Case review of severe acute radiation syndrome from whole body exposure: concepts of radiation-induced multi-organ dysfunction and failure

Acute radiation syndrome (ARS) due to whole body exposure (WBE) presents various clinical pictures, occasionally leading to fatal consequences. In this report, the literature providing details of the clinical course of severe ARS owing to WBE is reviewed and the lessons learned from recent accidents are discussed, to better prepare for another radiological event. Studies investigating radiological accidents that provided details of medical care for severe ARS were searched in official reports from the International Atomic Energy Agency and through the databases of PubMed, Medline, CiNii and Google Scholar and reviewed. Four fatal cases of severe ARS due to WBE in Soreq 1990 and Nesvizh 1992, and two cases in JCO Tokaimura 1999 were reviewed. A common set of medical interventions was carried out, that put a focus on medical management assuming the occurrence of hematopoietic disorders. However, clinicians were faced with a mixture of chronic hematological and non-hematological events including persistent gastrointestinal disorders, gradual and progressive skin disorders, liver and renal dysfunction and respiratory failure. Clinical pictures following high-dose WBE have become more complicated as treatment modalities improve. To address these issues, a concept of severe ARS due to WBE has been proposed with respect to radiation-induced multi-organ dysfunction syndrome (RI-MODS) and failure (RI-MOF). These patients need to be managed at institutions where multidisciplinary, resource-intensive therapy can be provided.