Степени на Ранните лъчеви ефекти

Acute Radiation Morbidity Scoring Criteria

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SKIN
No
change
over
baselin
e
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
baselin
e
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
baselin
e
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
baselin
e
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
baselin
e
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
baselin
e
Mild or
intermittent
hoarseness/coug
h 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
parasympatholyti
c 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/hematemes
is 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
parasympatholyti
c 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
Severe respiratory
insufficiency/ continuous
oxygen or assisted
ventilation

steroids may be
required
GENITOURINAR
Y
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
baselin
e
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/hospitalizatio
n required
HEMATOLOGIC
WBC (X 1000)
>=4.0 3.0 - <4.0 2.0 - <3.0 1.0 - <2.0 <1.0
PLATELETS (X
1000)
>=100 75 - <100 50 - <75 25 - <50
<25 or spontaneous
bleeding
NEUTROPHILS >=1.9 1.5 - <1.9 1.0 - <1.5 0.5 - <1.0 <0.5 or sepsis
HEMOGLOBIN
(GM %)
>11 11-9.5 <9.5 - 7.5 <7.5 - 5.0 -------
HEMATOCRIT
(%)
>=32 28 - <32 <28
Packed cell transfusion
required
-------
GUIDELINES: The acute morbidity criteria are used to score/grade toxicity from radiation therapy. The critera
are relevant from day 1, the commencement of therapy, through day 90. Therafter, the EORTC/RTOG Criteria
of Late Effects are to be utilized.
The evaluator must attempt to discriminate between disease- and treatment-related signs and symptoms.

An accurate baseline evaluation prior to commencement of therapy is necessary.

All toxicities Grade 3, 4 or 5
*
must be verified by the Principal Investigator.

*
ANY TOXICITY WHICH CAUSED DEATH IS GRADED 5.