The Radiation Therapy Oncology Group (RTOG) and the European Organization for Research on the Treatment of Cancer (EORTC) provide criteria for assessing the complications of radiation therapy affecting the heart.
Guidelines:
(1) Change in affected parameter is ascribed to radiation therapy and not underlying or concurrent disease.
(2) Considered acute if occurs from day 1 to 90; after day 90 considered late complication.
Acute Complications
Grade 0: none (no change from baseline)
Injury |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
symptoms |
asymptomatic |
symptomatic but no treatment required |
symptomatic and responds to treatment |
symptomatic unresponsive to medical treatment |
EKG |
minimal change |
mild |
moderate |
severe |
heart failure |
none |
mild |
moderate |
severe |
angina |
none |
mild |
moderate |
severe |
pericardium |
minimal abnormalities |
mild pericardial disease |
moderate pericardial disease |
severe pericardial disease |
Grade 5: death caused by acute cardiac effects of the irradiation
Late Complications
Grade 0: no change from baseline
Injury |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
symptoms |
asymptomatic or mild |
moderate angina on effort |
severe angina |
NA |
ECG |
transient T wave inversion and ST wave changes |
persistent abnormal T wave and ST wave changes; low QRS |
multiple EKG changes |
NA |
pericardium |
NA |
mild pericarditis |
pericardial effusion; constrictive pericarditis |
tamponade; severe constrictive pericarditis |
heart size |
normal |
normal |
cardiac enlargement |
NA |
heart failure |
NA |
NA |
moderate |
severe |
other |
sinus tachycardia (> 110 beats per minute at rest) |
NA |
NA |
NA |
Grade 5: death caused by late cardiac effects of the irradiation
Specialty: Hematology Oncology, Cardiology
ICD-10: ,