Advances in the Diagnosis and Management Of Cutaneous Radiation Syndrome (CRS) and Acute Local Radiation Injuries (LRI)

Daniel Flynn MD

Abstract

Radiation injury can be characterized as a result of uniform exposure producing total body injury, or from non-uniform whole-body exposure including cutaneous radiation syndrome (CRS) or local radiation injury (LRI). However, in some instances, there can be a combination of radiation injuries often characterized by the one which is most clinically significant.

The approximate threshold manifestations of cutaneous effects are: erythema (10 Gy), wet desquamation (20 Gy), radionecrotic ulcers (40 Gy), with the clinical appearance of first-, second-, and third-degree burns, respectively. These manifestations are commonly seen about two or three weeks following the acute exposure.

LRI to a small area is the most frequent injury in radiation accidents, with the fingers and hands being the most common sites. Sometimes there is a component of whole-body irradiation but it is often not clinically significant. LRI is generally managed as follows: conservative, non-surgical treatment initially, including antibiotics; surgical excision for painful, deep, or necrotic ulcers, followed by wound covering (grafting); amputation for necrotic extremity. Critical specific-organ damage and significant non-uniform whole-body exposure have been caused in association with LRI when high-intensity sources are in contact with chest and pelvic areas. The result can sometimes be life-threatening damage to specific critical organs with a background of some degree of bone marrow suppression.

CRS can be caused by prolonged skin contamination with intense radioisotopes or it can also be a result of a very high whole-body dose with or without radioactive contamination of the skin. Treatment is similar to that for conventional serious burns with the added complexity introduced by potential bone marrow suppression.

The early assessment of the expected degree of radiation injury, in order to predict the severity of cutaneous or local radiation effect, is difficult. Refinements in early physical dosimetry and techniques to predict severity of local radiation injury are important. New medical countermeasures, such as the use of somatic stem cells, use of cytokines, antimicrobials and other new drug therapies, show promise.