Степени на Късните лъчеви ефекти

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
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 O
2/ 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

C
T
S
ORGAN TISSUE 0 Grade 1 Grade 2 Grade 3 Grade 4 5
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