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RTOG/EORTC Late Radiation Morbidity Scoring Scheme APPENDIX IV |
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ORGAN TISSUE |
0 |
GRADE 1 |
GRADE 2 |
GRADE 3 |
GRADE 4 |
5 |
|
SKIN |
None |
Slight atrophy; Pigmentation change; Some hair loss |
Patch atrophy; Moderate telangiectasia; Total hair loss |
Marked atrophy; Gross telangiectasia |
Ulceration |
|
|
SUBCUTANEOUS TISSUE |
None |
Slight induration (fibrosis) and loss of subcutaneous fat |
Moderate fibrosis but asymptomatic; Slight field contracture; <10% linear reduction |
Severe induration and loss of subcutaneous tissue; Field contracture > 10% linear measurement |
Necrosis
|
|
|
MUCOUS MEMBRANE |
None |
Slight atrophy and dryness |
Moderate atrophy and telangiectasia; Little mucous |
Marked atrophy with complete dryness; Severe telangiectasia |
Ulceration |
D E |
|
SALIVARY GLANDS |
None |
Slight dryness of mouth; Good response on stimulation |
Moderate dryness of mouth; Poor response on stimulation |
Complete dryness of mouth; No response on stimulation |
Fibrosis |
A T |
|
SPINAL CORD |
None |
Mild L’Hermitte’s syndrome |
Severe L’Hermitte’s syndrome |
Objective neurological findings at or below cord level treated |
Mono, para quadriplegia |
H |
|
BRAIN |
None |
Mild headache; Slight lethargy |
Moderate headache; Great lethargy |
Severe headaches; Severe CNS dysfunction (partial loss of power or dyskinesia) |
Seizures or paralysis; Coma |
D I R |
|
EYE |
None |
Asymptomatic cataract; Minor corneal ulceration or keratitis |
Symptomatic cataract; Moderate corneal ulceration; Minor retinopathy or glaucoma |
Severe keratitis; Severe retinopathy or detachment Severe glaucoma |
Panopthalmitis/Blindness |
E C E |
|
LARYNX |
None |
Hoarseness; Slight arytenoid edema |
Moderate arytenoid edema; Chondritis |
Severe edema; Severe chondritis |
Necrosis |
T l |
|
LUNG |
None |
Asymptomatic or mild symptoms (dry cough); Slight radiographic appearances |
Moderate symptomatic fibrosis or pneumonitis (severe cough); Low grade fever; Patchy radiographic appearances |
Severe symptomatic fibrosis or pneumonitis; Dense radiographic changes |
Severe respiratory insufficiency/continuous O2/Assisted ventilation |
Y
R E |
|
HEART |
None |
Asymptomatic or mild symptoms; Transient T wave inversion & ST Changes; Sinus tachycardia >110 (at rest) |
Moderate angina on effort; Mild pericarditis; Normal heart size; Persistent abnormal T wave and ST changes ; Low ORS |
Severe angina; Pericardial effusion; Constrictive pericarditis; Moderate heart failure; Cardiac enlargement; EKG abnormalities |
Tamponade/Severe heart failure/Severe constrictive pericarditis |
L A T E D |
|
ESOPHAGUS |
None |
Mild fibrosis; Slight difficulty in swallowing solids; No pain on swallowing |
Unable to take solid food normally; Swallowing semi-solid food; Dilation may be indicated |
Severe fibrosis; Able to swallow only liquids; May have pain on swallowing Dilation required |
Necrosis/Perforation Fistula |
T O |
|
SMALL/LARGE INTESTINE |
None |
Mild diarrhea; Mild cramping; Bowel movement 5 times daily Slight rectal discharge or bleeding |
Moderate diarrhea and colic; Bowel movement >5 times daily; Excessive rectal mucus or intermittent bleeding |
Obstruction or bleeding, requiring surgery |
Necrosis/Perforation Fistula |
R A D I |
|
LIVER |
None |
Mild lassitude; Nausea, dyspepsia; Slightly abnormal liver function |
Moderate symptoms; Some abnormal liver; function tests; Serum albumin normal |
Disabling hepatitic insufficiency; Liver function tests grossly abnormal; Low albumin; Edema or ascites |
Necrosis/Hepatic coma or encephalopathy |
A T I O |
|
KIDNEY |
None |
Transient albuminuria; No hypertension; Mild impairment of renal function; Urea 25-35 mg%;Creatinine 1.5-2.0 mg%; Creatinine clearance > 75% |
Persistent moderate albuminuria (2+); Mild hypertension; No related anemia; Moderate impairment of renal function; Urea > 36-60mg% Creatinine clearance (50-74%) |
Severe albuminuria; Severe hypertension Persistent anemia (< 10%); Severe renal failure; Urea >60 mg% Creatinine >4.0 mg% Creatinine clearance < 50% |
Malignant hypotension; Uremic coma/Urea > 100% |
N
E F F E |
|
BLADDER |
None |
Slight epithelial atrophy; Minor telangiectasia (microscopic hematuria) |
Moderate frequency; Generalized telangiectasia; Intermittent macroscopic hematuria |
Severe frequency & dysuria Severe generalized Telangiectasia (often with petechiae); Frequent hematuria; Reduction in bladder capacity (< 150 cc) |
Necrosis/Contracted bladder (capacity < 100 cc); Severe hemorrhagic cystitis |
C T S |
|
BONE |
None |
Asymptomatic; No growth retardation; Reduced bone Density |
Moderate pain or tenderness; Growth retardation; Irregular bone sclerosis |
Severe pain or tenderness; Complete arrest of bone growth; Dense bone sclerosis |
Necrosis/Spontaneous fracture |
|
|
JOINT |
None |
Mild joint stiffness; Slight limitation of movement |
Moderate stiffness; Intermittent or moderate joint pain; Moderate limitation of movement |
Severe joint stiffness; Pain with severe limitation of movement |
Necrosis/Complete fixation |
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