Management Of Radiation Injury Research Articles

A CASE SERIES AND LITERATURE REVIEW: MANAGEMENT STRATEGIES FOR RADIATION-INDUCED ULCERS OF THE CHEST

Highlights: Radiotherapy leads to a high occurrence of skin alterations and can advance to different levels of tissue damage, presenting challenges in treatment. Management can be effective employing diverse wound treatment methods, although severe cases may necessitate surgical intervention. Surgery takes into several key considerations to increase chances of success and tackle specific issues of chest wall instability and breast reconstruction. Abstract: Introduction: Radiotherapy as an adjunct to cancer treatment causes a high incidence of radiation-induced tissue injury, ranging from radiation dermatitis to severe osteoradionecrosis. Currently, no gold standard exists in the management of radiation injury. Various strategies ranging from modern wound treatment to surgical management have been studied. Case Illustration: Three women presented with varying degrees of ulceration in the chest during or shortly following radiotherapy. Each case followed different approaches to management. One case solely received wound treatment, another received wound treatment and a sequestrectomy, and the third required surgical reconstruction of the chest wall and defect. Discussion: Methods of wound treatment range from topical agents, barrier films and dressings, hydrogel and hydrocolloid dressings, miscellaneous treatments, and biodressings. Surgery is required in severe cases, particularly with osteoradionecrosis. This may include wound debridement, biopsy, chest wall stabilization, closure using various flaps, and potential breast reconstruction. Conclusion: Radiation-induced ulcers of the chest pose a complex issue. Understanding effective treatment methods and key surgical principles is important for ensuring better outcomes. Further studies are needed to provide a complete guide to treatment.

1895 “The First Burn Is the Deepest:” A Cautionary Tale in Superficial APC Therapy for Radiation Proctopathy

INTRODUCTION: Globally, prostate cancer is the most commonly diagnosed cancer in men. Radiation therapy remains a mainstay in the armamentarium in the treatment of this disease. Radiation proctopathy is a common side effect of this treatment modality with an incidence in patients treated with brachytherapy alone estimated to range from 8 to 13%, and up to 21% in combination with other modalities [2]. Radiation proctopathy typically presents with diarrhea, mucoid discharge, urgency, tenesmus, and bleeding. Argon plasma coagulation (APC) has become the primary therapeutic modality in the management of radiation injury. It is essential that physicians of all specialties (as well as others who care for these patients) be aware of the multiple complications of this therapy. More severe adverse events, notably rectal ulcers following APC therapy are not uncommon, with an incidence ranging from 3 to 16%. CASE DESCRIPTION/METHODS: A 67-year-old man with a history of prostate cancer treated with radiation therapy one year prior presented with intermittent rectal bleeding for one and a half months. A colonoscopy was performed, which revealed a small area near the dentate line characterized by slightly oozing neovascularized tissue consistent with radiation proctopathy. This area was treated with APC with good effect. Biopsies of this area revealed hyperplastic crypts, lamina propria fibrosis, and vascular ectasias compatible with radiation injury. Three months following treatment, the patient developed recurrent rectal bleeding. A flexible sigmoidoscopy revealed a deep non-bleeding ulcer in the rectum. Subsequent CT enterography and MRI of the pelvis demonstrated a deep rectal ulcer with abutment of a 1.5cm peri-prostatic abscess. The patient was followed closely over the next several months in concert with colorectal surgical colleagues, with serial imaging and subsequent resolution of the peri-prostatic abscess as well as cessation of rectal bleeding. DISCUSSION: As more patients with prostate cancer are treated with radiation therapy the incidence of radiation proctopathy is increasing. Although argon plasma coagulation has been shown to be an effective therapy for this issue, providers must consider and discuss with patients the potential complications of this otherwise effective and generally well-tolerated mode of treatment.

The Comparison of Lecture-Based and Web-Based Education on Nursing Students’ Learning in the Management of Radiation Injuries

The Comparison of Lecture-Based and Web-Based Education on Nursing Students’ Learning in the Management of Radiation Injuries

The Comparison of Lecture-Based and Web-Based Education on Nursing Students’ Learning in the Management of Radiation Injuries

The Comparison of Lecture-Based and Web-Based Education on Nursing Students’ Learning in the Management of Radiation Injuries

Capabilities for Clinical Management of Radiation Injuries of the Nikiforov Russian Center of Emergency and Radiation Medicine (EMERCOM of Russia)

This article presents an overview of the capabilities for clinical management of radiation injuries available at the Nikiforov Russian Center of Emergency and Radiation Medicine (NRCERM) of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters (EMERCOM). NRCERM is a federal state budgetary institution and the Russian Federation's head organization for providing medical assistance for persons overexposed to ionizing radiation, responders to radiation emergencies and people evacuated from radiation contaminated areas. As the WHO Collaborating Center for Treatment and Rehabilitation of Accident Recovery Workers of Nuclear and Other Disasters and a member of the WHO Radiation Emergency Medical Preparedness and Assistance Network (REMPAN), NRCERM is prepared to provide assistance and technical support in case of a radiation accident. For this purpose, NRCERM hospitals are equipped with technologically advanced facilities and possess well-trained specialist staff.

In vivo EPR tooth dosimetry for triage after a radiation event involving large populations.

The management of radiation injuries following a catastrophic event where large numbers of people may have been exposed to life-threatening doses of ionizing radiation will rely critically on the availability and use of suitable biodosimetry methods. In vivo electron paramagnetic resonance (EPR) tooth dosimetry has a number of valuable and unique characteristics and capabilities that may help enable effective triage. We have produced a prototype of a deployable EPR tooth dosimeter and tested it in several in vitro and in vivo studies to characterize the performance and utility at the state of the art. This report focuses on recent advances in the technology, which strengthen the evidence that in vivo EPR tooth dosimetry can provide practical, accurate, and rapid measurements in the context of its intended use to help triage victims in the event of an improvised nuclear device. These advances provide evidence that the signal is stable, accurate to within 0.5 Gy, and can be successfully carried out in vivo. The stability over time of the radiation-induced EPR signal from whole teeth was measured to confirm its long-term stability and better characterize signal behavior in the hours following irradiation. Dosimetry measurements were taken for five pairs of natural human upper central incisors mounted within a simple anatomic mouth model that demonstrates the ability to achieve 0.5 Gy standard error of inverse dose prediction. An assessment of the use of intact upper incisors for dose estimation and screening was performed with volunteer subjects who have not been exposed to significant levels of ionizing radiation and patients who have undergone total body irradiation as part of bone marrow transplant procedures. Based on these and previous evaluations of the performance and use of the in vivo tooth dosimetry system, it is concluded that this system could be a very valuable resource to aid in the management of a massive radiological event.

Radiation necrosis following treatment of high grade glioma—a review of the literature and current understanding

Radiation therapy is an integral part of the standard treatment paradigm for malignant gliomas, with proven efficacy in randomized control trials. Radiation treatment is not without risk however, and radiation injury occurs in a certain proportion of patients. Difficulties in differentiating recurrence from radiation injury complicate the treatment course and can compromise care. These complexities are compounded by the recent distinction of two types of radiation injury: pseudoprogression and radiation necrosis, which are likely the result of radiation injury to the tumor and normal tissue, respectively. A thorough understanding of radiation-induced injury offers insights to guide further therapies. We detail the current knowledge of the mechanisms of radiation injury, along with potential targets for therapeutic intervention. Various diagnostic modalities are also described, in addition to the multiple options for treatment within the context of their pathophysiology and clinical efficacy. Radiation therapy is an integral part of the multidisciplinary management of gliomas, and the optimal diagnosis and management of radiation injury is paramount to improving patient outcomes.

Management of Radiation Injuries by Panax ginseng Extract

Chemical radiation protection is an important strategy to protect living beings against the deleterious effects of radiation. In the present study, the radioprotective effect of hydro-alcoholic extract of Panax ginseng extract (PGR-HAE) was studied on radiation-induced deleterious alterations in Swiss albino mice. Oral administration of such extract (25 mg/kg b wt/day/animal) for 5 consecutive days, half an h. before whole-body exposure to 6 Gy gamma radiation, enhanced the 30 days survival and also inhibited the radiogenic sickness, weight loss and life shortening. PGR-HAE ameliorated radiation induced depletion in blood constituents at different necropsy intervals between 12 h to 30 d, and significantly increased the number of femoral spleen colony forming units that survived after irradiation. Furthermore, it checked depletion of glutathione and antioxidant enzymes (superoxide dismutase, catalase, and glutathione S-transferase) as well as elevation of lipid peroxidation (LPO) level in blood and liver. The significant reduction in the yield of LPO demonstrates that PGR-HAE protects the membranes against radiation-induced oxidative damage. These findings conclude that such plant extract provides significant radioprotection, and it may be potentially valuable in the prevention of injuries caused during planned and unplanned radiation exposure.

Radiation Accident Preparedness: A European Approach to Train Physicians to Manage Mass Radiation Casualties

Mass casualties after radiation exposure pose an enormous logistical challenge for national health services worldwide. Successful medical treatment of radiation victims requires that a plan for medical radiation accident management be established, that the plan be tested in regular exercises, and that it be found to be effective in the management of actual victims of a radiological incident. These activities must be provided by a critical mass of clinicians who are knowledgeable in the diagnosis and management of radiation injury. Here, we describe efforts to provide education to physicians engaged in clinical transplantation. Following intensive discussion among European experts at the International Center for Advanced Studies in Health Sciences and Services, University of Ulm, Germany, an advanced training program on "radiation syndromes" was developed for physicians with experience in the management of patients with pancytopenia and multi-organ failure occurring in a transplant setting. The first European advanced training course using this educational tool took place at Oberschleissheim, Germany, on 28-30 November 2007. Small group discussions and practical exercises were employed to teach general principles and unique features of whole body radiation exposure. Topics included the biological effects of contamination, incorporation of radionuclides, clinical consequences of exposure to radiation, and approaches to medical management. Recommendations resulting from this initial educational experience include (1) provision of funding for attending, conducting and updating the curriculum, and (2) development of an educational program that is harmonized among European and non-European experts in medical management of mass casualties from a radionuclear incident.

Live Attenuated Salmonella Carrying Platelet Factor 4 cDNAs as Radioprotectors

To determine whether live attenuated Salmonella carrying platelet factor 4 cDNAs can protect mice from radiation damage, the attenuated Salmonella SL3261 was used as oral vector for targeted gene delivery. The recovery of mice receiving sublethal total-body irradiation (TBI) was investigated after the oral administration of attenuated Salmonella carrying cDNA for platelet factor 4 (PF4) or truncated PF4. This oral gene therapy protected mice from radiation damage after TBI. The number of bone marrow cells and high proliferative potential colony-forming cells (HPP-CFCs) increased significantly at day 7. Similarly, the administration of PF4 or PF4(17-70) protein also improved the survival of mice after TBI. Both PF4 gene therapy and protein administration accelerated hematopoietic recovery in vivo in mice after irradiation. In vitro, PF4 also promoted survival and proliferation of 5-fluorouracil-resistant hematopoietic stem/progenitor cells after irradiation. These data demonstrate a novel biological function of PF4 as a protector against radiation injury and suggest that attenuated Salmonella could be used in vivo as a PF4 DNA delivery vector in the management of radiation injury.

Development of a statewide hospital plan for radiologic emergencies

Although general guidelines have been developed for triage of victims in the field and for hospitals to plan for a radiologic event, specific information for clinicians and administrators is not available for guidance in efficient management of radiation victims during their early encounter in the hospital. A consensus document was developed by staff members of four Connecticut hospitals, two institutions of higher learning, and the State of Connecticut Department of Environmental Protection and Office of Emergency Preparedness, with assistance of the American Society for Therapeutic Radiology and Oncology. The objective was to write a practical manual for clinicians (including radiation oncologists, emergency room physicians, and nursing staff), hospital administrators, radiation safety officers, and other individuals knowledgeable in radiation monitoring that would be useful for evaluation and management of radiation injury. The rationale for and process by which the radiation response plan was developed and implemented in the State of Connecticut are reviewed. Hospital admission pathways are described, based on classification of victims as exposed, contaminated, and/or physically injured. This manual will be of value to those involved in planning the health care response to a radiologic event.

An Experience of Fatal Radiation Injuries during TOKAI-MURA Nuclear Accident: Successful Surgical Management of Radiation Injury

An Experience of Fatal Radiation Injuries during TOKAI-MURA Nuclear Accident: Successful Surgical Management of Radiation Injury

Operative management of radiation injuries of the intestinal tract

A review of forty cases of radiation-induced gastrointestinal injuries is presented. Based on this experience and reports in the literature, preoperative management and operative technics are discussed. The increased risk of radiation bowel injury is recognized in patients who have had previous operations. Preradiation contrast studies are advised to identify trapped loops of intestine in the pelvis. Small bowel resection is recommended with localized segments of disease. Bypass operations are preferable to avoid any extensive dissections. Bypass operations have anastomotic dehiscence rates similar to those of resections. Proctocolitis is usually managed by diverting colostomy, with resection in a few favorable cases or with treatment failures. Most rectovaginal fistulas are managed by permanent colostomy. Small bowel fistulas are best treated by bypass with partial or total exclusion rather than by primary resection. Vigorous preoperative and postoperative nutritional support and evaluation are vital because of the poor healing qualities of irradiated bowel. Multiple operative procedures should be anticipated because the natural history of radiation bowel injury is slowly progressive.

Surgical management of radiation injury of the small and large intestine.

The following principles should be observed during operations for radiation injuries of the small and large intestine: 1) The objective of operation is modest: to relieve symptoms. 2) Only healthy bowel, which was outside the radiation field, should be anastomosed. 3) Isolated small intestinal injuries should be resected or bypassed, and extensive dissection should be avoided. 4) Colorectal injuries should be treated by diverting descending colostomy, with or without resection of the diseased bowel.

Clinical Aspects and Management of Radiation Injury to Superficial Tissues

Clinical Aspects and Management of Radiation Injury to Superficial Tissues

Clinical Aspects and Management of Radiation Injury to Superficial Tissues

Clinical Aspects and Management of Radiation Injury to Superficial Tissues

Significance and Management of Radiation Injuries

It might have been expected that increasing familiarity with the biological effects of x-rays and radium, more thorough knowledge of the dangers ensuing from overdosage with these physical agents, and rapid progress in the technical development of x-ray equipment, as well as the marked improvement of means for radiation protection and better medical training in general, would have resulted in decreasing to a minimum the incidence of cutaneous injuries by x-rays and radium. Unfortunately this expectation has not materialized, and papers published in recent years, as well as cases in our own experience, give ample proof that x-ray injuries are seen with increasing frequency. Ironically and tragically the growing number of victims of excessive radiation includes not only patients hut more and more physicians as well. In support of this contention I might cite, among others, the publications of Saunders and Montgomery (6), who reported on 259 cases of radiation dermatitis in 1938; Duffy's paper (1), published...