RTOG/EORTC Late Radiation Morbidity Scoring Schema Late Radiation Links Skin Subcutaneous Tissue Mucous Membrane Salivary Glands Spinal Cord Brain Eye Larynx Lung Heart Esophagus Small/Large Intestine Liver Kidney Bladder Bone Joint   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 D E A T H D I R E C T L Y R E L A T E D T O R A D I A T I O N L A T E E F F E C T S SUBCUTANEOUS TISSUE None Slight induration (fibrosia) 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 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 SPINAL CORD None Mild L'Hermitte's syndrome Severe L'Hermitte's syndrome Objective neurological findings at or below cord level treated Mono, para quadraplegia 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 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 LARYNX None Hoarseness Slight arytenoid edema Moderate arytenoid edema Chondritis Severe edema Severe chondritis Necrosis 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 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 ESOPHAGUS None Mild fibrosis Slight difficulty in swallowing solids No pain on swallowing Unable to take solid food normally Swallowing semi-solid food Dilatation may be indicated Severe fibrosis Able to swallow only liquids May have pain on swallowing Dilation required Necrosis/ Perforation Fistula 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 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 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>36-60 mg% Creatinine clearance (50-74%) Severe albuminuria Severe hypertension Persistent anemia (<10g%) Severe renal failure Urea >60 mg% Creatinine >4.0 mg% Creatinine clearance <50% Malignant hypertension Uremic coma/Urea >100% BLADDER None Slight epithelial atrophy Minor telangiectasia (microscopic hematuria) Moderate frequency Generalized telangiectasia Intermittent macroscopic hematuria Severe frequency and dysuria Severe generalized telangiectasia (often with petechiae) Frequent hematuria Reduction in bladder capacity (<150 cc) Necrosis/ Contracted bladder (capacity <100 cc) Severe hemorrhagic cystitis 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