RTOG/EORTC Late Radiation Morbidity Scoring Scheme APPENDIX IV
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