Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

Abstract

<jats:title>ABSTRACT</jats:title><jats:p><jats:bold>Objectives:</jats:bold>The World Health Organization convened a panel of experts to rank the evidence for medical countermeasures for management of acute radiation syndrome (ARS) in a hypothetical scenario involving the hospitalization of 100 to 200 victims. The goal of this panel was to achieve consensus on optimal management of ARS affecting nonhematopoietic organ systems based upon evidence in the published literature.</jats:p><jats:p><jats:bold>Methods:</jats:bold>English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to conferees in advance of and updated during the meeting. Published case series and case reports of ARS, publications of randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation system. In cases in which data were limited or incomplete, a narrative review of the observations was made.</jats:p><jats:p><jats:bold>Results:</jats:bold>No randomized controlled trials of medical countermeasures have been completed for individuals with ARS. Reports of countermeasures were often incompletely described, making it necessary to rely on data generated in nonirradiated humans and in experimental animals. A strong recommendation is made for the administration of a serotonin-receptor antagonist prophylactically when the suspected exposure is &gt;2 Gy and topical steroids, antibiotics, and antihistamines for radiation burns, ulcers, or blisters; excision and grafting of radiation ulcers or necrosis with intractable pain; provision of supportive care to individuals with neurovascular syndrome; and administration of electrolyte replacement therapy and sedatives to individuals with significant burns, hypovolemia, and/or shock. A strong recommendation is made against the use of systemic steroids in the absence of a specific indication. A weak recommendation is made for the use of fluoroquinolones, bowel decontamination, loperamide, and enteral nutrition, and for selective oropharyngeal/digestive decontamination, blood glucose maintenance, and stress ulcer prophylaxis in critically ill patients.</jats:p><jats:p><jats:bold>Conclusions:</jats:bold>High-quality studies of therapeutic interventions in humans exposed to nontherapeutic radiation are not available, and because of ethical concerns regarding the conduct of controlled studies in humans, such studies are unlikely to emerge in the near future.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2011;5:183–201)</jats:p>

Radioprotective efficacy of delta-tocotrienol, a vitamin E isoform, is mediated through granulocyte colony-stimulating factor

“…G-CSF has also been shown to mitigate radiation injury in nonhuman primates (Farese et al, 2012(Farese et al, , 2013. There is general agreement in literature that G-CSF is an acceptable treatment for human subjects exposed to ≥ 3 Gy of total body irradiation or ≥ 2 Gy of total-body irradiation in combined injury (radiation plus wound/trauma/burn) (Waselenko et al, 2004;Dainiak et al, 2011aDainiak et al, , 2011bDainiak, 2010). G-CSF has been assigned a pre-emergencyuse authorization (EUA) package held by the Centers for Disease Co γ-irradiated mice.…”

Local, Regional and National Responses for Medical Management of a Radiological/Nuclear Incident

“…Chromosome analysis may be performed urgently or at a later period of time, depending on the needs and circumstances of the situation. Assessment of prognosis and clinical decision making are based upon radiation dose estimates and the presence of certain clinical signs and symptoms, such as time to onset of nausea and vomiting, rate of decline in absolute lymphocyte count, cutaneous lesions and neurovascular changes, including hypotension, tachycardia, fever and neurological and cognitive deficits (Dainiak et al 2011a;Dainiak et al 2011b).…”

A review of radiation countermeasures focusing on injury-specific medicinals and regulatory approval status: part I. Radiation sub-syndromes, animal models and FDA-approved countermeasures

“…The main therapeutic principles behind such strategy are the transplantation of hematopoietic stem cells (HSC), substitution with blood products, and the administration of cytokines or growth factors like granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF). There is a compelling need for internationally accepted strategies for the treatment of potentially lethally-exposed radiation victims (Dainiak et al 2011b).…”