RTOG/EORTC Late Radiation Morbidity Scoring Schema

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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 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