| [ 0 ] | [ 1 ] | [ 2 ] | [ 3 ] | [ 4 ] | |
|---|---|---|---|---|---|
| SKIN | No change over baseline | Follicular, faint or dull erythema/ epilation/dry desquamation/ decreased sweating | Tender or bright erythema, patchy moist desquamation/ moderate edema | Confluent, moist desquamatiom other than skin folds, pitting edema | Ulceration, hemorrhage, necrosis |
| MUCOUS MEMBRANE | No change over baseline | Injection/ may experience mild pain not requiring analgesic | Patchy mucositis which may produce an inflammatory serosanguinitis discharge/ may experience moderate pain requiring analgesia | Confluent fibrinous mucositis/ may include severe pain requiring narcotic | Ulceration, hemorrhage or necrosis |
| EYE | No change | Mild conjunctivitis with or without scleral injection/ increased tearing | Moderate conjunctivitis with or without keratitis requiring steroids &/or antibiotics/ dry eye requiring artificial tears/ iritis with photophobia | Severe keratitis with corneal ulceration/ objective decrease in visual acuity or in visual fields/ acute glaucoma/ panopthalmitis | Loss of vision (unilateral or bilateral) |
| EAR | No change over baseline | Mild external otitis with erythema, pruritis, secondary to dry desquamation not requiring medication. Audiogram unchanged from baseline | Moderate external otitis requiring topical medication/ serious otitis medius/ hypoacusis on testing only | Severe external otitis with dischange or moist desquamation/ symptomatic hypoacusis/tinnitus, not drug related | Deafness |
| SALIVARY GLAND | No change over baseline | Mild mouth dryness/ slightly thickened saliva/ may have slightly altered taste such as metallic taste/ these changes not reflected in alteration in baseline feeding behavior, such as increased use of liquids with meals | Moderate to complete dryness/ thick, sticky saliva/ markedly altered taste | ------- | Acute salivary gland necrosis |
| PHARYNX & ESOPHAGUS | No change over baseline | Mild dysphagia or odynophagia/ may require topical anesthetic or non-narcotic analgesics/ may require soft diet | Moderate dysphagia or odynophagia/ may require narcotic analgesics/ may require puree or liquid diet | Severe dysphagia or odynophagia with dehydration or weight loss(>15% from pre-treatment baseline) requiring N-G feeding tube, I.V. fluids or hyperalimentation | Complete obstruction, ulceration, perforation, fistula |
| LARYNX | No change over baseline | Mild or intermittent hoarseness/cough not requiring antitussive/ erythema of mucosa | Persistent hoarseness but able to vocalize/ referred ear pain, sore throat, patchy fibrinous exudate or mild arytenoid edema not requiring narcotic/ cough requiring antitussive | Whispered speech, throat pain or referred ear pain requiring narcotic/ confluent fibrinous exudate, marked arytenoid edema | Marked dyspnea, stridor or hemoptysis with tracheostomy or intubation necessary |
| UPPER G.I. | No change | Anorexia with <=5% weight loss from pretreatment baseline/ nausea not requiring antiemetics/ abdominal discomfort not requiring parasympatholytic drugs or analgesics | Anorexia with <=15% weight loss from pretreatment baseline/nausea &/ or vomiting requiring antiemetics/ abdominal pain requiring analgesics | Anorexia with >15% weight loss from pretreatment baseline or requiring N-G tube or parenteral support. Nausea &/or vomiting requiring tube or parenteral support/abdominal pain, severe despite medication/hematemesis or melena/ abdominal distention (flat plate radiograph demonstrates distended bowel loops | Ileus, subacute or acute obstruction, performation, GI bleeding requiring transfusion/abdominal pain requiring tube decompression or bowel diversion |
| LOWER G.I. INCLUDING PELVIS | No change | Increased frequency or change in quality of bowel habits not requiring medication/ rectal discomfort not requiring analgesics | Diarrhea requiring parasympatholytic drugs (e.g., Lomotil)/ mucous discharge not necessitating sanitary pads/ rectal or abdominal pain requiring analgesics | Diarrhea requiring parenteral support/ severe mucous or blood discharge necessitating sanitary pags/abdominal distention (flat plate radiograph demonstrates distended bowel loops) | Acute or subacute obstruction, fistula or perforation; GI bleeding requiring transfusion; abdominal pain or tenesmus requiring tube decompression or bowel diversion |
| LUNG | No change | Mild symptoms of dry cough or dyspnea on exertion | Persistent cough requiring narcotic, antitussive agents/ dyspnea with minimal effort but not at rest | Severe cough unresponsive to narcotic antitussive agent or dyspnea at rest/ clinical or radiologic evidence of acute pneumonitis/ intermittent oxygen or steroids may be required | Severe respiratory insufficiency/ continuous oxygen or assisted ventilation |
| GENITOURINARY | No change | Frequency of urination or nocturia twice pretreatment habit/ dysuria, urgency not requiring medication | Frequency of urination or nocturia which is less frequent than every hour. Dysuria, urgency, bladder spasm requiring local anesthetic (e.g., Pyridium) | Frequency with urgency and nocturia hourly or more frequently/ dysuria, pelvis pain or bladder spasm requiring regular, frequent narcotic/gross hematuria with/ without clot passage | Hematuria requiring transfusion/ acute bladder obstruction not secondary to clot passage, ulceration or necrosis |
| HEART | No change over baseline | Asymptomatic but objective evidence of EKG changes or pericardial abnormalities without evidence of other heart disease | Symptomatic with EKG changes and radiologic findings of congestive heart failure or pericardial disease/ no specific treatment required | Congestive heart failure, angina pectoris, pericardial disease responding to therapy | Congestive heart failure, angina pectoris, pericardial disease, arrhythmias not responsive to non-surgical measures |
| CNS | No change | Fully functional status (i.e., able to work) with minor neurologic findings, no medication needed | Neurologic findings present sufficient to require home case/ nursing assistance may be required/ medications including steroids/anti-seizure agents may be required | Neurologic findings requiring hospitalization for initial management | Serious neurologic impairment which includes paralysis, coma or seizures>3 per week despite medication/hospitalization required |