Skin
Grade 0 None
Grade 1 Mild atrophy, hyperpigmentation, little hair loss
Grade 2 lamellar atrophy, moderate capillary dilation, complete hair loss
Grade 3 Significant atrophy, significant capillary dilation
Grade 4 Ulceration
Grade 5 Direct death from late radiation reaction
Subcutaneous tissue
Grade 0 None
Grade 1 Mild sclerosis (fibrosis) and subcutaneous fat loss
Grade 2 Moderate fibrosis, but asymptomatic; mild field contracture; <10% linear reduction
Grade 3 Severe sclerosis and subcutaneous tissue reduction; field contracture >10% linear units
Grade 4 Necrosis
Grade 5 –
Mucosa
Grade 0 None
Grade 1 Mild atrophy and dryness
Grade 2 Moderate atrophy and capillary dilatation without mucus
Grade 3 Severe atrophy with complete dryness and severe capillary dilatation
Grade 4 Ulceration
Grade 5 –
Spinal cord
Grade 0 None
Grade 1 Mild L’Hermitte’s syndrome
Grade 2 Severe L’Hermitte’s syndrome
Grade 3 Objective neurological signs at or below the level of the treated spinal cord
Grade 4 Ipsilateral, contralateral quadrant paresis
Grade 5 –
Small bowel/large bowel
Grade 0 None
Grade 1 Mild diarrhea, mild cramping, mild increased rectal discharge or bleeding
Grade 2 Moderate diarrhea and colic, stools >5 times/day, profuse rectal mucus or intermittent bleeding
Grade 3 Obstruction or bleeding, requiring surgery
Grade 4 necrosis/perforation, fistula
Grade 5 –
Liver
Grade 0 None
Grade 1 Mild weakness; nausea, indigestion; mild liver function abnormalities
Grade 2 Moderate symptoms; somewhat abnormal liver function tests; normal serum albumin
Grade 3 Hepatic insufficiency; abnormal liver function tests; low albumin, edema or ascites
Grade 4 Necrosis/hepatic coma or hepatic encephalopathy
Grade 5 –
Kidney
Grade 0 None
Grade 1 transient albuminuria; no hypertension; mild renal impairment, urea 25-35 mg%, creatinine 1.5-2.0 mg/%, creatinine clearance >75%
Grade 2 persistent moderate proteinuria (++); moderate hypertension; no associated anemia; moderate renal impairment, urea >36-60mg/%, creatinine clearance 50%-74%
Grade 3 severe proteinuria; severe hypertension; persistent anemia (
Grade 4 Pernicious hypertension, uremia, coma, urea > 100%
Grade 5 –
Bladder
Grade 0 None
Grade 1 Mild epithelial atrophy; mild capillary dilatation (microscopic hematuria)
Grade 2 Moderate urinary frequency; extensive capillary dilatation, intermittent meatus hematuria
Grade 3 Severe dysuria and dyspareunia, severe extensive capillary dilatation (often with petechiae), frequent hematuria, reduced bladder volume (<150 ml =)
Grade 4 Necrosis/bladder contracture (volume <100 ml). Severe hemorrhagic cystitis
Grade 5 –
Bone
Grade 0 None
Grade 1 Asymptomatic, no growth arrest; decreased bone density
Grade 2 Moderate pain or tenderness; growth arrest; irregular osteosclerosis
Grade 3 Severe pain or tenderness; complete arrest of bone growth; dense osteosclerosis
Grade 4 necrotic spontaneous fracture
Grade 5 –
Joint
Grade 0 None
Grade 1 Mild joint ankylosis, mild limitation of motion
Grade 2 Moderate joint ankylosis, intermittent or moderate joint pain, moderate limitation of motion
Grade 3 Severe joint ankylosis, pain with severe limitation of motion
Grade 4 necrosis/complete fixation
Grade 5 –