;8:e32–e39.
⇑
Irene K. Veldhuijzen Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands ⇑Corresponding author. E-mail address:
[email protected] Harry L.A. Janssen Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
Conflict of interest The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
1058
Journal of Hepatology 2013 vol. 58 j 1053–1061
