Choroba popromienna
Leczenie

Choroba popromienna (ARS) jest wynikiem ekspozycji na wysokie dawki promieniowania jonizującego i wymaga wielodyscyplinarnego leczenia obejmującego dekontaminację, terapię uszkodzeń szpiku kostnego oraz eliminację wewnętrznego skażenia. Dekontaminacja polega na usunięciu odzieży i obuwia (redukcja skażenia o około 90%), myciu skóry oraz izolacji pacjenta, co zapobiega dalszemu rozprzestrzenianiu się radioaktywności. Uszkodzenie szpiku kostnego leczy się czynnikami stymulującymi tworzenie kolonii granulocytów (G-CSF), takimi jak filgrastym, sargramostym i pegfilgrastym, podawanymi w dawce 5 μg/kg masy ciała dziennie. W ciężkich przypadkach stosuje się transfuzje krwinek czerwonych i płytek oraz rozważa się przeszczep komórek macierzystych, zwłaszcza przy dawkach ≥7 Gy i utrzymującej się aplazji szpiku powyżej 14 dni. W przypadku wewnętrznego skażenia stosuje się specyficzne środki, m.in. jodek potasu (KI) w ciągu 4 godzin od ekspozycji na radioaktywny jod, błękit pruski (Radiogardase) na cezu i tal oraz DTPA na pluton, ameryk i kiur, dostępne w formie dożylnej lub nebulizowanej (dla dorosłych). Leczenie objawowe obejmuje przeciwwymiotne (antagoniści 5-HT3, kortykosteroidy), antybiotykoterapię profilaktyczną i leczniczą, analgetyki, leki przeciwzapalne i opioidy, a także wsparcie w postaci nawodnienia, leków na zapalenie błon śluzowych i zabiegów chirurgicznych w ciężkich przypadkach.

  1. Wprowadzenie do leczenia choroby popromiennej
  2. Dekontaminacja jako pierwszy etap leczenia
  3. Leczenie uszkodzeń szpiku kostnego
    1. Czynniki wzrostu hematopoezy
    2. Transfuzje krwi
    3. Przeszczep komórek macierzystych
  4. Leczenie skażeń wewnętrznych
    1. Jodek potasu
    2. Błękit pruski
    3. DTPA
    4. Nowe podejścia terapeutyczne
  5. Leczenie objawowe i wspomagające
    1. Leczenie nudności i wymiotów
    2. Zwalczanie infekcji
    3. Leczenie przeciwbólowe
    4. Inne metody leczenia wspomagającego
  6. Leczenie specyficznych powikłań popromiennych
    1. Zapalenie skóry popromienne
    2. Zapalenie płuc popromienne
    3. Popromienne zapalenie przełyku
    4. Popromienne zapalenie pęcherza moczowego
    5. Zaburzenia funkcji seksualnych
  7. Leczenie zaburzeń psychologicznych
  8. Opieka nad pacjentami z dawkami letalnymi
  9. Postępowanie kliniczne i monitorowanie
    1. Ocena początkowa
    2. Klasyfikacja pacjentów
    3. Monitorowanie i obserwacja długoterminowa
  10. Podsumowanie
    1. Kolejne rozdziały

Wprowadzenie do leczenia choroby popromiennej

Choroba popromienna, znana również jako zespół ostrej choroby popromiennej (ARS), powstaje w wyniku ekspozycji na wysokie dawki promieniowania jonizującego. Leczenie choroby popromiennej koncentruje się na kilku kluczowych celach: zapobieganiu dalszej kontaminacji promieniotwórczej, leczeniu zagrażających życiu obrażeń, łagodzeniu objawów oraz kontroli bólu1. Skuteczne leczenie wymaga wielodyscyplinarnego podejścia, które obejmuje świadczenia z zakresu intensywnej opieki medycznej, specjalistycznych środków farmakologicznych oraz wsparcia psychologicznego2. Warto podkreślić, że rodzaj i intensywność terapii zależą od stopnia ekspozycji, rodzaju promieniowania oraz indywidualnych czynników pacjenta3.

Dekontaminacja jako pierwszy etap leczenia

Pierwszym krokiem w leczeniu choroby popromiennej jest dekontaminacja, która polega na usunięciu zewnętrznych cząstek radioaktywnych1. Ten proces jest kluczowy dla zmniejszenia dalszej ekspozycji na promieniowanie zarówno u pacjenta, jak i u personelu medycznego4. Dekontaminacja obejmuje:

  • Usunięcie odzieży i obuwia, co eliminuje około 90% zewnętrznego skażenia15
  • Delikatne mycie skóry wodą i mydłem w celu usunięcia dodatkowych cząstek radioaktywnych1
  • Izolację pacjenta w celu zapobiegania rozprzestrzenianiu się materiałów radioaktywnych5

Procedury dekontaminacji powinny być przeprowadzane jak najszybciej po ekspozycji, aby zmniejszyć ryzyko wewnętrznego skażenia przez wdychanie, połknięcie lub przez otwarte rany5. Usunięcie zewnętrznego skażenia stanowi fundament dla skutecznego wdrożenia dalszych etapów leczenia3.

Leczenie uszkodzeń szpiku kostnego

Choroba popromienna często prowadzi do uszkodzenia szpiku kostnego, co skutkuje obniżeniem liczby komórek krwi i zwiększonym ryzykiem infekcji16. W leczeniu tego aspektu choroby zastosowanie znajdują:

Czynniki wzrostu hematopoezy

Białko znane jako czynnik stymulujący tworzenie kolonii granulocytów (G-CSF) może przeciwdziałać efektom choroby popromiennej na szpik kostny1. Leczenie lekami zawierającymi to białko obejmuje:

  • Filgrastym (Neupogen) – podawany podskórnie w dawce 5 μg/kg masy ciała dziennie67
  • Sargramostym (Leukine) – stymuluje produkcję granulocytów i makrofagów18
  • Pegfilgrastym (Neulasta) – forma pegylowana G-CSF o przedłużonym działaniu19

Badania kliniczne wykazały, że podawanie tych czynników zwiększa produkcję białych krwinek i zapobiega późniejszym infekcjom5. Szczególnie ważne jest wczesne rozpoczęcie leczenia cytokininami, najlepiej bezpośrednio po podejrzeniu lub potwierdzeniu ekspozycji na promieniowanie2.

Transfuzje krwi

W przypadku poważnego uszkodzenia szpiku kostnego, pacjenci mogą wymagać transfuzji:

  • Czerwonych krwinek w celu leczenia anemii10
  • Płytek krwi dla zapobiegania lub leczenia krwawień5

Transfuzje są istotnym elementem leczenia wspomagającego, szczególnie u pacjentów z ciężkim uszkodzeniem szpiku kostnego8. Decyzja o przeprowadzeniu transfuzji powinna uwzględniać stopień cytopenii oraz stan kliniczny pacjenta2.

Przeszczep komórek macierzystych

W ekstremalnych przypadkach, gdy inne metody leczenia nie przynoszą efektów, może być rozważany przeszczep komórek macierzystych szpiku kostnego11. Jednak według ekspertów METREPOL, przeszczep nie powinien być przeprowadzany u ofiar wypadków radiacyjnych, które mają potencjał endogennej regeneracji hematopoezy6. Przeszczep komórek macierzystych rozważa się głównie w przypadkach, gdy:

  • Aplazja szpiku utrzymuje się pomimo leczenia cytokinami przez ponad 14 dni6
  • Dawka promieniowania była bardzo wysoka (≥7 Gy), ale inne układy narządów nie są zagrożone w stopniu zagrażającym życiu2

Decyzja o przeprowadzeniu przeszczepu powinna być podejmowana przez zespół specjalistów, w tym hematologów/onkologów, onkologów radiacyjnych oraz lekarzy specjalizujących się w transplantacji komórek hematopoetycznych2.

Leczenie skażeń wewnętrznych

W przypadku wewnętrznego skażenia, gdy materiał radioaktywny dostał się do organizmu przez połknięcie, wdychanie lub przez skórę, stosuje się specyficzne środki lecznicze7. Metody leczenia zależą od rodzaju radionuklidu i mogą obejmować:

Jodek potasu

Jodek potasu (KI) jest nierozdioaktywną formą jodu12. Stosowany jest w przypadku narażenia na radioaktywny jod, który może zostać wchłonięty przez tarczycę13. Mechanizm działania obejmuje:

  • Wypełnienie „wakatów” w tarczycy, zapobiegając absorpcji radioaktywnego jodu12
  • Ochronę gruczołu tarczowego przed wchłanianiem radioaktywnego jodu3

Jodek potasu jest najskuteczniejszy, gdy zostanie podany w ciągu czterech godzin od wewnętrznego skażenia radioaktywnym jodem2. Szczególnie zaleca się go wszystkim dzieciom i kobietom w ciąży, które zostały narażone na ekspozycję3. Należy jednak pamiętać, że jodek potasu nie jest uniwersalnym środkiem i jest skuteczny głównie w przypadku narażenia na radioaktywny jod12.

Błękit pruski

Błękit pruski (Radiogardase) to rodzaj barwnika, który wiąże się z cząsteczkami radioaktywnych pierwiastków, takich jak cez i tal12. Jego działanie polega na:

  • Wiązaniu radioaktywnych pierwiastków w jelitach i zapobieganiu ich wchłanianiu13
  • Przyspieszeniu eliminacji radioaktywnych cząstek z organizmu poprzez układ pokarmowy12

Błękit pruski podaje się w postaci kapsułek, co umożliwia przejście radioaktywnych pierwiastków przez układ trawienny i wydalenie ich wraz z kałem13. FDA zatwierdziła nierozpuszczalny błękit pruski do leczenia znanego lub podejrzewanego wewnętrznego skażenia radioaktywnym cezem i/lub radioaktywnym lub nieradioaktywnym talem u osób powyżej 2 roku życia14.

DTPA

Kwas dietylenotriaminopentaoctowy (DTPA) to substancja wiążąca metale12. DTPA wiąże się z cząsteczkami radioaktywnych pierwiastków, takich jak pluton, ameryk i kiur12. Mechanizm działania obejmuje:

  • Wiązanie radioaktywnych cząstek, które następnie są wydalane z moczem12
  • Zmniejszenie ilości absorbowanego promieniowania4

DTPA jest dostępny w dwóch formach: jako trójsodowy pentetynian wapnia i jako trójsodowy pentetynian cynku14. FDA zatwierdziła DTPA do dożylnego leczenia znanego lub podejrzewanego wewnętrznego skażenia amerykiem, kiurem i plutonem14. W przypadku skażenia drogą oddechową, DTPA może być również podawany w formie nebulizowanej, ale tylko u dorosłych14.

Nowe podejścia terapeutyczne

Prowadzone są badania nad nowymi metodami leczenia skażeń wewnętrznych, w tym:

  • Enterosorbenty – materiały, takie jak aktywowany węgiel i pektyny, które mogą wiązać i usuwać toksyny i molekuły radioaktywne z organizmu15
  • Kombinacja fluorochinolonów i rBPI21 (syntetycznej wersji BPI) – badania wykazały, że ta kombinacja może być skuteczna nawet gdy podawana jest dzień po ekspozycji na wysokie dawki promieniowania1617
  • TP508 – lek pierwotnie zaprojektowany do pomocy pacjentom w regeneracji komórek poprzez zwiększenie przepływu krwi i zmniejszenie stanu zapalnego, który w badaniach na myszach wykazał zdolność do zapobiegania zniszczeniu komórek bariery jelitowej nawet gdy podawany jest 24 godziny po ekspozycji18

Te nowe podejścia terapeutyczne mogą w przyszłości znacząco poprawić możliwości leczenia wewnętrznego skażenia radioaktywnego1517.

Leczenie objawowe i wspomagające

Leczenie objawowe i wspomagające stanowi istotny element terapii choroby popromiennej, szczególnie w przypadkach, gdy nie ma specyficznego leczenia dla danego typu ekspozycji1. Obejmuje ono szereg interwencji mających na celu złagodzenie objawów i poprawę komfortu pacjenta.

Leczenie nudności i wymiotów

Nudności i wymioty są częstymi objawami choroby popromiennej19. W ich leczeniu stosuje się:

  • Antagonistów receptora 5-HT3 – wykazują największą skuteczność w profilaktyce i leczeniu nudności i wymiotów wywołanych promieniowaniem20
  • Kortykosteroidy – często stosowane w połączeniu z antagonistami receptora 5-HT36
  • Leki przeciwwymiotne – podawane przed lub po każdej sesji napromieniania w celu zapobiegania nudnościom21

Odpowiednie zapobieganie i leczenie nudności i wymiotów wywołanych promieniowaniem są niezbędne dla ukończenia kursu radioterapii, aby pozytywny wynik leczenia mógł zostać osiągnięty bez przerw20. Dla pacjentów poddawanych radioterapii całego ciała, która wiąże się z najwyższym ryzykiem nudności i wymiotów, zaleca się dwulekowy schemat profilaktyki20.

Zwalczanie infekcji

Choroba popromienna zwiększa podatność na infekcje ze względu na obniżoną liczbę białych krwinek22. W zwalczaniu infekcji stosuje się:

  • Antybiotyki – podawane profilaktycznie lub w przypadku rozwinięcia się infekcji2324
  • Izolację odwrotną – stosowaną u pacjentów z dawkami całego ciała większymi niż 2-3 Gy6
  • Standardowe schematy postępowania w przypadku gorączki neutropenicznej22

Istnieje bezpośredni związek między stopniem neutropenii, która pojawia się po ekspozycji na promieniowanie, a zwiększonym ryzykiem rozwoju infekcji22. Dlatego też leczenie powinno obejmować szerokie spektrum antybiotyków aktywnych przeciwko tlenowym bakteriom Gram-ujemnym22.

Leczenie przeciwbólowe

Ból jest częstym objawem choroby popromiennej, szczególnie w przypadkach, gdy doszło do oparzeń lub uszkodzeń tkanek3. W leczeniu bólu stosuje się:

  • Analgetyki – dobraną do nasilenia bólu25
  • Leki przeciwzapalne – w przypadku bólu związanego ze stanem zapalnym26
  • Opioidy – w przypadkach ciężkiego bólu, szczególnie u pacjentów z dawkami letalnymi5

U osób, które przeżyły ekspozycję na bardzo duże dawki promieniowania i mają niewielką szansę na powrót do zdrowia, leczenie przeciwbólowe stanowi istotny element opieki paliatywnej1.

Inne metody leczenia wspomagającego

W zależności od indywidualnych potrzeb pacjenta, leczenie wspomagające może obejmować również:

  • Nawodnienie i wyrównanie elektrolitów – szczególnie istotne w przypadku biegunki i wymiotów27
  • Sukralfat – agent miejscowy stosowany w profilaktyce i leczeniu zapalenia błon śluzowych (mucositis)28
  • Inhibitory pompy protonowej i leki prokinetyczne – w leczeniu zapalenia przełyku popromiennego29
  • Leki przeciwbiegunkowe – takie jak loperamid, stosowane w kontrolowaniu biegunki8

W ciężkich przypadkach mogą być również stosowane zabiegi chirurgiczne, takie jak wycięcie i przeszczep owrzodzeń popromiennych lub zlokalizowanej martwicy z nieustępującym bólem8.

Leczenie specyficznych powikłań popromiennych

Ekspozycja na promieniowanie może prowadzić do różnych powikłań, które wymagają specyficznego podejścia terapeutycznego. Poniżej omówiono leczenie najczęstszych powikłań popromiennych.

Zapalenie skóry popromienne

Zapalenie skóry popromienne (radiation dermatitis) jest częstym powikłaniem radioterapii30. W jego leczeniu stosuje się:

  • Miejscowe kortykosteroidy – klasy I-III stosowane na oparzenia, owrzodzenia lub pęcherze popromienne8
  • Miejscowe antybiotyki – w przypadku zakażonych zmian skórnych8
  • Maści zawierające deksapantenol – często przepisywane, choć istnieje niewystarczająca liczba dowodów na ich skuteczność29
  • Opatrunki srebrne – badania sugerują, że srebrny opatrunek nylonowy jest jedną z najlepszych opcji dla oparzeń popromiennych30

Profilaktyka zapalenia skóry popromiennego obejmuje stosowanie filtrów przeciwsłonecznych o wysokim faktorze ochronnym (SPF 30 lub wyższym) na odsłoniętą skórę, codziennie, nawet w pochmurne dni31.

Zapalenie płuc popromienne

Zapalenie płuc popromienne (radiation pneumonitis) jest potencjalnie poważnym powikłaniem radioterapii w obszarze klatki piersiowej29. W jego leczeniu stosuje się:

  • Doustny prednizon – w dawkach co najmniej 50-60 mg dziennie przez tydzień, a następnie stopniowe zmniejszanie dawki, co wykazało złagodzenie objawów i poprawę funkcji płuc29
  • Pentoksyfilinę – stosowaną razem z prednizonem29

Wczesne rozpoznanie i leczenie zapalenia płuc popromiennego jest kluczowe dla zapobiegania długotrwałym uszkodzeniom płuc32.

Popromienne zapalenie przełyku

Popromienne zapalenie przełyku może być poważnym powikłaniem radioterapii w obszarze klatki piersiowej lub szyi29. W jego leczeniu stosuje się:

  • Modyfikację diety – dostosowanie konsystencji posiłków do możliwości pacjenta29
  • Inhibitory pompy protonowej – zmniejszające kwasowość soku żołądkowego29
  • Leki prokinetyczne – poprawiające perystaltykę przełyku29
  • Lidokainę w postaci lepkiej – do miejscowego znieczulenia29

W ciężkich przypadkach, gdy pacjent ma trudności z przyjmowaniem posiłków, może być konieczne zastosowanie suplementów płynnych lub odżywiania przez sondę21.

Popromienne zapalenie pęcherza moczowego

Popromienne zapalenie pęcherza moczowego (radiation cystitis) może być ostrym lub przewlekłym powikłaniem radioterapii w obszarze miednicy29. W jego leczeniu stosuje się:

  • Leki antycholinergiczne – łagodzące objawy częstomoczu i parcia na mocz29
  • Fenazopirydynę – działającą przeciwbólowo na błonę śluzową dróg moczowych29
  • Nawodnienie dożylne i leki uroprotektywne – w tym mesna (Mesnex) i amifostyna, które wykazały skuteczność w leczeniu krwotocznego zapalenia pęcherza moczowego29
  • Terapię tlenem hiperbarycznym – która wykazała poprawę wyników u pacjentów z popromiennym krwotocznym zapaleniem pęcherza moczowego2933

W badaniu przedstawionym przez Cardinal i wsp., 84% pacjentów z popromiennym krwotocznym zapaleniem pęcherza moczowego miało częściowe lub całkowite ustąpienie objawów po zastosowaniu terapii tlenem hiperbarycznym34.

Zaburzenia funkcji seksualnych

Radioterapia w obszarze miednicy może prowadzić do zaburzeń funkcji seksualnych zarówno u mężczyzn, jak i u kobiet29. W ich leczeniu stosuje się:

  • Inhibitory fosfodiesterazy typu 5 – takie jak sildenafil (Viagra) i tadalafil (Cialis), które są skuteczne w leczeniu zaburzeń erekcji związanych z radioterapią2929
  • Kremy nawilżające do pochwy – stosowane w przypadku podrażnienia pochwy po radioterapii29

Ważna jest otwarta rozmowa z lekarzem o występujących problemach, aby można było wdrożyć odpowiednie leczenie35.

Leczenie zaburzeń psychologicznych

Ekspozycja na promieniowanie i późniejsza choroba popromienna mogą prowadzić do znacznych zaburzeń psychologicznych3. W ich leczeniu stosuje się:

  • Psychoterapię (terapię rozmową) – pomagającą pacjentom w radzeniu sobie z traumą psychologiczną3
  • Leki – w tym leki przeciwdepresyjne i przeciwlękowe, jeśli jest to wskazane3
  • Wsparcie duszpasterskie – które może być korzystne dla niektórych pacjentów, szczególnie tych z dawkami letalnymi1

Wsparcie psychologiczne jest istotnym elementem kompleksowej opieki nad pacjentami z chorobą popromienną, pomagając im w radzeniu sobie z lękiem, depresją i innymi problemami emocjonalnymi23.

Opieka nad pacjentami z dawkami letalnymi

Osoba, która została narażona na bardzo duże dawki promieniowania (6 Gy lub więcej), ma niewielkie szanse na przeżycie5. W zależności od ciężkości choroby, śmierć może nastąpić w ciągu dwóch dni lub dwóch tygodni1. W takich przypadkach opieka koncentruje się na:

  • Kontroli bólu – poprzez odpowiednie dawkowanie leków przeciwbólowych1
  • Łagodzeniu nudności, wymiotów i biegunki – za pomocą odpowiednich leków1
  • Wsparciu psychologicznym i duszpasterskim – pomagającym pacjentowi i jego rodzinie w radzeniu sobie z sytuacją136

Celem opieki paliatywnej jest zapewnienie komfortu i godności pacjentowi w ostatnich dniach życia36. Oprócz leków przeciwbólowych, przeciwwymiotnych i przeciwbiegunkowych, ważne jest również utrzymanie odpowiedniego nawodnienia i odżywienia pacjenta36.

Postępowanie kliniczne i monitorowanie

Postępowanie kliniczne w chorobie popromiennej wymaga systematycznego podejścia i regularnego monitorowania stanu pacjenta23.

Ocena początkowa

Początkowa ocena pacjenta z podejrzeniem choroby popromiennej powinna obejmować:

  • Szczegółowy wywiad dotyczący okoliczności ekspozycji na promieniowanie37
  • Badanie morfologii krwi ze szczególnym uwzględnieniem liczby limfocytów, co 2-3 godziny w ciągu pierwszych 8 godzin po ekspozycji (i co 4-6 godzin przez następne 2 dni)23
  • Ocenę według systemu METREPOL – klasyfikacja pacjentów według narządów (układ nerwowo-naczyniowy, hematopoeza, skóra i jelita) w celu ustalenia postępowania terapeutycznego i przewidywania niewydolności wielonarządowej6
  • Potwierdzenie początkowej oceny dawki za pomocą cytogenetycznego biomarkera aberracji chromosomowych, jeśli jest to możliwe23

Na podstawie tej oceny podejmowane są decyzje dotyczące dalszego postępowania, w tym potrzeby hospitalizacji i rodzaju leczenia2.

Klasyfikacja pacjentów

Pacjenci z chorobą popromienną są klasyfikowani w zależności od ciężkości objawów i dawki promieniowania2:

  • Pacjenci z toksycznością hematologiczną stopnia ≥2 lub toksycznością skórną, żołądkowo-jelitową lub mózgowo-naczyniową stopnia ≥3 powinni być hospitalizowani2
  • Większość pacjentów z toksycznością hematologiczną stopnia ≥3 powinna być leczona w warunkach intensywnej opieki, na przykład na oddziale transplantacyjnym lub oddziale intensywnej terapii2
  • Pacjenci z powikłaniami skórnymi stopnia ≥3 mogą odnieść korzyść z leczenia na specjalistycznym oddziale oparzeń2

Dla pacjentów, u których ocena nie wykazała ekspozycji na promieniowanie, postępowanie powinno być oparte na charakterze i zakresie innych obrażeń2.

Monitorowanie i obserwacja długoterminowa

Monitorowanie pacjentów z chorobą popromienną obejmuje:

  • Regularne badania morfologii krwi w celu oceny regeneracji szpiku kostnego6
  • Monitorowanie objawów infekcji i wdrażanie antybiotykoterapii w razie potrzeby11
  • Regularne badania tarczycy u dzieci, które otrzymały ekspozycję promieniowania na gruczoł tarczowy2

Częstotliwość i metoda obserwacji pacjentów napromieniowanych zależy od ich szacowanego ryzyka i wyników klinicznych przy początkowej ocenie2. Długoterminowe monitorowanie jest szczególnie ważne ze względu na możliwość wystąpienia późnych efektów promieniowania, takich jak zwiększone ryzyko nowotworów38.

Podsumowanie

Leczenie choroby popromiennej wymaga kompleksowego, wielodyscyplinarnego podejścia, które obejmuje dekontaminację, leczenie uszkodzeń szpiku kostnego, eliminację wewnętrznego skażenia, łagodzenie objawów oraz wsparcie psychologiczne12. Skuteczność leczenia zależy od wielu czynników, w tym dawki i rodzaju promieniowania, czasu od ekspozycji do rozpoczęcia leczenia oraz indywidualnych cech pacjenta3.

Chociaż w niektórych przypadkach, szczególnie przy bardzo wysokich dawkach promieniowania, pełne wyleczenie może nie być możliwe, odpowiednie postępowanie medyczne może znacząco poprawić jakość życia pacjenta i w wielu przypadkach prowadzić do pełnego wyzdrowienia27. Postęp w badaniach nad nowymi metodami leczenia, takimi jak czynniki wzrostu hematopoezy, terapie cytokininowe czy specyficzne środki do eliminacji wewnętrznego skażenia, stale poprawia możliwości terapeutyczne w przypadku choroby popromiennej28.

Należy również podkreślić znaczenie profilaktyki i przygotowania na wypadek incydentów radiacyjnych, zarówno na poziomie indywidualnym, jak i systemowym, co może znacząco wpłynąć na zmniejszenie liczby przypadków choroby popromiennej i poprawę wyników leczenia2.

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 09.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Radiation sickness – Diagnosis and treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/radiation-sickness/diagnosis-treatment/drc-20377061
    The treatment goals for radiation sickness are to prevent further radioactive contamination; treat life-threatening injuries, such as from burns and trauma; reduce symptoms; and manage pain. […] Decontamination involves removing external radioactive particles. Removing clothing and shoes eliminates about 90% of external contamination. Gently washing with water and soap removes additional radiation particles from the skin. […] A protein called granulocyte colony-stimulating factor, which promotes the growth of white blood cells, may counter the effect of radiation sickness on bone marrow. Treatment with this protein-based medicine, which includes filgrastim (Neupogen), sargramostim (Leukine) and pegfilgrastim (Neulasta), may increase white blood cell production and help prevent subsequent infections.
  • #1 Radiation sickness – Diagnosis and treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/radiation-sickness/diagnosis-treatment/drc-20377061
    Some treatments may reduce damage to internal organs caused by radioactive particles. Medical personnel would use these treatments only if you’ve been exposed to a specific type of radiation. These treatments include the following: […] If you have radiation sickness, you may receive additional medicines or interventions to treat: […] A person who has absorbed very large doses of radiation has little chance of recovery. Depending on the severity of illness, death can occur within two days or two weeks. People with a lethal radiation dose receive medicine to control pain, nausea, vomiting and diarrhea. They also may benefit from psychological or pastoral care.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Management of acute radiation syndrome is best provided by a multidisciplinary team. […] Supportive care for hematopoietic ARS can generally be managed with supportive care, including transfusions, growth factors (cytokines), and management of infections. […] Patients exposed to radiation but who are not contaminated pose no contamination risk to others. […] For patients who were exposed to <7 Gy radiation, hematopoietic ARS can generally be managed with supportive care, including transfusions, growth factors (cytokines), and management of infections. [...] Cytokine support for patients who experienced substantial radiation exposure and/or hematopoietic toxicity should be given as soon as possible after suspected or confirmed exposure. [...] Management of internal contamination varies with the radioactive element and its chemical form.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Patients exposed to radiation but who are not contaminated pose no contamination risk to others. […] For patients who were exposed to <7 Gy radiation, hematopoietic ARS can generally be managed with supportive care, including transfusions, growth factors (cytokines), and management of infections. [...] Patients with grade ≥2 hematologic toxicity or grade ≥3 cutaneous, gastrointestinal, or cerebrovascular toxicity should be hospitalized. [...] Cytokine support for patients who experienced substantial radiation exposure and/or hematopoietic toxicity should be given as soon as possible after suspected or confirmed exposure. [...] Management of hematopoietic radiation injury may require a multidisciplinary team, including hematologist/oncologists, radiation oncologists, physicians skilled in hematopoietic cell transplantation, and other medical specialists.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Supportive care for hematopoietic ARS can generally be managed with supportive care, including transfusions, growth factors (cytokines), and management of infections. Hematopoietic failure in irradiated victims is managed with the same principles used to manage other patients with pancytopenia, with the recognition that symptoms requiring treatment may not develop until 21 to 30 days after exposure. […] For patients who were exposed to <7 Gy radiation, hematopoietic ARS can generally be managed with supportive care, including transfusions, growth factors (cytokines), and management of infections. [...] Cytokine support for patients who experienced substantial radiation exposure and/or hematopoietic toxicity should be given as soon as possible after suspected or confirmed exposure. The levels of exposure/hematopoietic injury for which cytokine support is warranted are described above.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Management of acute radiation syndrome is best provided by a multidisciplinary team. Depending on the findings from the clinical evaluation and screening laboratory studies, a trauma surgeon, burn specialist, dermatologist, gastroenterologist, neurologist, and/or hematologist may participate in care. Information regarding risk level should be provided to medical caregivers by the medical center’s radiation safety officer. Consultation with experts in radiation accident management is encouraged and is available through the Radiation Emergency Assistance Center and Training Site (REAC/TS). […] Management of hematopoietic radiation injury may require a multidisciplinary team, including hematologist/oncologists, radiation oncologists, physicians skilled in hematopoietic cell transplantation, and other medical specialists. Disposition to an outpatient, inpatient, or specialty center (eg, transplantation unit) setting is informed by the severity of the injury.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Potassium iodide is most effective when administered within four hours of internal contamination with radioactive iodine. […] Chelating agents for internal contamination should be administered to patients contaminated with substances such as cesium-137, rubidium-82, or thallium-201 to enhance the elimination of the radioactive material. […] Management of radiation exposure, for an individual or a community, requires knowledge of the principles of radiation safety, advance preparation, and planning at both the regional and health care facility levels. […] Supportive care for hematopoietic ARS can generally be managed with supportive care, including transfusions, growth factors (cytokines), and management of infections. […] Patients exposed to radiation but who are not contaminated pose no contamination risk to others.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Patients exposed to radiation but who are not contaminated pose no contamination risk to others. These patients warrant evaluation and further care per the Radiation Emergency Assistance Center/Training Site algorithm. […] Patients with grade ≥2 hematologic toxicity or grade ≥3 cutaneous, gastrointestinal, or cerebrovascular toxicity should be hospitalized. Most patients with grade ≥3 hematologic toxicity should be managed in a critical care setting, such as a transplantation unit or intensive care unit, while those with grade ≥3 cutaneous complications may benefit from management in a specialized burn unit. […] For patients whose evaluation found no evidence of radiation exposure, management should be based on the nature and extent of other injuries. […] Follow-up should be individualized based on the manifestations and complications of radiation injury and should respond to the concerns of the individual.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Children who received radiation exposure to the thyroid gland should have their thyroid glands checked regularly. The frequency and method of follow-up of irradiated patients depends upon their estimated risk and the clinical findings at the initial evaluation. […] Further guidance on the management of radiation exposure is available as follows: United States Health and Human Services: Radiation Emergency Medical Management. […] Hospitals that are designated as receiving centers for radiation accidents and facilities that handle radioactive materials should have a policy to rapidly access chelating agents. […] Chelating agents for internal contamination should be administered to patients contaminated with substances such as cesium-137, rubidium-82, or thallium-201 to enhance the elimination of the radioactive material.
  • #2 Management of radiation injury – UpToDate
    https://www.uptodate.com/contents/management-of-radiation-injury
    Management of radiation injury […] No drug references linked in this topic. […] This topic will address the management of radiation injury in adults and children. Clinical manifestations of acute radiation exposure and long-term consequences of radiation exposure and the management of victims of chemical terrorism are discussed separately. […] Management of radiation exposure, for an individual or a community, requires knowledge of the principles of radiation safety, advance preparation, and planning at both the regional and health care facility levels. The hospital should develop a medical response plan for a nuclear or radiologic emergency as part of an all-hazards emergency management plan and ensure that it is practiced and regularly revised based upon periodic drills. This plan is required for hospital certification in many countries. Rehearsal of and familiarity with these protocols help to educate medical staff about radiation safety and their roles and responsibilities during a radiation incident. Emergency departments that are eligible to receive victims of radiation accidents must be prepared to manage large numbers of victims.
  • #3 Radiation Sickness (Acute Radiation Syndrome)
    https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness
    What is the treatment for radiation sickness? The treatment for radiation sickness varies based on its severity. As significant exposure usually results from radiological or nuclear emergencies, healthcare providers and first responders prioritize care based on the severity of symptoms and injuries. General treatment strategies include: […] Decontamination. Removing clothing and washing your body protects others from further exposure. […] Surgical procedures. Life-threatening injuries may require surgery. […] Supportive care. This may involve getting fluids and electrolytes, taking medications to manage pain associated with burns or other injuries, and getting treated for any signs of infection with antibiotics. […] Prevention of thyroid cancer. Providers typically recommend that all children and pregnant women who were exposed take potassium iodide to protect their thyroid from the uptake of radioactive iodine. […] Management of psychological trauma. Treatments include psychotherapy (talk therapy) and medication.
  • #4 Acute Radiation Syndrome: Symptoms, Treatment, and Recovery
    https://www.healthline.com/health/acute-radiation-syndrome
    The first step in treating ARS is decontamination, which involves taking off any clothing and washing your body with soap and water. This removes all radioactive particles from the skin and ensures that no further exposure occurs. […] After decontamination, you might need: […] Treatment to promote the growth of white blood cells can counter the effects of ARS that are damaging your bone marrow. […] Blood transfusions: Transfusions of red blood cells and platelets can restore the damage that bone marrow ARS causes. […] Potassium iodide: This treatment can help keep your thyroid from absorbing too much radiation. […] Prussian blue: This treatment speeds up your body’s elimination of radiation through your digestive system. […] Diethylenetriamine pentaacetic acid (DTPA): This helps your body pass radiation out of your body as a waste product in urine.
  • #5
    https://flutrackers.com/forum/forum/health-humanitarian-issues/105241-recognizing-and-treating-radiation-sickness
    There is no cure for radiation sickness, which is caused by body tissue exposed to radioactive substances. The symptoms are treated on a case by case basis since the degree of sickness and the symptoms vary from person to person. The effects cannot be reversed, but if they’re treated in a timely manner the damage may be contained. […] The treatment goals for radiation sickness are to prevent further radioactive contamination, treat damaged organs, reduce symptoms and manage pain. […] Decontamination is the removal of as much external radioactive particles as possible. Removing clothing and shoes eliminates about 90 percent of external contamination. Gently washing with water and soap removes additional radiation particles from the skin. Decontamination prevents further distribution of radioactive materials and lowers the risk of internal contamination from inhalation, ingestion or open wounds.
  • #5
    https://flutrackers.com/forum/forum/health-humanitarian-issues/105241-recognizing-and-treating-radiation-sickness
    A protein called granulocyte colony-stimulating factor, which promotes the growth of white blood cells, may counter the effect of radiation sickness on bone marrow. Treatment with this protein-based medication, which includes filgrastim (Neupogen) and pegfilgrastim (Neulasta), may increase white blood cell production and help prevent subsequent infections. If you have severe damage to bone marrow, you may also receive transfusions of red blood cells or blood platelets. […] Some treatments may reduce damage to internal organs caused by radioactive particles. Medical personnel would use these treatments only if you’ve been exposed to a specific type of radiation. These treatments include potassium iodide, Prussian blue, and diethylenetriamine pentaacetic acid (DTPA). […] If you have radiation sickness, you may receive additional medications or interventions to treat bacterial infections, headache, fever, diarrhea, nausea and vomiting, and dehydration.
  • #5
    https://flutrackers.com/forum/forum/health-humanitarian-issues/105241-recognizing-and-treating-radiation-sickness
    A person who has absorbed large doses of radiation (6 Gy or greater) has little chance of recovery. Depending on the severity of illness, death can occur within two days or two weeks. People with a lethal radiation dose will receive medications to control pain, nausea, vomiting and diarrhea. They may also benefit from psychological or pastoral care.
  • #6 Medical management of the acute radiation syndrome
    https://pmc.ncbi.nlm.nih.gov/articles/PMC3863169/
    The acute radiation syndrome (ARS) occurs after whole-body or significant partial-body irradiation (typically at a dose of 1 Gy). […] Granulocyte-colony stimulating factor (G-CSF) at a dose of 5 g/kg body weight per day subcutaneously has been recommended as treatment of neutropenia, and antibiotics, antiviral and antifungal agents for prevention or treatment of infections. […] Finally, if severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. […] Treatment of the ARS is not indicated when exposure dose is very low (1 Gy) or very high (10 Gy). […] Reverse isolation is needed for patients with whole body doses greater than 23 Gy and antacids and H2 blockers should be avoided to maintain gastric acidity, using sucralfate to prevent stress ulcers.
  • #6 Medical management of the acute radiation syndrome
    https://pmc.ncbi.nlm.nih.gov/articles/PMC3863169/
    Beyond the first 48 h, a second patient scoring is done by organs (neurovascular, hematopoiesis, cutaneous and gut) according to the METREPOL Document for therapeutic management and multiple organ failure (MOF) prediction. […] The following dosages of selective 5-HT3 receptor antagonists are recommended for radiation-induced emesis. […] There is general agreement that granulocyte colony-stimulating factor (G-CSF) is an acceptable choice for treatment of individuals receiving a whole-body dose of 3 Gy or more, or when clinical signs and symptoms indicate a level 3 degree of toxicity. […] Individuals receiving a whole-body dose of 2 Gy with mechanical trauma and/or burns (i.e., combined injury) are candidates for cytokine therapy, as are individuals at extremes of age (i.e., children 12 years of age and the elderly). […] The METREPOL conference experts agreed that hematopoietic stem cell (HSC) transplantation should not be performed on radiation accident victims who have the potential of endogenous hematopoietic recovery.
  • #7 Treatment of Radiation Exposure and Contamination | Radiation Emergencies | CDC
    https://www.cdc.gov/radiation-emergencies/treatment/index.html
    There are different medications that can help limit or treat the health effects of certain types of radiation. […] A medical professional will know which treatment is right for you. […] Removing internal contamination from the body will help reduce the risk for health effects. […] Some medical treatments are available for limiting or removing internal contamination depending on the type of radioactive material involved. […] Medical professionals will determine if treatments are needed. […] Medications that speed up blood cell production, including Neupogen, may help the body heal and protect from infections. […] Medical professionals will determine if treatments are needed.
  • #8 Radiation Exposure and Contamination – Injuries; Poisoning – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/injuries-poisoning/radiation-exposure-and-contamination/radiation-exposure-and-contamination
    Surgical excision and graft of radiation ulcers or localized necrosis with intractable pain. […] Supportive care is provided as needed and includes managing shock and hypoxia and relieving pain and anxiety. […] There is no specific treatment for the cerebrovascular syndrome. […] The gastrointestinal syndrome is treated with aggressive fluid resuscitation and electrolyte replacement. […] Management of the hematopoietic syndrome is similar to that of bone marrow hypoplasia and pancytopenia of any cause. […] Blood products should be transfused to treat anemia and thrombocytopenia, and hematopoietic growth factors should be given as soon as possible. […] Hematopoietic stem cell transplantation has had limited success but should be considered for exposure 7 to 10 Gy. […] Recommended medications and dosages include Filgrastim (granulocyte colony-stimulating factor [G-CSF]) subcutaneously administered as soon as possible after suspected or confirmed exposure to radiation doses greater than 2 Gy. […] Sargramostim (granulocyte macrophage colony-stimulating factor [GM-CSF]) subcutaneously. […] Pegfilgrastim (pegylated G-CSF) subcutaneously.
  • #8 Radiation Exposure and Contamination – Injuries; Poisoning – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/injuries-poisoning/radiation-exposure-and-contamination/radiation-exposure-and-contamination
    Erythropoietic stimulating agents in patients with prolonged anemia. […] Hematopoietic stem cells after failure of 2 to 3 weeks of cytokine treatment to induce recovery from marrow aplasia in the absence of non-hematopoietic organ failure. […] Fluoroquinolone or similar antibiotic from 2 to 4 days after radiation exposure. […] Bowel decontamination and parenteral antibiotics when indicated. […] Prophylactic serotonin receptor antagonist when suspected exposure is 2 Gy. […] Loperamide, as needed for control of diarrhea. […] Topical class IIIII corticosteroids, topical antibiotics, and topical antihistamines applied to radiation burns, ulcers, or blisters. […] Systemic corticosteroids for radiation burns, ulcers, or necrosis in the absence of a specific indication for systemic corticosteroid use.
  • #9 Neulasta Approved for Treatment of Acute Radiation Syndrome
    https://globalbiodefense.com/2015/12/03/pegfilgrastim-neulasta-acute-radiation-syndrome/
    In November 2015, the Food and Drug Administration approved the use of Amgens pegfilgrastim (Neulasta) to increase survival of people acutely exposed to high-dose radiation that damages the bone marrow. […] NIAID-funded research contributed to the approval of pegfilgrastim for treatment of acute radiation syndrome, which will improve access to the drug in the event of a public health emergency such as a nuclear power plant accident or terrorist attack. […] Pegfilgrastim is the second radiation medical countermeasure to be approved under FDAs Animal Rule, a regulation that permits approval of some products based on efficacy testing in animals and safety testing in humans. […] Both approvals were based on findings from NIAID-funded animal research indicating that these drugs are reasonably likely to increase survival of people with radiation-induced bone marrow damage. […] Administering pegfilgrastim nearly doubled survival: 91 percent of animals given pegfilgrastim survived 60 days after radiation exposure, compared to 48 percent without the drug.
  • #10 Radiation Sickness – What You Need to Know
    https://www.drugs.com/cg/radiation-sickness.html
    How is radiation sickness treated? Treatment goals include treating and preventing infections, keeping you hydrated, and treating injuries and burns. You may need medicines to help your bone marrow replace cells that have died. You may also need stem cell transfusions. Platelet transfusions may also be needed to help treat bleeding.
  • #11 Treatment of acute radiation injuries | Tidsskrift for Den norske legeforening
    https://tidsskriftet.no/en/2013/10/treatment-acute-radiation-injuries
    Animal studies have shown that rapidly initiated treatment with granulocyte-colony stimulating factor that stimulates the remaining haematopoietic stem cells reduces the fall in neutrophil granulocytes and shortens the time in granulocytopenia after exposure to radiation. This is consequently regarded as the standard treatment in the case of acute radiation syndrome. […] Allogeneic haematopoietic stem cell transplantation is considered in cases where the bone marrow is unlikely to regenerate spontaneously and other organ systems are not affected to a life-threatening degree. […] With the exception of drugs that stimulate the bone marrow, only supportive treatment is relevant, including empirical antibiotic treatment, prophylactic transfusions of thrombocytes to prevent haemorrhaging, monitoring of the fluid and electrolyte balance, and use of antiemetics for nausea, vomiting and similar.
  • #12 Mayo Clinic Health Library – Radiation sickness | Swiss Medical Network
    https://www.swissmedical.net/en/healtcare-library/con-20377044
    Some treatments may reduce damage to internal organs caused by radioactive particles. Medical personnel would use these treatments only if you’ve been exposed to a specific type of radiation. These treatments include the following: […] Potassium iodide. This is a nonradioactive form of iodine. Iodine is essential for proper thyroid function. If you’re exposed to significant radiation, your thyroid will absorb radioactive iodine (radioiodine) just as it would other forms of iodine. The radioiodine is eventually cleared from the body in urine. […] If you take potassium iodide, it may fill „vacancies” in the thyroid and prevent the absorption of radioiodine. Potassium iodide isn’t a cure-all and is most effective if taken within a day of exposure. […] Prussian blue (Radiogardase). This type of dye binds to particles of radioactive elements known as cesium and thallium. The radioactive particles then pass out of the body in feces. This treatment speeds up the elimination of the radioactive particles and reduces the amount of radiation cells may absorb.
  • #12 Mayo Clinic Health Library – Radiation sickness | Swiss Medical Network
    https://www.swissmedical.net/en/healtcare-library/con-20377044
    Diethylenetriamine pentaacetic acid (DTPA). This substance binds to metals. DTPA binds to particles of the radioactive elements plutonium, americium and curium. The radioactive particles pass out of the body in urine. That lowers the amount of radiation absorbed. […] If you have radiation sickness, you may receive additional medicines or interventions to treat: […] A person who has absorbed very large doses of radiation has little chance of recovery. Depending on the severity of illness, death can occur within two days or two weeks. People with a lethal radiation dose receive medicine to control pain, nausea, vomiting and diarrhea. They also may benefit from psychological or pastoral care.
  • #13 Radiation sickness: Sources, effects, and protection
    https://www.medicalnewstoday.com/articles/219615
    Radiation sickness describes damage to the body that occurs after a large dose of radiation. […] There is no cure, but barriers can prevent exposure and some medications may remove some radiation from the body. […] Possible treatments include: Removing all clothing, Rinsing with water and soap. Use of potassium iodide (KI) to block thyroid uptake if a person inhales or swallows too much radioiodine. Prussian blue, given in capsules, can trap cesium and thallium in the intestines and prevent them from being absorbed. This allows them to move through the digestive system and leave the body in bowel movements. Filgrastim, or Neupogen, stimulates the growth of white blood cells. This can help if radiation has affected the bone marrow. […] Depending on exposure, radiation can affect the whole body. For cardiovascular, intestinal, and other problems, treatment will target the symptoms.
  • #14 Managing Internal Radiation Contamination
    https://remm.hhs.gov/int_contamination.htm
    Isotopes of Interest: Properties, Treatment, and Fact Sheets […] Treatment: References for use […] DTPA is FDA-approved for intravenous Rx of known or suspected internal contamination with Am, Cm, and Pu only […] DTPA is FDA-approved for nebulized inhalation in adults only, and if the only route of contamination is through inhalation […] Potassium iodide (KI) […] Blocking agent […] FDA-approved […] Prussian blue, insoluble […] Ion exchange; inhibits enterohepatic recirculation in GI tract […] Prussian blue, insoluble, is FDA-approved for Rx of known or suspected internal contamination with radioactive Cs and/or radioactive or non-radioactive thallium; FDA-approved for ages 2 years old only […] Dimercaprol (REMM site) (AKA British anti-Lewisite – BAL) […] Chelating agent
  • #15 A new way to treat radiation sickness | Research and Innovation
    https://projects.research-and-innovation.ec.europa.eu/en/projects/success-stories/all/new-way-treat-radiation-sickness
    Currently there are no therapy options available for those suffering acute radiation sickness. […] Unfortunately, treatment options are extremely limited. […] But this could soon change, thanks to a class of materials called enterosorbents. […] The end goal is to mitigate some of the side effects of irradiation in the body. […] The project focused on applying activated carbon materials and pectins two well-known adsorbents. […] Nonetheless, the project has opened the door to an effective treatment option for mitigating the side effects of radiation sickness. […] We envision combining both activated carbons and pectins and making them available as either a tablet or inside a polymeric capsule that can be taken just like any other pill, says Silvestre-Albero. […] Combining both components into a single pill ensures that all targeted toxins and molecules can be safely removed in one go.
  • #16 Study identifies possible therapy for radiation sickness
    https://www.dana-farber.org/newsroom/news-releases/2011/study-identifies-possible-therapy-for-radiation-sickness
    A combination of two drugs may alleviate radiation sickness in people who have been exposed to high levels of radiation, even when the therapy is given a day after the exposure occurred, according to a study led by scientists from Dana-Farber Cancer Institute and Children’s Hospital Boston. […] In contrast, the larger time window for administering the two-drug regimen raises the prospect that it could become a mainstay of the response to public health threats such as a nuclear power plant accident or nuclear terror attack. […] Mice that received the combination a day after being exposed to high doses of radiation fared far better than mice that received neither or only one of the agents. […] The investigators also found that the ability to generate new blood cells which can shut down in the aftermath of radiation exposure rebounded much more quickly and vigorously in the mice treated with fluoroquinolone and rBPI21 (the synthetic version of BPI), potentially contributing to their return to health.
  • #17 Study identifies possible therapy for radiation sickness
    https://www.dana-farber.org/newsroom/news-releases/2011/study-identifies-possible-therapy-for-radiation-sickness
    „Both fluoroquinolone antibiotics and rBPI21 have been shown to be quite safe in humans,” says Levy. „Their combined effectiveness in our study involving mice is an indication that they may be equally beneficial in people.” […] The treatment approach developed by Guinan, Levy and their colleagues takes direct aim at two potential contributors to radiation sickness: bacteria and the endotoxins on their surface. […] „We theorized that a two-drug therapy would be most effective,” Levy states. […] The promise of this approach is underscored by the nature of the two agents, the study authors say. […] Both have a proven safety record in humans and can be stored for long periods of time, making them suitable for stockpiling. […] „These observations led to the hypothesis that replenishing BPI could decrease the toxicity of radiation,” Levy adds. […] „This result is a promising new strategy for response to a nuclear event.”
  • #18 Drug Can Stop Radiation Poisoning Up To 24 Hours After Exposure
    https://www.popsci.com/drug-protects-intestinal-barrier-against-acute-radiation-damage/
    The new drug, called TP508, was originally designed to help patients regenerate cells by increasing blood flow and decreasing inflammation, according to the press releaseits been used to ensure that diabetic patients dont lose a foot, or to help patients with wrist fractures heal more quickly. In this study, the researchers exposed mice to acute levels of radiation, then gave them an injection of TP508 after 24 hours. Not only did the drug prevent the destruction of the intestinal barrier cells, it boosted biomarkers characteristic of cell repair. […] Even if this treatment proves to be as effective in humans as it was in this experiment on mice, it would have limitationsits not a panacea for all the damage that acute radiation can cause. But if its efficacy holds up in future studies, TP508 would be an important new tool in radioactive emergencies by buying doctors more time to get patients more sophisticated treatments.
  • #19 Side effects of radiation therapy | Canadian Cancer Society
    https://cancer.ca/en/treatments/treatment-types/radiation-therapy/side-effects-of-radiation-therapy
    In general, the side effects of radiation therapy will depend on: the type of radiation therapy, the part of your body being treated, the amount (dose) of radiation and treatment schedule, your overall health. […] Fatigue is one of the most common side effects of radiation therapy. It usually happens after a few weeks of radiation therapy and can get worse as treatment goes on. It can be caused by a number of things. During radiation therapy, your body uses more energy to heal itself. Fatigue is more common when larger areas of the body are treated. Radiation therapy to areas of bone marrow, such as the pelvis can cause anemia. Anemia can cause fatigue. […] Nausea and vomiting can be a common side effect of external radiation therapy, especially if the treatment area includes the stomach and abdomen. It can also happen as a general side effect regardless of the area being treated. Radiation sickness usually goes away a few weeks after radiation therapy is finished.
  • #20 Management of Radiation-Induced Nausea and Vomiting
    https://www.uspharmacist.com/article/management-of-radiationinduced-nausea-and-vomiting
    Radiation is one of the treatment modalities used for the management of malignancies. One of the side effects of radiation therapy is radiation-induced emesis; however, antiemetics appear to sometimes be underutilized. […] Appropriate prevention and treatment of radiation-induced nausea and vomiting are necessary for completing the course of radiation therapy so that a positive treatment outcome may be achieved without interruption. […] A variety of antiemetic agents have been used for the prevention and treatment of radiation-induced nausea and vomiting, but the most evidence is available for 5-HT3 receptor antagonists. […] Three different guidelines on the management of radiation-induced nausea have been developed by the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the Multinational Association of Supportive Care in Cancer (MASCC) and European Society for Medical Oncology (ESMO).
  • #20 Management of Radiation-Induced Nausea and Vomiting
    https://www.uspharmacist.com/article/management-of-radiationinduced-nausea-and-vomiting
    The NCCN lists total-body radiation as having the highest risk of nausea and vomiting because it induces this condition in more than 90% of patients. […] For concurrent administration of chemotherapy and radiation, it is recommended that an antiemetic regimen appropriate for chemotherapy be used. […] The ASCO guidelines classify radiation-induced nausea and vomiting into four risk categories (high-, moderate-, low-, and minimal-risk) based on the anatomical site of radiation administration. […] It is recommended that patients who are undergoing high-risk (total-body) radiation be offered a two-drug regimen for prevention of radiation-induced nausea and vomiting. […] The MASCC/ESMO guidelines also classify radiation-induced nausea and vomiting into four categories based on the irradiation site.
  • #21 Appetite Loss & Nausea | Radiation Therapy Side Effects | Cancer Council NSW
    https://www.cancercouncil.com.au/cancer-information/cancer-treatment/radiation-therapy/side-effects/appetite-loss-and-nausea/
    Some people may lose interest in food or find it difficult to eat well during radiation therapy. This can depend on the part of the body being treated. It is important to try to keep eating well so you can maintain your weight. Good nutrition will give you more strength, help you manage any side effects, and improve how you respond to treatment. […] Your radiation oncologist may prescribe medicine (an antiemetic) to take at home before and after each session to prevent nausea. […] If you are finding it difficult to eat well and get the nutrition you need, a dietitian can suggest changes to your diet, liquid supplements or a feeding tube. […] Let your treatment team know if you are having trouble eating or if your weight has changed. […] Ask your doctor if you can try anti-nausea medicine. It’s important to take anti-nausea medicine as directed to help prevent nausea – don’t wait until you feel sick.
  • #22 Acute radiation syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Acute_radiation_syndrome
    Treatment of ARS is generally supportive care. This may include blood transfusions, antibiotics, colony-stimulating factors, or stem cell transplant. […] Complications such as leukemia and other cancers among those who survive are managed as usual. Short-term outcomes depend on the dose exposure. […] Treatment usually involves supportive care with possible symptomatic measures employed. The former involves the possible use of antibiotics, blood products, colony stimulating factors, and stem cell transplant. […] There is a direct relationship between the degree of the neutropenia that emerges after exposure to radiation and the increased risk of developing infection. […] The treatment of established or suspected infection following exposure to radiation (characterized by neutropenia and fever) is similar to the one used for other febrile neutropenic patients. […] A standardized management plan for people with neutropenia and fever should be devised. Empirical regimens contain antibiotics broadly active against Gram-negative aerobic bacteria.
  • #23 Acute Radiation Syndrome: Information for Clinicians | Radiation Emergencies | CDC
    https://www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.html
    The diagnosis of ARS can be difficult to make because ARS causes no unique sign or symptom. […] If a patient is known to have been or suspected of having been exposed to a large radiation dose, draw blood for CBC analysis with special attention to the lymphocyte count, every 2 to 3 hours during the first 8 hours after exposure (and every 4 to 6 hours for the next 2 days). […] After consultation, begin the following (as indicated): Supportive care in an environment that provides neutropenic precautions (if available, the use of a burn unit may be quite effective) […] Prevention and treatment of infections […] Stimulation of hematopoiesis by use of growth factors […] Stem cell transplantation or platelet transfusions (if platelet count is too low) […] Psychological support […] Confirmation of initial dose estimate using chromosome aberration cytogenetic bioassay when possible (although resource intensive, this is the best method of dose assessment following acute exposures) […] Consultation with experts in radiation accident management.
  • #24 Radiation sickness: MedlinePlus Medical EncyclopediaLock
    https://medlineplus.gov/ency/article/000026.htm
    Radiation sickness is illness and symptoms resulting from excessive exposure to ionizing radiation. […] Radiation exposure can occur as a single large exposure (acute). Or it can occur as a series of small exposures spread over time (chronic). Exposure may be accidental or intentional (as in radiation therapy for disease treatment). […] Your health care provider will advise you how best to treat these symptoms. Medicines may be prescribed to help reduce nausea, vomiting, and pain. Blood transfusions may be given for anemia (low counts of healthy red blood cells). Antibiotics are used to prevent or fight infections. […] If symptoms occur during or after medical radiation treatments: Tell the provider or seek medical treatment right away. Handle affected areas gently. Treat symptoms or illnesses as recommended by the provider.
  • #25 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
    https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
    Blood transfusions and injections of growth factors that stimulate blood cell production (such as erythropoietin and colony-stimulating factor) are given to increase blood counts. […] Treatment for the cerebrovascular syndrome is geared toward providing comfort by relieving pain, anxiety, and breathing difficulties. […] Pain caused by radiation-induced sores or ulcers is treated with analgesics. […] People who survive may need regular monitoring for cataracts and thyroid disorders, but no other regular monitoring is needed.
  • #26 Radiation Enteritis: Treatment & Management
    https://my.clevelandclinic.org/health/diseases/22846-radiation-enteritis
    It might not be possible to repair chronic intestinal cell damage from radiation exposure. But medical management of radiation enteritis can help you stay comfortable and avoid complications. […] Your care may include: […] Antibiotics if there are too many bacteria in your intestines. […] Antidiarrheals, medications that slow intestinal activity to relieve diarrhea. […] Corticosteroids to quiet inflammation in your intestines. […] Pain relievers. […] The options that are right for you depend on the type of complication. Strictures, fistulas and perforations often need surgery. You may need supplements or tube feeding if you arent getting enough nutrients. […] If youre experiencing symptoms of radiation enteritis, talk to your healthcare provider. Treatments can relieve discomfort and lower the risk of complications.
  • #27 Radiation Sickness: Facts, Symptoms, Treatment
    https://www.webmd.com/cancer/radiation-sickness-facts
    Radiation damages your stomach and intestines, blood vessels, and bone marrow, which makes blood cells. Damage to bone marrow lowers the number of disease-fighting white blood cells in your body. As a result, most people who die from radiation sickness are killed by infections or internal bleeding. […] Your doctor will try to help you fight off infections. They might give you blood transfusions to replace lost blood cells. Or they may give you medications to try to help your bone marrow recover. Or they may try a transplant. […] They also will give you fluids and treat other injuries like burns. Recovery from radiation sickness can take up to 2 years. But you’ll still be at risk of other health problems after recovery. For example, your odds of getting cancer are higher.
  • #28 Prevention and Management of Radiation Side Effects – Virginia Cancer Institute
    https://www.vacancer.com/diagnosis-and-treatment/radiation-therapy/prevention-and-management-of-radiation-side-effects/
    Ethyol® is a radiation protector and the only drug that has been approved by the FDA for xerostomia (dry mouth) in patients receiving radiation therapy for cancers of the head and neck. […] As part of your radiation therapy treatment, your physician may prescribe steroids such as Prednisone® or Decadron® (generic name is dexamethasone). These drugs help decrease swelling in body tissues. […] Some drugs can be applied topically to mucus membranes to decrease or treat radiation damage. The topical agent sucralfate may protect mucus membranes by several mechanisms and is often used during and after radiation therapy for the prevention and treatment of mucositis (mouth sores). […] The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the prevention and management of radiation side effects will result from the continued evaluation of new treatments in clinical trials.
  • #29 Managing the Adverse Effects of Radiation Therapy | AAFP
    https://www.aafp.org/pubs/afp/issues/2010/0815/p381.html
    Patient information: See related handout on the side effects of radiation therapy, written by the author of this article. […] Radiation dermatitis is treated with topical steroids and emollient creams. […] Radiation pneumonitis is treated with oral prednisone and pentoxifylline. […] Radiation esophagitis is treated with dietary modification, proton pump inhibitors, promotility agents, and viscous lidocaine. […] Radiation-induced emesis is ameliorated with receptor antagonists and steroids. […] Symptomatic treatments for chronic 5-hydroxytryptamine3 radiation cystitis include anticholinergic agents and phenazopyridine. […] Phosphodiesterase type 5 inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis), are effective for erectile dysfunction associated with radiation therapy.
  • #29 Managing the Adverse Effects of Radiation Therapy | AAFP
    https://www.aafp.org/pubs/afp/issues/2010/0815/p381.html
    Topical steroids and dexpanthenol-containing emollients are often prescribed for radiation dermatitis, although there is insufficient evidence to firmly support or refute this recommendation. […] Prednisone, in dosages of at least 50 to 60 mg per day for one week followed by an extended taper, has been shown to abate symptoms and improve lung function. […] Intravenous hydration and uroprotective agents, including mesna (Mesnex) and amifostine, have demonstrated effectiveness in treating hemorrhagic cystitis, although the studies are primarily in patients receiving chemotherapy. […] Phosphodiesterase type 5 inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis), are effective for radiation-associated erectile dysfunction. […] There is some evidence to support the use of vaginal lubricating creams for vaginal irritation following radiation. […] Hyperbaric oxygen therapy has also demonstrated improved outcomes in patients with radiation-induced hemorrhagic cystitis.
  • #30 Radiation Dermatitis: Causes, Symptoms, and 5 Treatment Methods
    https://www.healthline.com/health/radiation-dermatitis
    Radiation dermatitis is a common skin condition caused by radiation therapy. Treatment options can help. […] Treatment options include topical corticosteroids, antibiotics, silver dressings, and others. […] With the right approach, this side effect can be reduced or eliminated. The best method is to combine topical and oral treatment options. Medical treatment options include: […] Topical steroid cream is often prescribed for radiation dermatitis, although clinical evidence is mixed concerning this treatment option. […] Oral and topical antibiotics have shown effectiveness in treating the burns associated with radiotherapy. […] Amifostine is a medication that removes free radicals and reduces toxicity from radiation. […] These over-the-counter remedies may help soothe skin affected by radiation dermatitis. […] Studies suggest that silver leaf nylon dressing is one of the best options for radiation burns. […] Zinc helps the body promote immune function. […] Treatment options include medications. Home remedies such as zinc ointment and silver dressings may also help.
  • #31
    https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh4793
    Always wear sunscreen on exposed skin. Make sure to use a broad-spectrum sunscreen that has a sun protection factor (SPF) of 30 or higher. Use it every day, even when it is cloudy. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have a fever. You have abnormal bleeding. You have new or worse pain. You think you have an infection. You have new symptoms, such as a cough, belly pain, vomiting, diarrhea, or a rash. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: You are much more tired than usual. You have swollen glands in your armpits, groin, or neck. You do not get better as expected.
  • #32 Radiation Therapy for Lung Cancer | American Lung Association
    https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/treatment/types-of-treatment/radiation-therapy
    Radiation is a type of lung cancer treatment designed to only target cancer cells and not affect other parts of the body. […] Lung cancer radiation therapy uses powerful, high-energy X-rays to kill cancer cells or keep them from growing. […] During radiation. Radiation is designed to only target cancer cells and not affect other parts of the body. […] Radiation therapy for lung cancer also can be used to relieve symptoms caused by the cancer, such as pain, bleeding or blockage of airways by the tumor. […] Doctors use several different radiation techniques to administer therapy. […] Discuss concerns, possible side effects and any effects that you experience with your doctor.
  • #33 Treating Radiation Damage with Hyperbaric Oxygen Therapy
    https://www.hyperbaricmedicalsolutions.com/blog/treating-radiation-damage-with-hyperbaric-oxygen-therapy
    Hyperbaric oxygen therapy can target and repair damaged tissue caused by radiation treatment. Hyperbaric oxygen therapy is FDA-approved for latent radiation tissue injuries. […] Hyperbaric oxygen therapy has been successful with many patients following radiation treatment by improving the oxygenation of the damaged tissues. […] Hyperbaric oxygen therapy is recognized by the FDA for a number of medical conditions, all of which are generally covered by insurance. […] HBOT can help improve these symptoms. […] Hyperbaric oxygen therapy drives oxygen further into the body, ultimately delivering 10 to 14 times the standard amount of oxygen to damaged tissue. […] The treatments must be done in a medical grade hyperbaric chamber at a specific protocol, using pressure of 2.0 to 2.4 ATA. […] Hyperbaric Medical Solutions is committed to making HBOT accessible and affordable, accepting most major insurance plans.
  • #34 Treating Radiation Damage with Hyperbaric Oxygen Therapy
    https://www.hyperbaricmedicalsolutions.com/blog/treating-radiation-damage-with-hyperbaric-oxygen-therapy
    Hyperbaric oxygen therapy has been used in various forms since the 1600s but became more widely recognized for its clinical medicinal uses in the early 19th century. […] Research investigating the effects of hyperbaric oxygen therapy on radiation injuries showed that HBOT is a safe treatment modality for radiation therapy induced soft tissue injuries in the pelvic region. […] In a study presented by Cardinal et al., 84% of radiation-induced hemorrhagic cystitis patients had a partial or complete resolution of symptoms. […] The production of new blood vessels and the release of stem cells also helps to heal delayed radiation injury. […] Hyperbaric oxygen therapy can target and repair damaged tissue caused by radiation treatment.
  • #35 Side-Effects of Radiation Therapy for Cancer Treatment
    https://www.webmd.com/cancer/what-to-expect-from-radiation-therapy
    Let your doctor know if you’re struggling with fatigue. They might be able to help. There are also things you can do to feel better: Take care of your health. Be sure you’re taking your medications the way you’re supposed to. Get plenty of rest, be as active as you can, and eat the right foods. […] Tell your cancer team about any of these problems so they can help you feel better. […] The doctor will likely prescribe medications to help control it. They’ll also suggest changes in your diet, such as eating small meals more often, avoiding high-fiber foods, and getting enough potassium. […] If you want to start a family or have more children, it’s important to talk to your doctor about how the treatment will affect your fertility before treatment begins. […] Your doctor can help you understand what might happen and how you can handle it. […] Talk openly with your partner about how you can stay close. Make sure you listen to their concerns, too. […] Talk with your doctor about the potential risk and how it compares to the benefits you’ll get from radiation therapy.
  • #36 Understanding Radiation Sickness: Symptoms, Causes, and Treatment of Acute Radiation Syndrome – Raybloc X-ray Protection
    https://raybloc.com/radiation-sickness/
    Treatment for Internal Contamination […] In cases of internal contamination, specific agents known as chelators or decorporation agents are administered. These agents bind to radioactive materials within the body, facilitating their excretion and reducing the internal radiation dose. This treatment is crucial in cases where radioactive substances have been ingested, inhaled, or absorbed through the skin. […] Supportive Treatment […] Supportive treatment is vital in managing the symptoms of ARS and in preventing secondary infections. This includes administering anti-nausea medications, pain relievers, antibiotics, and other supportive care measures. Maintaining hydration and nutrition, managing pain, and preventing infections are key aspects of supportive care. […] End-of-life Care […] In severe cases of radiation exposure where recovery is not possible, end-of-life care focuses on providing comfort and psychological support to the patient. Pain management, emotional and psychological support, and palliative care are important in ensuring the patient’s quality of life during this time.
  • #37 Radiation Exposure: MedlinePlus
    https://medlineplus.gov/radiationexposure.html
    What are the treatments for acute radiation sickness? Before they start treatment, health care professionals need to figure out how much radiation your body absorbed. They will ask about your symptoms, do blood tests, and may use a device that measures radiation. They also try get more information about the exposure, such as what type of radiation it was, how far away you were from the source of the radiation, and how long you were exposed.
  • #38 Radiation Sickness Symptoms, Doctors, Treatments, Advances & More | MediFind
    https://www.medifind.com/conditions/radiation-sickness/4545
    The severity of symptoms and illness (acute radiation sickness) depends on the type and amount of radiation, how long you were exposed, and which part of the body was exposed. Symptoms of radiation sickness may occur right after exposure, or over the next few days, weeks, or months. Bone marrow and the gastrointestinal tract are especially sensitive to radiation injury. […] Preventive measures include: Avoid unnecessary exposure to radiation, including unnecessary CT scans and x-rays. People working in radiation hazard areas should wear badges to measure their exposure level. Protective shields should always be placed over the parts of the body not being treated or studied during x-ray imaging tests or radiation therapy. […] Cytokine therapy of acute radiation syndrome. […] MIIST305 mitigates gastrointestinal acute radiation syndrome injury and ameliorates radiation-induced gut microbiome dysbiosis. […] Characterization of Cutaneous Radiation Syndrome in a Mouse Model Using [18F]F- Fluorodeoxyglucose Positron Emission Tomography.

Zobacz więcej

cytopenia sargramostym antagonista receptora 5-HT3 mucositis fluorochinolon gorączka neutropeniczna choroba popromienna przeszczep komórek macierzystych czynnik stymulujący tworzenie kolonii granulocytów skażenie radioaktywne zespół ostrej choroby popromiennej zapalenie płuc popromienne filgrastym inhibitor fosfodiesterazy typu 5 zapalenie skóry popromienne transfuzja krwi aplazja szpiku uszkodzenie szpiku kostnego błękit pruski kwas dietylenotriaminopentaoctowy popromienne zapalenie przełyku neutropenia pegfilgrastym promieniowanie jonizujące dekontaminacja terapia tlenem hiperbarycznym jodek potasu