The outcome of local radiation injuries: 14 years of follow-up after the Chernobyl accident

The Chernobyl nuclear power plant accident on April 26, 1986 was the larges t in the history of the peaceful use of nuclear energy. Of the 237 individu als initially suspected to have been significantly exposed to radiation dur ing or in the immediate aftermath of the accident, the diagnosis of acute r adiation sickness (ARS) could be confirmed in 134 cases on the basis of cli nical symptoms. Of these, 54 patients suffered from cutaneous radiation syn drome (CRS) to varying degrees. Among the 28 patients who died from the imm ediate consequences of accidental radiation exposure, acute hemopoietic syn drome due to bone marrow failure was the primary cause of death only in a m inority. In 16 of these 28 deaths, the primary cause was attributed to CRS. This report describes the characteristic cutaneous sequelae as well as ass ociated clinical symptoms and diseases of 15 survivors of the Chernobyl acc ident with severe localized exposure who were systematically followed up by our groups between 1991 and 2000. All patients presented with CRS of varyi ng severity, showing xerosis, cutaneous telangiectasias and subungual splin ter hemorrhages, hemangiomas and lymphangiomas, epidermal atrophy, dissemin ated keratoses, extensive dermal and subcutaneous fibrosis with partial ulc erations, and pigmentary changes including radiation lentigo. Surprisingly, no cutaneous malignancies have been detected so Far in those areas that re ceived large radiation exposures and that developed keratoses; however, two patients first presented in 1999 with basal cell carcinomas on the nape of the neck and the right lower eyelid, areas that received lower exposures. During the followup period, two patients were lost due to death from myelod ysplastic syndrome in 1995 and acute myelogenous leukemia in 1998, respecti vely. Other radiation-induced diseases such as dry eye syndrome (3/15), rad iation cataract (5/15), xerostomia (4/15) and increased FSH levels (7/15) i ndicating impaired fertility were also documented. This study, which analyz es 14 years in the clinical course of a cohort of patients with a unique ex posure pattern, corroborates the requirement for long-term, if not life-lon g, follow-up not only in atomic bomb survivors, but also after predominantl y local radiation exposure. (C) 2001 by Radiation Research Society.