Table 1 RTOG acute and late toxicity grading scale
Organ tissue | 0 | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|---|
Skin (acute) | No change over baseline | Follicular, faint or dull erythema/epilation/dry desquamation/decreased sweating | Tender or bright erythema, patchy moist desquamation/moderate oedema | Confluent, moist desquamation other than skin folds, pitting oedema | Ulceration, haemorrhage, necrosis | NA |
Skin (late) | None | Slight atrophy; pigmentation change; some hair loss | Patch atrophy; moderate telangiectasia; total hair loss | Market atrophy; gross telangiectasia | Ulceration | Death directly related to radiation late effects |
Subcutaneous tissue | None | Slight induration (fibrosis) and loss or 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 | |
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 02/assisted ventilation | |
Chest or rib pain | 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 | |
Shoulder morbidity | 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 | |
Cardiac | None | Asymptomatic or mild symptoms; transient T wave inversion & ST changes; sinus tachy> 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 |