Common Toxicity Criteria (CTC) for Neurological Adverse Events Associated with Cancer Therapy

arachnoiditis, meningismus, radiculitis

none

0

mild pain, does not interfere with function

1

moderate pain, interferes with function but not ADL

2

severe pain, interferes with ADL

3

unable to function or perform ADL, bedridden, paraplegia

4

ataxia

none

0

asymptomatic, abnormal physical exam, does not interfere with function

1

mild symptoms, interfere with function but not ADL

2

moderate symptoms, interferes with ADL

3

bedridden or disabled

4

CNS cerebrovascular ischemia

none

0

transient ischemia attack (TIA)

3

permanent event (stroke)

4

cognitive disturbance or learning problems

none

0

cognitive disability, does not interfere with work or school performance; intelligence preserved

1

cognitive disability, interferes with work or school performance; decline in intelligence, loss of developmental milestones (regression)

2

cognitive disability, significant impairment work or school, significant cognitive decline

3

unable to work, frank mental retardation

4

confusion

none, normal

0

confusion or disorientation or brief attention deficit, resolves spontaneously without sequelae

1

confusion or disorientation or attention deficit; interferes with function but not ADL

2

confusion or delirium interfering with ADL

3

harmful to others or self; requires hospitalization

4

delusions

none

0

present

3

toxic psychosis

4

depressed level of consciousness

normal

0

somnolence or sedation, does not interfere with function

1

somnolence or sedation, interfere with function but not ADL

2

obtundation or stupor, difficult to arouse, interferes with ADL

3

coma

4

dizziness, lightheadedness

none

0

does not interfere with function

1

interferes with function but not ADL

2

interferes with ADL

3

bedridden or disabled

4

extrapyramidal/involuntary movement, restlessness

none

0

mild involuntary movements not interfering with function

1

moderate involuntary movements that interfere with function but not ADL

2

severe involuntary movements or torticollis that interfere with ADL

3

bedridden or disabled

4

hallucinations

normal

0

present

3

toxic psychosis

4

insomnia

none

0

occasional difficulty, does not interfere with function

1

difficulty sleeping, interferes with function but not ADL

2

frequent difficulty, interferes with ADL

3

irritability

normal

0

mild, easily consolable

1

moderate, requires increased attention

2

severe, inconsolable

3

leukoencephalopathy associated with radiological findings

none

0

mild increase in subarachnoid space (SAS), mild ventriculomegaly, small focal T2 hyperintensities involving periventricular white matter or less than a third of susceptible areas of cerebrum

1

moderate increase in SAS, moderate ventriculomegaly, focal T2 hyperintensities extending into centrum ovale, involves one to two thirds  of susceptible areas of cerebrum

2

severe increase in SAS, severe ventriculomegaly, near total white matter T2 hyperintensities or diffuse low attenuation, focal white matter necrosis

3

severe increase in SAS, severe ventriculomegaly, diffuse low attentuation with calcification, diffuse white matter necrosis

4

memory loss

none

0

memory loss but does not interfere with function

1

memory loss interferes with function but not ADL

2

interferes with ADL

3

amnesia

4

mood alteration with anxiety and/or agitation

none

0

mild mood alteration, does not interfere with function

1

moderate mood alteration interferes with function but not ADL

2

severe mood alteration interferes with ADL

3

suicidal ideation, danger to self

4

mood alteration with depression

none

0

mild mood alteration, does not interfere with function

1

moderate mood alteration interferes with function but not ADL

2

severe mood alteration interferes with ADL

3

suicidal ideation, danger to self

4

mood alteration with euporia

none

0

mild mood alteration, does not interfere with function

1

moderate mood alteration interferes with function but not ADL

2

severe mood alteration interferes with ADL

3

danger to self

4

neuropathy, cranial

none

0

present, does not interfere with ADL

2

present, interfere with ADL

3

life-threatening, disabling

4

neuropathy, motor

none

0

subjective weakness but no objective findings

1

mild objective weakness that interferes with function but not ADL

2

objective weakness, interferes with ADL

3

paralysis

4

neuropathy, sensory

none

0

loss of deep tendon reflexes, paresthesias; do not interfere with function

1

objective sensory loss or paresthesia that interfere with function, but not ADL

2

sensory loss or paresthesia that interfere with ADL

3

permanent sensory loss that interferes with function

4

nystagmus

absent

0

present

1

personality, behavioral

normal

0

change but not disruptive to patient or family

1

disruptive to patient or family

2

disruptive to patient and family, requires mental health intervention

3

harmful to others or to self, requires hospitalization

4

pyramidal tract dysfunction

normal

0

asymptomatic but abnormal physical exam

1

symptomatic or interferes with function but not ADL

2

interferes with ADL

3

bedridden or disabled, paralysis

4

seizures

none

0

self-limited and consciousness preserved

2

consciousness altered

3

prolonged, repetitive, difficult to control

4

speech impairment

normal

0

awareness of receptive or expressive dysphasia, does not impair ability to communicate

2

receptive or expressive dysphasia with impaired ability to communicate

3

unable to communicate

4

syncope, fainting

absent

0

present

3

tremor

none

0

mild and brief or intermittent, does not interfere with ADL

1

moderate, interferes with function but not ADL

2

severe, interferes with ADL

3

vertigo

none

0

does not interfere with function

1

interferes with function but not ADL

2

interferes with ADL

3

bedridden or disabled

4

neurologic symptom, other

none

0

mild

1

moderate

2

severe

3

life-threatening or totally disabling

4