Grade 0 1 2 3 4 Skin Basically no change Slight erythema, mild dry skin reaction Scattered erythema, wet skin reaction due to skin folds or moderate edema Fused, wet skin reaction, diameter ³1.5 cm Skin ulceration, necrosis, or hemorrhage Mucous membranes Basically no change Presence of erythema of mucous membranes Scattered pseudomembranous membrane reaction (diameter £1.5 cm) Fused Pseudomembrane reaction (diameter >1.5 cm) Necrosis or deep ulceration of mucous membranes, including hemorrhage Eyes Basically no change Slight conjunctivitis or scleral congestion/increased tearing Moderate conjunctivitis (with or without keratitis), dry eyes, need for ophthalmic moisturizing medications, photophobia, and iritis Severe keratitis with corneal ulceration/decreased visual acuity or field of view or acute glaucoma Loss of vision (unilateral or bilateral) Ear Basically no change Changes Mild otitis externa with erythema, itching, mild dry reaction but no treatment needed, no hearing changes Moderate otitis externa with topical medication needed, or severe otitis media with dulled hearing on testing Severe otitis externa with overflow or wet reaction, symptoms of dulled hearing, tinnitus not related to medication Hearing loss Salivary glands Basically no changes Mild dry mouth with slightly thicker saliva, with altered sense of taste but eating is largely unimpaired Moderate dry mouth, /saliva viscous, with marked alteration in taste —- Acute salivary gland necrosis Hypopharynx/esophagus Largely unchanged Mild dysphagia or painful swallowing Moderate dysphagia or painful swallowing Severe dysphagia or painful swallowing associated with dehydration or loss of body weight (>15% of body weight relative to pretreatment weight) Complete obstruction, ulceration, perforation, fistulae Larynx Largely unchanged Mild intermittent hoarseness, cough, mucosal erythema Continuous , cough, erythema of mucous membranes Persistent hoarseness but able to speak, reflex otalgia, sore throat, scattered fibrin secretions, mild arytenoid edema Loss of voice, sore throat, radiating otalgia, large amounts of fibrin secretions, significant arytenoid edema Significant dyspnea, stridor, hemoptysis, need for tracheal intubation Purpose: To evaluate or grade acute reactions induced by radiation therapy using RTOG acute reaction evaluation criteria. Definition of acute response: a response to radiation therapy that occurs from the first day of treatment through day 90. The researcher must differentiate between symptoms of illness and treatment-generated reactions. A pre-treatment evaluation must be completed prior to the start of treatment and used as a baseline for evaluating acute radiation reactions that occur later. All Grade 3, 4, or 5 acute radiation therapy reactions must be tested and confirmed by the Principal Investigator. Any toxic reaction that causes death is a grade 5.