Choroba popromienna – Rokowania, prognozy i postęp choroby

Choroba popromienna
Rokowania, prognozy i postęp choroby

Rokowanie w ostrym zespole popromiennym (ARS) jest ściśle zależne od pochłoniętej dawki promieniowania oraz szybkości ekspozycji. Dawki poniżej 2 Gy wiążą się z niemal 100% powrotem do zdrowia w ciągu miesiąca, natomiast dawka 2,5-5 Gy stanowi LD50/60, z około 50% śmiertelnością bez opieki medycznej. Przy dawce 6 Gy z opieką medyczną przeżywa około połowa pacjentów, natomiast dawki powyżej 8 Gy są niemal zawsze śmiertelne, nawet przy intensywnej terapii. Czas do zgonu skraca się wraz ze wzrostem dawki, a główne przyczyny zgonu to zniszczenie szpiku kostnego, infekcje, krwotoki, odwodnienie i niewydolność wielonarządowa. W praktyce klinicznej rokowanie opiera się na ocenie objawów klinicznych, poziomie limfocytów po 24 godzinach oraz systemie METREPOL, gdzie ocena 3 wskazuje na minimalne szanse przeżycia i rozwój niewydolności wielonarządowej.

Choroba popromienna (Radiation sickness) – Prognoza (rokowanie)

Rokowanie w zależności od dawki promieniowania
Predykcja rokowania we wczesnym okresie
Czas przeżycia w zależności od ciężkości uszkodzeń
Czynniki wpływające na rokowanie u pacjentów poddanych terapii
Efekt biologiczny promieniowania a rokowanie
Przewidywanie odpowiedzi na radioterapię
Odległe powikłania i długoterminowe rokowanie
Szczególne przypadki prognostyczne
Kolejne rozdziały

Choroba popromienna (Radiation sickness) – Prognoza (rokowanie)

Rokowanie w chorobie popromiennej (ostrym zespole popromiennym, ARS) zależy od wielu czynników, przede wszystkim od pochłoniętej dawki promieniowania oraz szybkości, z jaką nastąpiła ekspozycja.¹² Istnieje wyraźna korelacja między nasileniem objawów klinicznych ostrego zespołu popromiennego a dawką promieniowania.³ Dodatkowo na rokowanie wpływają takie czynniki jak stan zdrowia pacjenta oraz dostępność i jakość opieki medycznej.⁴⁵

Rokowanie w zależności od dawki promieniowania

Dawka promieniowania pochłonięta przez organizm jest kluczowym czynnikiem prognostycznym w chorobie popromiennej:⁶⁷

Dawka poniżej 2 Gy – niemal 100% pacjentów wraca do pełni zdrowia w ciągu miesiąca, choć mogą pojawić się odległe powikłania, takie jak nowotwory⁸
Dawka 2,5-5 Gy – stanowi LD50/60 (dawka śmiertelna dla 50% populacji w ciągu 60 dni)⁹
Dawka powyżej 3 Gy bez opieki medycznej – śmiertelność wynosi około 50%¹⁰
Dawka 6 Gy z opieką medyczną – około 50% pacjentów przeżywa¹¹
Dawka powyżej 8 Gy – niemal zawsze śmiertelna, nawet przy intensywnej opiece medycznej¹²
Dawka powyżej 10-12 Gy – praktycznie bez szans na przeżycie¹³¹⁴

Predykcja rokowania we wczesnym okresie

W praktyce klinicznej często trudno jest dokładnie określić dawkę promieniowania, jakiej poddany był pacjent. W takich przypadkach rokowanie określa się na podstawie objawów klinicznych i wyników badań laboratoryjnych.¹⁵¹⁶ Szczególnie istotne są:

Poziom limfocytów po 24 godzinach od ekspozycji – może pomóc w ocenie rokowania¹⁷
System oceny METREPOL – umożliwia klasyfikację ciężkości ARS oraz przewidywanie rozwoju niewydolności wielonarządowej (MOF)¹⁸
Pacjenci z oceną 3 w skali METREPOL – przewidywany rozwój niewydolności wielonarządowej i minimalne szanse na przeżycie¹⁹

Warto zaznaczyć, że w pierwszych 48 godzinach nie jest możliwe uzyskanie indywidualnej dozymetrii fizycznej i biologicznej. Te kluczowe informacje stają się dostępne dopiero po 48 godzinach i stanowią podstawę do dalszych decyzji medycznych.²⁰

Czas przeżycia w zależności od ciężkości uszkodzeń

Czas do zgonu zmniejsza się wraz ze wzrostem dawki promieniowania.²¹ W przypadku bardzo dużych dawek promieniowania:

Zespół mózgowo-naczyniowy – śmierć może nastąpić w ciągu 3 dni, prawdopodobnie z powodu załamania się układu krążenia i zwiększonego ciśnienia wewnątrzczaszkowego w wyniku obrzęku, zapalenia naczyń i zapalenia opon mózgowych²²
Zespół żołądkowo-jelitowy – śmierć zwykle następuje w ciągu 2 tygodni od ekspozycji z powodu infekcji, odwodnienia i zaburzeń elektrolitowych²³
Ciężkie uszkodzenia popromienne – w zależności od nasilenia, śmierć może nastąpić w ciągu 2 dni do 2 tygodni²⁴

Czynniki wpływające na rokowanie u pacjentów poddanych terapii

U pacjentów z ciężką aplazją szpiku kostnego utrzymującą się ponad 14 dni pomimo stosowania cytokin, należy rozważyć możliwość przeszczepienia komórek macierzystych hematopoezy (HSC).²⁵ Eksperci METREPOL uzgodnili jednak, że przeszczepienie HSC nie powinno być wykonywane u ofiar wypadków radiacyjnych, które mają potencjał endogennej odnowy hematopoezy.²⁶

Pacjenci znajdujący się w grupie ryzyka ARS na podstawie szacunkowej dawki, ale bez objawów i w dobrym stanie ogólnym, mogą być wypisani ze szpitala.²⁷ Z kolei pacjenci z ciężkimi obrażeniami i/lub spełniający kryteria przyjęcia do szpitala z powodu ARS (wg narzędzia EAST) wymagają hospitalizacji i monitorowania morfologii krwi, ze szczególnym uwzględnieniem liczby limfocytów.²⁸

Efekt biologiczny promieniowania a rokowanie

Badania wskazują, że efekt biologiczny indukowany przez fizyczną dawkę promieniowania (np. mierzony wskaźnikiem GARD – Genomic-Adjusted Radiation Dose) istotnie koreluje zarówno z przeżyciem, jak i nawrotami choroby, podczas gdy sama fizyczna dawka promieniowania nie wykazuje takiej korelacji.²⁹

Analiza zbiorcza wykazała, że GARD jako zmienna ciągła jest związany z nawrotem (HR = 0,982, CI [0,970, 0,994], p = 0,002) i przeżyciem (HR = 0,970, CI [0,953, 0,988], p = 0,001).³⁰ Wskazuje to, że biologiczny efekt radioterapii, mierzony za pomocą GARD, jest predyktorem korzyści z radioterapii, podczas gdy sama fizyczna dawka promieniowania nie ma takiego znaczenia prognostycznego.³¹

Przewidywanie odpowiedzi na radioterapię

W przypadku pacjentów poddawanych radioterapii określone biomarkery i pomiary dozymetryczne mogą pomóc w przewidywaniu odpowiedzi na leczenie:

Badania nad pacjentami z przerzutami raka jelita grubego do wątroby wykazały, że średnia dawka pochłonięta (Dmean) określona na podstawie pozytonowej tomografii emisyjnej PET/CT po selektywnej wewnętrznej radioterapii (SIRT) koreluje z odpowiedzią metaboliczną i dłuższym całkowitym przeżyciem (OS)³²
Pacjenci, u których wszystkie zmiany miały Dmean > 39 Gy, osiągnęli znacznie dłuższe OS (13 miesięcy) niż pacjenci, u których co najmniej jedna zmiana miała Dmean < 39 Gy (OS = 5 miesięcy) (p = 0,012; współczynnik ryzyka 2,6 (95% CI 0,98-7,00))³³

W przypadku rdzeniaków (medulloblastoma) odpowiedź na radioterapię jest niezależnym czynnikiem prognostycznym wpływającym na przeżycie.³⁴ Pięcioletnie przeżycie wolne od progresji po radioterapii i całkowite przeżycie były wyższe u pacjentów, którzy osiągnęli całkowitą odpowiedź (CR) w porównaniu z tymi, którzy jej nie osiągnęli (prtPFS: 67% ± 6% vs. 42% ± 6%, P < 0,001; prtOS: 82% ± 5% vs. 44% ± 6%, P < 0,001).³⁵

Odległe powikłania i długoterminowe rokowanie

Osoby, które przeżyły ostrą chorobę popromienną, nadal narażone są na odległe powikłania:³⁶³⁷

Zwiększone ryzyko rozwoju nowotworów indukowanych promieniowaniem, w tym białaczki i raka tarczycy³⁸
Pacjenci nienarażeni na ARS mogą nadal mieć zwiększone ryzyko rozwoju nowotworów w późniejszym okresie życia, w zależności od otrzymanej dawki promieniowania³⁹
Proces zdrowienia może trwać od kilku tygodni do dwóch lat⁴⁰

Szczególne przypadki prognostyczne

W przypadku szczurzenia (trismus) po radioterapii z modulacją intensywności wiązki (IMRT) u pacjentów z rakiem jamy ustnej, wykazano że wynik badania rezonansu magnetycznego (MRI) może służyć jako biomarker do przewidywania nasilenia i progresji tego powikłania.⁴¹

Wskaźnik SA (ocena na podstawie seryjnych badań MRI) wykazał dobrą korelację (r=0,52, p<0,005) z klinicznym nasileniem szczurzenia, co sugeruje, że nasilenie tego powikłania można przewidzieć za pomocą obrazowania.⁴² Przy optymalnym punkcie odcięcia wskaźnika propensity score wynoszącym 0,38, możliwe jest wykrycie pacjentów z niekorzystnym rokowaniem szczurzenia z czułością 100% i swoistością 93%, co jest lepszym wynikiem niż przewidywanie na podstawie samej dawki promieniowania (czułość i swoistość około 63%/90%).⁴³

Dawka promieniowania	Rokowanie bez opieki medycznej	Rokowanie z opieką medyczną	Czas do zgonu	Główna przyczyna zgonu
< 2 Gy	Pełne wyzdrowienie u niemal 100% pacjentów	Pełne wyzdrowienie u niemal 100% pacjentów	Nie dotyczy	Nie dotyczy
2,5 – 5 Gy (LD50/60)	Około 50% śmiertelność	Lepsza przeżywalność, zależna od jakości leczenia	4-6 tygodni	Zniszczenie szpiku kostnego, infekcje, krwotoki
5 – 8 Gy	Wysoka śmiertelność (>75%)	Około 50% śmiertelność przy dawce 6 Gy	2-4 tygodnie	Infekcje, krwotoki
8 – 10 Gy	Niemal 100% śmiertelność	Bardzo wysoka śmiertelność, sporadyczne przypadki przeżycia	1-2 tygodnie	Infekcje, odwodnienie, zaburzenia elektrolitowe
> 10-12 Gy	100% śmiertelność	Praktycznie bez szans na przeżycie	2 dni – 2 tygodnie	Niewydolność wielonarządowa, zespół mózgowo-naczyniowy

Podsumowując, rokowanie w chorobie popromiennej jest ściśle związane z dawką pochłoniętego promieniowania, szybkością ekspozycji, stanem zdrowia pacjenta oraz dostępnością i jakością opieki medycznej. Wczesna identyfikacja pacjentów wysokiego ryzyka, oparta na objawach klinicznych i badaniach laboratoryjnych, pozwala na wdrożenie odpowiedniego leczenia, które może poprawić rokowanie. U osób, które przeżyły ostrą chorobę popromienną, istnieje zwiększone ryzyko rozwoju nowotworów indukowanych promieniowaniem w późniejszym okresie życia.⁴⁴⁴⁵⁴⁶

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Materiały źródłowe

#1 Acute radiation syndrome – Wikipedia
https://en.wikipedia.org/wiki/Acute_radiation_syndrome
Prognosis depends on the exposure dose. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care. […] Complications from ARS include an increased risk of developing radiation-induced cancer later in life.
#2 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#3 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). […] There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. […] Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. […] There is virtually no chance of survival following a total body exposure in excess of 1012 Gy. […] Patients with a score of 3 are those patients who are predicted to develop multi-organ failure (MOF) and unfortunately have almost no hope of recovering. […] After the initial 48 h, scoring of the patient is re-evaluated on the basis of METREPOL. […] It is unfortunately not possible to know during the first 48 h the individual physical and biological dosimetry: these key pieces of information only become accessible after 48 h, at which point they become the basis of further medical decision-making.
#4 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#5 Radiation Sickness (Acute Radiation Syndrome)
https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness
The prognosis (outlook) of radiation sickness depends on several factors, including: […] Radiation sickness is often fatal. The time to death decreases as the dose of radiation increases. […] With survivors, long-term complications may occur. Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.
#6 Acute radiation syndrome – Wikipedia
https://en.wikipedia.org/wiki/Acute_radiation_syndrome
Prognosis depends on the exposure dose. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care. […] Complications from ARS include an increased risk of developing radiation-induced cancer later in life.
#7 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#8 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#9 Acute Radiation Syndrome: Information for Clinicians | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.html
The survival rate of patients with this syndrome decreases with increasing dose. The primary cause of death is the destruction of the bone marrow, resulting in infection and hemorrhage. […] Survival is extremely unlikely with this syndrome. Destructive and irreparable changes in the GI tract and bone marrow usually cause infection, dehydration, and electrolyte imbalance. Death usually occurs within 2 weeks. […] Death may occur within 3 days. Death likely is due to collapse of the circulatory system as well as increased pressure in the confining cranial vault as the result of increased fluid content caused by edema, vasculitis, and meningitis. […] Most patients who do not recover will die within months of exposure. The recovery process lasts from several weeks up to two years. […] The LD50/60 is about 2.5 to 5 Gy (250 to 500 rads). […] Death is due to infection, dehydration, and electrolyte imbalance. Death occurs within 2 weeks of exposure. […] No recovery is expected.
#10 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#11 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#12 Acute radiation syndrome – Wikipedia
https://en.wikipedia.org/wiki/Acute_radiation_syndrome
Prognosis depends on the exposure dose. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care. […] Complications from ARS include an increased risk of developing radiation-induced cancer later in life.
#13 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). […] There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. […] Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. […] There is virtually no chance of survival following a total body exposure in excess of 1012 Gy. […] Patients with a score of 3 are those patients who are predicted to develop multi-organ failure (MOF) and unfortunately have almost no hope of recovering. […] After the initial 48 h, scoring of the patient is re-evaluated on the basis of METREPOL. […] It is unfortunately not possible to know during the first 48 h the individual physical and biological dosimetry: these key pieces of information only become accessible after 48 h, at which point they become the basis of further medical decision-making.
#14 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#15 Radiation Injury – Injuries and Poisoning – Merck Manual Consumer Version
https://www.merckmanuals.com/home/injuries-and-poisoning/radiation-injury/radiation-injury
The outcome depends on the radiation dose, dose rate (how quickly the exposure occurs), and the parts of the body that are affected. Other factors include people’s state of health and whether they receive medical care. […] In general, without medical care, half of all people who receive more than 3 Gy of whole-body radiation at one time die. Nearly all people who receive more than 8 Gy die. Nearly all of those who receive less than 2 Gy fully recover within 1 month, although long-term complications such as cancer may occur. With medical care, about half of people survive 6 Gy of whole-body radiation. Some people have survived doses of up to 10 Gy. […] Because doctors are unlikely to know the amount of radiation a person has received, they usually predict outcome based on the person’s symptoms and laboratory test results.
#16 Radiation sickness – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/radiation-sickness/diagnosis-treatment/drc-20377061
When a person has experienced known or probable exposure to a high dose of radiation from an accident or attack, medical personnel take a number of steps to determine the absorbed radiation dose. This information is essential for determining how serious the illness is likely to be, which treatments to use and whether a person is likely to survive. […] 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.
#17 Emergency Department: Evaluation and Management of Affected Patients | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/nuclear-detonations/evaluation-and-management.html
Acute Radiation Syndrome (ARS) is likely to cause significant morbidity and mortality for people exposed to high levels of radiation from a nuclear detonation. […] A whole-body dose estimate will be helpful for assessing total radiation exposure, which is predictive of overall prognosis of ARS. Lymphocyte levels at 24 hours after exposure can also help prognosticate. […] Patients with severe injuries and/or meeting criteria for inpatient admission for ARS (REMM: EAST tool) will need admission. Complete blood counts (CBC) should be followed with focus on lymphocyte count. […] Patients at risk of ARS based on dose but who are asymptomatic and appear well can be discharged from the hospital. […] Patients not at risk for ARS may still have increased risk for developing cancer later in life, depending on the amount of radiation exposure received.
#18 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). […] There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. […] Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. […] There is virtually no chance of survival following a total body exposure in excess of 1012 Gy. […] Patients with a score of 3 are those patients who are predicted to develop multi-organ failure (MOF) and unfortunately have almost no hope of recovering. […] After the initial 48 h, scoring of the patient is re-evaluated on the basis of METREPOL. […] It is unfortunately not possible to know during the first 48 h the individual physical and biological dosimetry: these key pieces of information only become accessible after 48 h, at which point they become the basis of further medical decision-making.
#19 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). […] There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. […] Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. […] There is virtually no chance of survival following a total body exposure in excess of 1012 Gy. […] Patients with a score of 3 are those patients who are predicted to develop multi-organ failure (MOF) and unfortunately have almost no hope of recovering. […] After the initial 48 h, scoring of the patient is re-evaluated on the basis of METREPOL. […] It is unfortunately not possible to know during the first 48 h the individual physical and biological dosimetry: these key pieces of information only become accessible after 48 h, at which point they become the basis of further medical decision-making.
#20 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). […] There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. […] Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. […] There is virtually no chance of survival following a total body exposure in excess of 1012 Gy. […] Patients with a score of 3 are those patients who are predicted to develop multi-organ failure (MOF) and unfortunately have almost no hope of recovering. […] After the initial 48 h, scoring of the patient is re-evaluated on the basis of METREPOL. […] It is unfortunately not possible to know during the first 48 h the individual physical and biological dosimetry: these key pieces of information only become accessible after 48 h, at which point they become the basis of further medical decision-making.
#21 Radiation Sickness (Acute Radiation Syndrome)
https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness
The prognosis (outlook) of radiation sickness depends on several factors, including: […] Radiation sickness is often fatal. The time to death decreases as the dose of radiation increases. […] With survivors, long-term complications may occur. Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.
#22 Acute Radiation Syndrome: Information for Clinicians | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.html
The survival rate of patients with this syndrome decreases with increasing dose. The primary cause of death is the destruction of the bone marrow, resulting in infection and hemorrhage. […] Survival is extremely unlikely with this syndrome. Destructive and irreparable changes in the GI tract and bone marrow usually cause infection, dehydration, and electrolyte imbalance. Death usually occurs within 2 weeks. […] Death may occur within 3 days. Death likely is due to collapse of the circulatory system as well as increased pressure in the confining cranial vault as the result of increased fluid content caused by edema, vasculitis, and meningitis. […] Most patients who do not recover will die within months of exposure. The recovery process lasts from several weeks up to two years. […] The LD50/60 is about 2.5 to 5 Gy (250 to 500 rads). […] Death is due to infection, dehydration, and electrolyte imbalance. Death occurs within 2 weeks of exposure. […] No recovery is expected.
#23 Acute Radiation Syndrome: Information for Clinicians | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.html
The survival rate of patients with this syndrome decreases with increasing dose. The primary cause of death is the destruction of the bone marrow, resulting in infection and hemorrhage. […] Survival is extremely unlikely with this syndrome. Destructive and irreparable changes in the GI tract and bone marrow usually cause infection, dehydration, and electrolyte imbalance. Death usually occurs within 2 weeks. […] Death may occur within 3 days. Death likely is due to collapse of the circulatory system as well as increased pressure in the confining cranial vault as the result of increased fluid content caused by edema, vasculitis, and meningitis. […] Most patients who do not recover will die within months of exposure. The recovery process lasts from several weeks up to two years. […] The LD50/60 is about 2.5 to 5 Gy (250 to 500 rads). […] Death is due to infection, dehydration, and electrolyte imbalance. Death occurs within 2 weeks of exposure. […] No recovery is expected.
#24 Radiation sickness – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/radiation-sickness/diagnosis-treatment/drc-20377061
When a person has experienced known or probable exposure to a high dose of radiation from an accident or attack, medical personnel take a number of steps to determine the absorbed radiation dose. This information is essential for determining how serious the illness is likely to be, which treatments to use and whether a person is likely to survive. […] 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.
#25 Medical management of the acute radiation syndrome
https://pmc.ncbi.nlm.nih.gov/articles/PMC3863169/
If severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. […] 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.
#26 Medical management of the acute radiation syndrome
https://pmc.ncbi.nlm.nih.gov/articles/PMC3863169/
If severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. […] 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.
#27 Emergency Department: Evaluation and Management of Affected Patients | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/nuclear-detonations/evaluation-and-management.html
Acute Radiation Syndrome (ARS) is likely to cause significant morbidity and mortality for people exposed to high levels of radiation from a nuclear detonation. […] A whole-body dose estimate will be helpful for assessing total radiation exposure, which is predictive of overall prognosis of ARS. Lymphocyte levels at 24 hours after exposure can also help prognosticate. […] Patients with severe injuries and/or meeting criteria for inpatient admission for ARS (REMM: EAST tool) will need admission. Complete blood counts (CBC) should be followed with focus on lymphocyte count. […] Patients at risk of ARS based on dose but who are asymptomatic and appear well can be discharged from the hospital. […] Patients not at risk for ARS may still have increased risk for developing cancer later in life, depending on the amount of radiation exposure received.
#28 Emergency Department: Evaluation and Management of Affected Patients | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/nuclear-detonations/evaluation-and-management.html
Acute Radiation Syndrome (ARS) is likely to cause significant morbidity and mortality for people exposed to high levels of radiation from a nuclear detonation. […] A whole-body dose estimate will be helpful for assessing total radiation exposure, which is predictive of overall prognosis of ARS. Lymphocyte levels at 24 hours after exposure can also help prognosticate. […] Patients with severe injuries and/or meeting criteria for inpatient admission for ARS (REMM: EAST tool) will need admission. Complete blood counts (CBC) should be followed with focus on lymphocyte count. […] Patients at risk of ARS based on dose but who are asymptomatic and appear well can be discharged from the hospital. […] Patients not at risk for ARS may still have increased risk for developing cancer later in life, depending on the amount of radiation exposure received.
#29 GARD is a pan-cancer predictor of radiation therapy benefit | medRxiv
https://www.medrxiv.org/content/10.1101/2020.12.19.20248484.full
Pooled analysis of all available data reveal that GARD as a continuous variable is associated with recurrence (HR = 0.982, CI [0.970, 0.994], p = 0.002) and survival (HR = 0.970, CI [0.953, 0.988], p = 0.001). […] The biologic effect of radiation therapy, as quantified by GARD, is significantly associated with recurrence and survival for those patients treated with radiation: it is predictive of RT benefit; and physical RT dose is not. […] The results of our pan-cancer pooled analysis demonstrate that the biologic effect induced by physical RT dose, as quantified by GARD, is associated with both survival and recurrence, while the physical RT dose is not. […] This pooled analysis demonstrates that GARD, a quantification of the biological effect of RT dose, is predictive of RT treatment benefit and our standard measure of radiation dose is not.
#30 GARD is a pan-cancer predictor of radiation therapy benefit | medRxiv
https://www.medrxiv.org/content/10.1101/2020.12.19.20248484.full
Pooled analysis of all available data reveal that GARD as a continuous variable is associated with recurrence (HR = 0.982, CI [0.970, 0.994], p = 0.002) and survival (HR = 0.970, CI [0.953, 0.988], p = 0.001). […] The biologic effect of radiation therapy, as quantified by GARD, is significantly associated with recurrence and survival for those patients treated with radiation: it is predictive of RT benefit; and physical RT dose is not. […] The results of our pan-cancer pooled analysis demonstrate that the biologic effect induced by physical RT dose, as quantified by GARD, is associated with both survival and recurrence, while the physical RT dose is not. […] This pooled analysis demonstrates that GARD, a quantification of the biological effect of RT dose, is predictive of RT treatment benefit and our standard measure of radiation dose is not.
#31 GARD is a pan-cancer predictor of radiation therapy benefit | medRxiv
https://www.medrxiv.org/content/10.1101/2020.12.19.20248484.full
Pooled analysis of all available data reveal that GARD as a continuous variable is associated with recurrence (HR = 0.982, CI [0.970, 0.994], p = 0.002) and survival (HR = 0.970, CI [0.953, 0.988], p = 0.001). […] The biologic effect of radiation therapy, as quantified by GARD, is significantly associated with recurrence and survival for those patients treated with radiation: it is predictive of RT benefit; and physical RT dose is not. […] The results of our pan-cancer pooled analysis demonstrate that the biologic effect induced by physical RT dose, as quantified by GARD, is associated with both survival and recurrence, while the physical RT dose is not. […] This pooled analysis demonstrates that GARD, a quantification of the biological effect of RT dose, is predictive of RT treatment benefit and our standard measure of radiation dose is not.
#32 90Y-PET/CT-based dosimetry after selective internal radiation therapy predicts outcome in patients with liver metastases from colorectal cancer | EJNMMI Research | Full Text
https://ejnmmires.springeropen.com/articles/10.1186/s13550-018-0419-z
In chemorefractory mCRC patients treated with SIRT, lesion Dmean determined on post-SIRT 90Y-PET/CT correlates with metabolic response and higher lesion Dmean is associated with prolonged OS. […] Patients with all lesions Dmean 39 Gy had a significantly longer OS (13 months) than patients with at least one lesion Dmean 39 Gy (OS = 5 months) (p = 0.012; hazard-ratio, 2.6 (95% CI 0.987.00)). […] Our results confirmed that there is a correlation between the lesion post-treatment Dmean and the metabolic response assessed by TLG-decrease (R2=0.82). Two tumour mean absorbed dose cutoffs of 39 and 60 Gy were defined for predicting respectively the non-metabolic response (less than 15% TLG-decrease) and a high metabolic response (more than 50% TLG-decrease). Our results also demonstrated that patients in which all the lesions had a Dmean superior to 39 Gy had a significant prolonged OS compared to the patients in which at least one lesion had a Dmean inferior to 39 Gy, 13 vs 5 months respectively. […] OS curves revealed a significant difference (p=0.012) between median OS of treated patients (N=11) and under-treated patients (N=13), 13 versus 5 months and a hazard ratio (HR) of 2.6 (95% CI 0.987.00).
#33 90Y-PET/CT-based dosimetry after selective internal radiation therapy predicts outcome in patients with liver metastases from colorectal cancer | EJNMMI Research | Full Text
https://ejnmmires.springeropen.com/articles/10.1186/s13550-018-0419-z
In chemorefractory mCRC patients treated with SIRT, lesion Dmean determined on post-SIRT 90Y-PET/CT correlates with metabolic response and higher lesion Dmean is associated with prolonged OS. […] Patients with all lesions Dmean 39 Gy had a significantly longer OS (13 months) than patients with at least one lesion Dmean 39 Gy (OS = 5 months) (p = 0.012; hazard-ratio, 2.6 (95% CI 0.987.00)). […] Our results confirmed that there is a correlation between the lesion post-treatment Dmean and the metabolic response assessed by TLG-decrease (R2=0.82). Two tumour mean absorbed dose cutoffs of 39 and 60 Gy were defined for predicting respectively the non-metabolic response (less than 15% TLG-decrease) and a high metabolic response (more than 50% TLG-decrease). Our results also demonstrated that patients in which all the lesions had a Dmean superior to 39 Gy had a significant prolonged OS compared to the patients in which at least one lesion had a Dmean inferior to 39 Gy, 13 vs 5 months respectively. […] OS curves revealed a significant difference (p=0.012) between median OS of treated patients (N=11) and under-treated patients (N=13), 13 versus 5 months and a hazard ratio (HR) of 2.6 (95% CI 0.987.00).
#34 Impact of radiation response on survival in pediatric medulloblastoma with residual or disseminated disease | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-025-02632-9
Radiation response was an independent prognostic factor for survival in patients with MB. […] Patients who did not achieve CR after RT should receive intensified adjuvant chemotherapy to improve survival. […] The five-year post-RT progression-free (prtPFS) and overall survival (prtOS) were superior in patients who achieved CR compared to those who did not (prtPFS: 67% 6% vs. 42% 6%, P0.001; prtOS: 82% 5% vs. 44% 6%, P0.001). […] Multivariate Cox analysis revealed that radiation response and large cell/anaplastic subtype were independent prognostic factors for survival (P0.05). […] In univariable logistic regression analyses, patients with stage M+ (OR, 2.955; 95%CI, 1.4805.899, P=0.002) and residual diseases in both sites (OR, 7.312; 95%CI, 3.37515.845, P0.001) were associated with non-CR.
#35 Impact of radiation response on survival in pediatric medulloblastoma with residual or disseminated disease | Radiation Oncology | Full Text
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-025-02632-9
Radiation response was an independent prognostic factor for survival in patients with MB. […] Patients who did not achieve CR after RT should receive intensified adjuvant chemotherapy to improve survival. […] The five-year post-RT progression-free (prtPFS) and overall survival (prtOS) were superior in patients who achieved CR compared to those who did not (prtPFS: 67% 6% vs. 42% 6%, P0.001; prtOS: 82% 5% vs. 44% 6%, P0.001). […] Multivariate Cox analysis revealed that radiation response and large cell/anaplastic subtype were independent prognostic factors for survival (P0.05). […] In univariable logistic regression analyses, patients with stage M+ (OR, 2.955; 95%CI, 1.4805.899, P=0.002) and residual diseases in both sites (OR, 7.312; 95%CI, 3.37515.845, P0.001) were associated with non-CR.
#36 Acute radiation syndrome – Wikipedia
https://en.wikipedia.org/wiki/Acute_radiation_syndrome
Prognosis depends on the exposure dose. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care. […] Complications from ARS include an increased risk of developing radiation-induced cancer later in life.
#37 Radiation Sickness (Acute Radiation Syndrome)
https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness
The prognosis (outlook) of radiation sickness depends on several factors, including: […] Radiation sickness is often fatal. The time to death decreases as the dose of radiation increases. […] With survivors, long-term complications may occur. Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.
#38 Radiation Sickness (Acute Radiation Syndrome)
https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness
The prognosis (outlook) of radiation sickness depends on several factors, including: […] Radiation sickness is often fatal. The time to death decreases as the dose of radiation increases. […] With survivors, long-term complications may occur. Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.
#39 Emergency Department: Evaluation and Management of Affected Patients | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/nuclear-detonations/evaluation-and-management.html
Acute Radiation Syndrome (ARS) is likely to cause significant morbidity and mortality for people exposed to high levels of radiation from a nuclear detonation. […] A whole-body dose estimate will be helpful for assessing total radiation exposure, which is predictive of overall prognosis of ARS. Lymphocyte levels at 24 hours after exposure can also help prognosticate. […] Patients with severe injuries and/or meeting criteria for inpatient admission for ARS (REMM: EAST tool) will need admission. Complete blood counts (CBC) should be followed with focus on lymphocyte count. […] Patients at risk of ARS based on dose but who are asymptomatic and appear well can be discharged from the hospital. […] Patients not at risk for ARS may still have increased risk for developing cancer later in life, depending on the amount of radiation exposure received.
#40 Acute Radiation Syndrome: Information for Clinicians | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.html
The survival rate of patients with this syndrome decreases with increasing dose. The primary cause of death is the destruction of the bone marrow, resulting in infection and hemorrhage. […] Survival is extremely unlikely with this syndrome. Destructive and irreparable changes in the GI tract and bone marrow usually cause infection, dehydration, and electrolyte imbalance. Death usually occurs within 2 weeks. […] Death may occur within 3 days. Death likely is due to collapse of the circulatory system as well as increased pressure in the confining cranial vault as the result of increased fluid content caused by edema, vasculitis, and meningitis. […] Most patients who do not recover will die within months of exposure. The recovery process lasts from several weeks up to two years. […] The LD50/60 is about 2.5 to 5 Gy (250 to 500 rads). […] Death is due to infection, dehydration, and electrolyte imbalance. Death occurs within 2 weeks of exposure. […] No recovery is expected.
#41 Predicting the Severity and Prognosis of Trismus after Intensity-Modulated Radiation Therapy for Oral Cancer Patients by Magnetic Resonance Imaging | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0092561
To develop magnetic resonance imaging (MRI) indicators to predict trismus outcome for post-operative oral cavity cancer patients who received adjuvant intensity-modulated radiation therapy (IMRT), 22 patients with oral cancer treated with IMRT were studied over a two-year period. […] Patients having progressive trismus had higher mean doses of radiation to multiple structures, including the masticator and lateral pterygoid muscles, and the parotid gland (p0.05). […] At the optimum cut-off points of 0.38 for the propensity score, the sensitivity was 100% and the specificity was 93% for predicting the prognosis of the trismus patients. […] The SA score, as determined using MRI, can reflect the radiation injury and correlate to trismus severity. Together with the radiation dose, it could serve as a useful biomarker to predict the outcome and guide the management of trismus following radiation therapy.
#42 Predicting the Severity and Prognosis of Trismus after Intensity-Modulated Radiation Therapy for Oral Cancer Patients by Magnetic Resonance Imaging | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0092561
The SA score based on the serial MRI findings proved to have good correlation (r=0.52, p0.005) with the clinical trismus severity, hinting that the severity of trismus could be predicted by imaging. […] According to our model, applying the optimum cut-off point of the propensity score at 0.38, we are able to pick out poor-prognostic trismus patients with 100% sensitivity and 93% specificity, which is better than predicted by radiation dose (sensitivity and specificity around 63%/90%). […] MRI SA score and the radiation dose of masticators muscles are useful in predicting trismus severity per se and its prognosis in OCC patients after RT or CCRT.
#43 Predicting the Severity and Prognosis of Trismus after Intensity-Modulated Radiation Therapy for Oral Cancer Patients by Magnetic Resonance Imaging | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0092561
The SA score based on the serial MRI findings proved to have good correlation (r=0.52, p0.005) with the clinical trismus severity, hinting that the severity of trismus could be predicted by imaging. […] According to our model, applying the optimum cut-off point of the propensity score at 0.38, we are able to pick out poor-prognostic trismus patients with 100% sensitivity and 93% specificity, which is better than predicted by radiation dose (sensitivity and specificity around 63%/90%). […] MRI SA score and the radiation dose of masticators muscles are useful in predicting trismus severity per se and its prognosis in OCC patients after RT or CCRT.
#44 Acute radiation syndrome – Wikipedia
https://en.wikipedia.org/wiki/Acute_radiation_syndrome
Prognosis depends on the exposure dose. […] The prognosis for ARS is dependent on the exposure dose, with anything above 8 Gy being almost always lethal, even with medical care. […] Complications from ARS include an increased risk of developing radiation-induced cancer later in life.
#45 Radiation Sickness (Acute Radiation Syndrome)
https://my.clevelandclinic.org/health/diseases/24328-radiation-sickness
The prognosis (outlook) of radiation sickness depends on several factors, including: […] Radiation sickness is often fatal. The time to death decreases as the dose of radiation increases. […] With survivors, long-term complications may occur. Survivors have an increased likelihood of radiation-induced cancer, including leukemia and thyroid cancer.
#46 Emergency Department: Evaluation and Management of Affected Patients | Radiation Emergencies | CDC
https://www.cdc.gov/radiation-emergencies/hcp/nuclear-detonations/evaluation-and-management.html
Acute Radiation Syndrome (ARS) is likely to cause significant morbidity and mortality for people exposed to high levels of radiation from a nuclear detonation. […] A whole-body dose estimate will be helpful for assessing total radiation exposure, which is predictive of overall prognosis of ARS. Lymphocyte levels at 24 hours after exposure can also help prognosticate. […] Patients with severe injuries and/or meeting criteria for inpatient admission for ARS (REMM: EAST tool) will need admission. Complete blood counts (CBC) should be followed with focus on lymphocyte count. […] Patients at risk of ARS based on dose but who are asymptomatic and appear well can be discharged from the hospital. […] Patients not at risk for ARS may still have increased risk for developing cancer later in life, depending on the amount of radiation exposure received.