RTOG/EORTC Late Radiation Morbidity Scoring Schema
| 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 |