Treatment of Radiation Injuries

240 Pages·1990·4.665 MB·English

by  Richard Champlin (auth.), Doris Browne, Joseph F. Weiss, Thomas J. MacVittie, Madhavan V. Pillai (eds.)

Treatment
of
Radiation Injuries
Treatment
of
Radiation Injuries
Edited by
Doris Browne
Joseph F. Weiss
Thomas J. MacVittie
Madhavan V. Pillai
Defense Nuclear Agency
Armed Forces Radiobiology Research Institute
Bethesda, Maryland
Springer Science+Business Media, LLC
Library of Congress Catalog1ng-1n-Pub11cat1on Data
Consensus Development Conference on the Treatment of Radiation
Injuries C1st : 1989 : ~ashington, D.C.)
Treat~ent of radiation injuries I edited by Doris Browne ... [et
a 1.].
p. em.
"Proceedings of the First Consensus Development Conference on the
Treatment of Radiation Injuries, held May 10-13, 1989, in
~ashington, D.C."--T.p. verso.
Includes bibliographical references.
Includes index.
ISBN 978-1-4899-0866-7 ISBN 978-1-4899-0864-3 (eBook)
DOI 10.1007/978-1-4899-0864-3
1. Radiation injuries--Treatment--Congresses. 2. Hematopoietic
syste~--Radiation injuries--Congresses. 3. Radiation injuries-
-Complications and sequelae--Congresses. I. Browne, Doris.
II. Title.
[DNLM: 1. Accidents--congresses. 2. Bone Marrow Diseases
-therapy--congresses. 3. Growth Substances--therapeutic use-
-congresses. 4. Infection--congresses. 5. Radiation Injuries-
-complications--congresses. 6. Radiation Injuries--therapy-
-congresses. 7. ~ounds and Injuries--congresses. ~N 610 C7548t
1989]
RC93.C66 1989
616.9'897--dc20
DNLM/DLC
for Library of Congress 90-14216
CIP
Proceedings of the First Consensus Development Conference on the Treatment of
Radiation Injuries, held May 10-13, 1989, in Washington, D.C.
Views presented in these proceedings are those of the authors; no endorsements by
their organizations have been given or should be inferred.
© 1990 Springer Science+Business Media New York
Originally published by Plenum Press, New York in 1990
Softcover reprint of the hardcover 1st edition 1990
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Preface
The proliferation of radioactive materials in industry, in diagnostic and
therapeutic medicine, in scientific and medical research, in the military, and
as a source of energy has increased the likelihood of accidental exposure to
ionizing radiation. Further, the number of individuals exposed in accidents,
such as Chernobyl, U.S.S.R.; Goiania, Brazil; and San Salvador, El Salvador,
underscores the potential for large-scale radiation accidents. Because of these
accidents, health care providers have found themselves treating patients with
acute radiation injuries and subsequent complications. Often the radiation
injuries are combined with burns or other trauma and the infectious and
immune complications associated with such injuries. The treatment of victims
of these accidents has provided important information about the medical
management of radiation casualties. However, development of techniques to
improve the diagnosis and treatment of radiation injuries, to collect follow
up data on survivors, and to determine the long-term effects of uncontrolled
radiation exposure must continue.
The Armed Forces Radiobiology Research Institute, Bethesda, Maryland, and
its Medical Radiobiology Advisory Team sponsored the First Consensus
Development Conference on the Treatment of Radiation Injuries in
Washington, DC, on May 10-13, 1989. The proceedings of the conference are
presented in this volume, which we hope will serve as a reference for clinicians
and basic research scientists who require knowledge of the latest developments
in the diagnosis and treatment of radiation injuries. This conference was
designed specifically to address the areas of hematopoietic injury, infectious
complications, and combined injury. Other issues pertaining to radiation
injuries, such as biologic dosimetry, chemical radioprotection, internal and
external radionuclide decontamination, treatment of beta radiation skin burns,
potassium iodide prophylaxis, and the development of medical emergency
response teams and regional treatment centers, were beyond the scope of
this conference and will be addressed at future conferences.
While there have been several significant recent advances in the treatment
of infections and burns in immunocompromised patients, this has not been
the case with patients sustaining injuries from uncontrolled radiation exposure.
Controversy exists regarding the most appropriate techniques in treating the
infectious and hematopoietic complications that accompany radiation injuries
and/or combined radiation/trauma/burn injuries. A new era in medical
v
vi Preface
radiobiology has dawned. The promise of technological advances in biomedical
research generates new insight into the application of this technology to treat
individuals with ionizing radiation injuries.
Participants at the consensus conference addressed many factors related to
the hematopoietic injury complications of radiation exposure, including bone
marrow failure following radiation accidents, the role and use of human
recombinant colony-stimulating factors in radiation victims, the use of blood
and bone marrow products, bone marrow transplantation, treatment of
irradiated animals with recombinant human colony-stimulating factors, and
the myeloprotective effects of growth factors.
Additionally, the attendees discussed the infectious complications resulting
from radiation injury, including antibiotic, antifungal, and antiviral therapy in
neutropenia postirradiation; the role of immunotherapy in preventing
infectious complications; treatment of infections in the acute radiation
syndrome; prevention of infections with endogenous organisms; and the use
of colony-stimulating factors in the Brazilian accident victims. The current status
of combined injury and burn management therapy, the implications for healing
and infection in the wound environment, and the complications of combined
injury in animal models were addressed. These data were correlated to recent
radiation accidents.
The consensus statement, developed by the panel of medical and radiobiology
experts, evolved from the scientific evidence presented, small group workshops,
and roundtable discussions during the conference. Although this consensus
statement does not address all aspects of radiation injury, it provides state
of-the-art guidelines for recognizing and treating them.
The editors gratefully acknowledge the contributions of the conference
organizing committee; the small group facilitators; the audiovisual support
of David H. Morse and Darrell Grant; and the clerical and administrative support
staff, especiallyDarlene Stewart, Judy Kendrick, Gloria Contreras, Mary Jones,
Sidney Gibson, Catherine Williams, and Harold Modrow. Our special thanks
to the Information Services Department, Armed Forces Radiobiology Research
Institute, for its assistance in the development and completion of this book,
especially Gloria Ruggiero, Modeste Greenville, Catherine Sund, and Carolyn
Wooden. Also, our special thanks to Janet B. Gillette and 0. D. Miller for
typesetting the text.
Doris Browne
Contents
Hematopoietic Injury Complications
Medical Assessment and Therapy in Bone Marrow Failure Due to 3
Radiation Accidents: Role of Bone Marrow Transplantation and Hematopoietic
Growth Factors
Richard Champlin
Use of rhGM-CSF in Bone Marrow Failure: Is There a Therapeutic Role 11
for GM-CSF in Accidental Radiation Injuries?
Joseph H. Antin
Blood and Bone Marrow Products in the Treatment of Radiation 19
Injury
C. Robert Valeri
Total-Body Irradiation in Bone Marrow Transplantation 29
Rainer Storb, H. Joachim Deeg, Frederick R. Appelbaum,
Friedrich G. Schuening, Robert Raff, and Theodore Graham
Rescue of lethally Irradiated Animals: Therapeutic Use of rhG-CSF and 35
rhGM-CSF in Preclinical Models of Radiation-Induced Marrow Aplasia
Thomas J. MacVittie and Rodney L. Monroy
Myeloprotective Effects of lnterleukin-1 Following Exposure to 51
Chemoradiotherapy
Joseph Laver, Alfred Gillio, Miguel Abboud, Cristina Gasparetto,
David Warren, Richard J. O'Reilly, and Malcolm A. S. Moore
vii
viii Contents
Effects of Combined Application of IL-3 and G-CSF on Subhuman 61
Primates
Dorothee Krumwieh, Ernst Weinmann, Bernhard Siebold, and
Friedrich R. Seiler
Roundtable Discussion 67
Infectious Complications
Infections in Radiation Accidents: An Overview 75
Stephen C. Schimpf!
Antibiotics in Postirradiation Infection 87
Itzhak Brook
Treatment of Infectious Complications of the Hematopoietic 95
Syndrome
Alexandre R. Oliveira
Role of Immunotherapy in Preventing and Managing 101
Po~tirradiation Infections
Richard I. Walker
Management of Fungal Infections Complicating Granulocytopenia: 109
Implications for Patients With Radiation Injuries
Thomas J. Walsh and Philip A. Pizzo
Prevention of Infection With Endogenous Organisms 115
Gary P. Zaloga
Role of Hematopoietic Growth Factors in Radiation Victims: 127
RhGM-CSF Following the Goiania Accident
Anna Butturini and Robert Peter Gale
Contents ix
Roundtable Discussion 133
Combined Injury Complications
The Status of Combined Injuries 141
Erwin F. Hirsch
Combined Radiation and Thermal Injury After Nuclear Attack 145
William K. Becker, Teresa M. Buescher, William G. Cioffi,
William F. McManus, and Basil A. Pruitt, Jr.
Complications of Combined Injury: Radiation Damage and Skin Wound 153
Trauma in Mouse Models
G. David Ledney, Gary S. Madonna, Daniel G. McChesney,
Thomas B. Elliott, and Itzhak Brook
Wound Environment: Implications for Healing and Infection 165
Patricia M. Mertz and William H. Eaglstein
Roundtable Discussion 175
Future Directions and Consensus Summary Statement
A Historical Perspective on the Therapy of Total-Body Radiation 183
Injury
Eugene P. Cronkite
Acute Effects of Radiation Exposure Following the Chernobyl 195
Accident: Immediate Results of Radiation Sickness and Outcome of Treatment
Angelina K. Guskova, N. M. Nadezhina, Anjelika V. Barabanova,
A/exandr E. Baranov, I. A. Gusev, Tatiana G. Protasova, V. B.
Bogus/avskij, and V. N. Pokrovskaya
X Contents
Potential Role for Human Colony-Stimulating Factors in the 211
Treatment of Radiation Injuries
William P. Peters
Consensus Summary Statement on the Treatment of Radiation 219
Injuries
Appendixes
Appendix A: Consensus Panel Participants 233
Appendix B: Conference Participants 235
Index 241