Diagnosis & Management of the Cutaneous Radiation Syndrome & Local Radiation Injuries

Professor Viktor Meineke MD, Colonel, Medical Corps
Director, Bundeswehr Institute of Radiobiology
Munich Germany
Affiliated with the University of Ulm
Adjunct Associate Professor of Radiation Oncology
Northwestern University
Chicago Illinois USA

Abstract

The cutaneous radiation syndrome (CRS) is among the earliest clinical signs and symptoms of accidental radiation exposure at considerable doses in case of whole body or significant partial body exposures, such as those resulting from nuclear scenarios. Therefore, CRS plays an important role as both an early indicator of exposure and as a prognostic indicator for the development of radiation induced multi-organ interactions and multi-organ failure (RIMOF). The current understanding of the contribution of CRS to the pathophysiology of whole body radiation reactions is more and more a systemic perspective. This view has tremendous impact on concepts of CRS management. Local radiation injuries (LRI) are a common denominator of many accidental radiation exposures in industry, such as an unintentional exposure to orphan radiation sources. Time courses of development depend on exposure conditions, mode, degree and clinical pictures of tissue damage that are different from CRS after high dose and whole body exposure. Systemic inflammatory reactions at the tissue and organ levels are the link between CRS and LRI. Therapeutic strategies have to consider commonalities and differences between the management of more local versus systemic skin reactions after accidental radiation exposure. The current and up-to-date standards of diagnosis and management will be reviewed.