Rtog Toxicity 5f6w2u

ACUTE For all: 0 - no symptoms, 5 - death directly related to radiation effects

Tissue Skin

Mucous membrane

Eye

Ear

Salivary gland

Pharynx & esophagus

Larynx

Upper GI

RTOG ACUTE Radiation Morbidity Grade 1 2 3 Follicular, faint or dull erythema / epilation / dry desquamation / decreased sweating

Tender or bright Confluent, moist erythema, patchy moist desquamation other desquamation / than skin folds, pitting moderate edema edema Patchy mucositis that may produce an Confluent fibrinous Injection / may inflammatory mucositis / may include experience mild pain serosanguinous severe pain requiring not requiring analgesic discharge / may narcotic experience moderate pain requiring analgesia Moderate conjunctivitis Severe keratitis with w/ or w/o keratitis corneal ulceration / Mild conjunctivitis w/ requiring steroids objective decrease in or w/o scleral and/or antibiotics / dry visual acuity or in injection / increased eye requiring artificial visual fields / acute tearing tears / iritis with glaucoma / photophobia panophthalmitis Mild external otitis Moderate external otitis Severe external otitis with erythema, pruritus, requiring topical with discharge or moist secondary to dry medication / serous desquamation / desquamation not otitis media / symptomatic requiring medication. hypoacusis on testing hypoacusis / tinnitus, Audiogram unchanged only not drug related from baseline Mild mouth dryness / slightly thickened saliva / may have slightly altered taste such as metallic taste / Moderate to complete these changes not dryness / thick, sticky (none) reflected saliva / markedly altered taste in alteration in baseline feeding behavior, such as increased use of liquids with meals Severe dysphagia or Mild dysphagia or Moderate dysphagia or odynophagia with odynophagia / may odynophagia / may dehydration or weight require topical require narcotic loss > 15% from anesthetic or nonanalgesics / may pretreatment baseline narcotic analgesics / require puree or liquid requiring NG feeding may require soft diet diet tube, IV fluids, or hyperalimentation Persistent hoarseness but able to vocalize / referred ear pain, sore Whispered speech, throat, patchy fibrinous throat pain or referred Mild or intermittent ear pain requiring hoarseness / cough not exudate or mild narcotic / confluent arytenoid edema not requiring antitussive / fibrinous exudate, requiring narcotic / erythema of mucosa marked arytenoid cough edema Anorexia with ≤ 5% weight loss from pretreatment baseline / nausea not requiring

requiring antitussive Anorexia with ≤ 15% weight loss from pretreatment baseline / nausea and/or vomiting

4 Ulceration, hemorrhage, necrosis

Ulceration, hemorrhage or necrosis

Loss of vision (uni or bilateral)

Deafness

Acute salivary gland necrosis

Complete obstruction, ulceration, perforation, fistula

Marked dyspnea, stridor or hemoptysis with tracheostomy or intubation necessary

Anorexia with > 15% Ileus, subacute or acute weight loss from obstruction, perforation, pretreatment baseline or GI bleeding requiring requiring NG tube or transfusion / abdominal

Lower GI / Pelvis

Lung

parenteral . Nausea and/or vomiting requiring tube or parenteral / antiemetics / abdominal abdominal pain, severe discomfort not requiring antiemetics / pain requiring tube despite medication / requiring abdominal pain decompression or hematemesis or parasympatholytic requiring analgesics bowel diversion melena / abdominal drugs or analgesics distention (flat plate radiograph demonstrates distended bowel loops) Diarrhea requiring Diarrhea requiring Acute or subacute parenteral / Increased frequency or parasympatholytic obstruction, fistula or severe mucous or blood change in quality of drugs (e.g. Lomotil) / perforation; GI bleeding discharge necessitating bowel habits not mucous discharge not requiring transfusion; sanitary pads / requiring medication / necessitating sanitary abdominal pain or abdominal distention rectal discomfort not pads / rectal or tenesmus requiring tube (flat plate radiograph requiring analgesics abdominal pain decompression or demonstrates distended requiring analgesics bowel diversion bowel loops) Severe cough unresponsive to narcotic antitussive agent or dyspnea at rest Persistent cough / clinical or radiological Severe respiratory Mild symptoms of dry requiring narcotic, insufficiency / evidence of acute cough or dyspnea on antitussive agents / continuous oxygen or pneumonitis / exertion dyspnea with minimal intermittent oxygen or assisted ventilation effort but not at rest

Genitourinary

Frequency of urination or nocturia twice pretreatment habit / dysuria, urgency not requiring medication

Heart

Asymptomatic but objective evidence of EKG changes or pericardial abnormalities without evidence of other heart disease

CNS

Fully functional status (i.e. able to work) with minor neurological findings, no medication needed

steroids may be required Frequency with urgency and nocturia Frequency of urination hourly or more or nocturia that is less frequenty / dysuria, pelvis pain or bladder frequent than every hour. Dysuria, urgency, spasm requiring regular, frequent bladder spasm narcotic / gross requiring local hematuria anesthetic (e.g. Pyridium) with/without clot age Symptomatic with EKG changes and Congestive heart radiological findings of failure, angina pectoris, congestive heart failure pericardial disease or pericardial disease / responding to therapy no specific treatment required Neurological findings present sufficient to require home care / Neurological findings nursing assistance may requiring be required / hospitalization for medications including initial management steroids/antiseizure agents may be required

1

2

Hematuria requiring transfusion / acute bladder obstruction not secondary to clot age, ulceration, or necrosis

Congestive heart failure, angina pectoris, pericardial disease, arrhythmias not responsive to nonsurgical measures Serious neurological impairment that includes paralysis, coma, or seizures > 3 per week despite medication / hospitalization required

HEME WBC

3.0 - < 4.0

2.0 - < 3.0

1.0 - < 2.0

3 < 1.0

4

Platelets

75 - < 100

50 - < 75

25 - < 50

<25 or spontaneous bleeding

Neutrophils

1.5 - < 1.9

1.0 - < 1.5

0.5 - < 1.0

< 0.5 or sepsis

Hgb / Hct

11 - 9.5 (28% - < 32%) < 9.5 - 7.5 ( < 28%)

< 7.5 - 5.0 (Packed cell (none) transfusion required)

[edit] LATE For all: 0 - no symptoms, 5 - death directly related to radiation effects

EORTC LATE Radiation Morbidity Grade 1

2

3

4

Slight atrophy; Patch atrophy; moderate pigmentation Marked atrophy; telangiectasia; total hair Ulceration change; some hair gross telangiectasia loss loss Severe induration and Moderate fibrosis but Slight induration loss of subcutaneous asymptomatic; slight (fibrosis) and loss tissue; field Necrosis field contracture; <10% of subcutaneous fat contracture > 10% linear reduction linear measurement Moderate atrophy and Slight atrophy and Marked atrophy with telangiectasia; little Ulceration dryness complete dryness mucous Slight dryness of Moderate dryness of Complete dryness of mouth; good mouth; poor response on mouth; no response on Fibrosis response on stimulation stimulation stimulation Objective neurological Mild L'Hermitte's Severe L'Hermitte's findings at or below Mono, para quadraplegia syndrome syndrome cord level treated Severe headache; severe CNS Mild headache; Moderate headache; dysfunction (partial Coma slight lethargy great lethargy loss of power or dyskinesia) Asymptomatic Symptomatic cataract; Severe keratitis; cataract; minor moderate corneal severe retinopathy or Panophthalmitis / blindness corneal ulceration ulceration; minor detachment or keratitis retinopathy or glaucoma Hoarseness; slight Moderate arytenoid Severe edema; severe Necrosis arytenoid edema edema; chondritis chondritis Asymptomatic or Moderate symptomatic Severe symptomatic mild symptoms fibrosis or pneumonitis Severe respiratory fibrosis or (dry cough); slight (severe cough); low insufficiency / Continuous pneumonitis; dense radiographic grade fever; patchy oxygen / assisted ventilation radiographic changes appearances radiographic appearances Severe angina; Asymptomatic or Moderate angina on pericardial effusion; mild symptoms; effort; mild pericarditis; constrictive Tamponade / severe heart transient T wave normal heart size; pericarditis; moderate failure; severe constrictive inversion & ST persistent abnormal T heart failure; cardiac pericarditis changes; sinus wave and ST changes; enlargement; EKG tachy > 110 (at rest) low ORS abnormalities Mild fibrosis; slight Severe fibrosis; able to to take solid food Unable difficulty in swallow only liquids; normally; swallowing swallowing solids; may have pain on Necrosis / perforation fistula semisolid food; dilatation no pain on swallowing; dilatation may be indicated swallowing required Mild diarrhea; mild Moderate diarrhea and cramping; bowel colic; bowel movement > Obstruction or movement 5 times 5 times daily; excessive bleeding, requiring Necrosis / perforation fistula daily; slight rectal rectal mucus or surgery discharge or intermittent bleeding bleeding Mild lassitude; Moderate symptoms; Disabling hepatic Necrosis / hepatic coma or nausea, dyspepsia; some abnormal liver insufficiency; liver encephalopathy

slightly abnormal liver function

function tests; serum albumin normal

function tests grossly abnormal; low albumin; edema or ascites

Transient albuminuria; no hypertension; mild impairment of renal function; urea 2535 mg/dL; creatinine 1.5-2.0 mg/dL; creatinine clearance > 75%

Persistent moderate albuminuria (2+); mild hypertension; no related anemia; moderate impairment of renal function; urea > 36-60; creatinine clearance 5074%

Severe albuminuria; severe hypertension; persistent anemia (< 10); severe renal Malignant hypertension; failure; urea > 60; uremic coma; urea > 100 creatinine > 4.0; creatinine clearance < 50%

Slight epithelial atrophy; minor telangiectasia (microscopic hematuria)

Moderate frequency; generalized telangiectasia; intermittent macroscopic hematuria

Asymptomatic; no growth retardation; reduced bone density Mild t stiffness; slight limitation of movement

Severe frequency & dysuria; severe telangiectasia (often with petechiae); frequent hematuria; reduction in bladder capacity (<150 cc) Moderate pain or Severe pain or tenderness; growth tenderness; complete retardation; irregular arrest of bone growth; bone sclerosis dense bone sclerosis Moderate stiffness; Severe t stiffness; intermittent or moderate pain with severe t pain; moderate limitation of limitation of movement movement

Necrosis/contracted bladder (capacity < 100 cc); severe hemorrhagic cystitis

Necrosis / spontaneous fracture

Necrosis / complete fixation