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Article: Pneumocystis Jiroveci Infection and Craniospinal Irradiation with Arc Therapy: a Report of Two cases

TitlePneumocystis Jiroveci Infection and Craniospinal Irradiation with Arc Therapy: a Report of Two cases
Authors
Issue Date2016
PublisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkjr.org
Citation
Hong Kong Journal of Radiology, 2016, v. 19 n. 2, p. 126-131 How to Cite?
AbstractTomotherapy, a form of arc therapy, is often preferred to craniospinal irradiation (CSI) because of its better dose homogeneity when planning target volume and minimising organ risk. We report the cases of two young men with central nervous system germ cell tumour who had unnoticed severe and prolonged lymphopenia after completing CSI with tomotherapy. Both developed Pneumocystis jiroveci pneumonia and one died of respiratory failure. We hypothesise that the rapid drop in lymphocyte count may have been in part due to the ‘low dose bath’ of radiation to the whole pulmonary vasculature with consequent killing of the circulating lymphocytes, in addition to low-dose radiation to a high volume of the thymus, thoracic duct, and bone marrow. We therefore suggest close monitoring of lymphocyte count during tomotherapy-CSI and consideration of co-trimoxazole prophylaxis in severe lymphopenic patients. Further large-scale study is required to understand the possible correlation of V1-V5 lung dosimetry with risk of lymphopenia.
Persistent Identifierhttp://hdl.handle.net/10722/229162
ISSN
2015 SCImago Journal Rankings: 0.113

 

DC FieldValueLanguage
dc.contributor.authorSo, TH-
dc.contributor.authorHo, PYP-
dc.contributor.authorLeung, TW-
dc.contributor.authorKwong, DLW-
dc.date.accessioned2016-08-23T14:09:22Z-
dc.date.available2016-08-23T14:09:22Z-
dc.date.issued2016-
dc.identifier.citationHong Kong Journal of Radiology, 2016, v. 19 n. 2, p. 126-131-
dc.identifier.issn2223-6619-
dc.identifier.urihttp://hdl.handle.net/10722/229162-
dc.description.abstractTomotherapy, a form of arc therapy, is often preferred to craniospinal irradiation (CSI) because of its better dose homogeneity when planning target volume and minimising organ risk. We report the cases of two young men with central nervous system germ cell tumour who had unnoticed severe and prolonged lymphopenia after completing CSI with tomotherapy. Both developed Pneumocystis jiroveci pneumonia and one died of respiratory failure. We hypothesise that the rapid drop in lymphocyte count may have been in part due to the ‘low dose bath’ of radiation to the whole pulmonary vasculature with consequent killing of the circulating lymphocytes, in addition to low-dose radiation to a high volume of the thymus, thoracic duct, and bone marrow. We therefore suggest close monitoring of lymphocyte count during tomotherapy-CSI and consideration of co-trimoxazole prophylaxis in severe lymphopenic patients. Further large-scale study is required to understand the possible correlation of V1-V5 lung dosimetry with risk of lymphopenia.-
dc.languageeng-
dc.publisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkjr.org-
dc.relation.ispartofHong Kong Journal of Radiology-
dc.rightsHong Kong Journal of Radiology. Copyright © Hong Kong Academy of Medicine Press.-
dc.titlePneumocystis Jiroveci Infection and Craniospinal Irradiation with Arc Therapy: a Report of Two cases-
dc.typeArticle-
dc.identifier.emailSo, TH: sth495@hku.hk-
dc.identifier.emailHo, PYP: pattyho@hku.hk-
dc.identifier.emailLeung, TW: ltw920@hkucc.hku.hk-
dc.identifier.emailKwong, DLW: dlwkwong@hku.hk-
dc.identifier.authoritySo, TH=rp01981-
dc.identifier.authorityKwong, DLW=rp00414-
dc.identifier.doi10.12809/hkjr1615329-
dc.identifier.hkuros261636-
dc.identifier.volume19-
dc.identifier.issue2-
dc.identifier.spage126-
dc.identifier.epage131-
dc.publisher.placeHong Kong-

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