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 central nervous system (brain and spinal cord).
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 |
|
central nervous system |
fully functional status with minor neurologic findings; no medications needed |
neurologic findings present sufficient to require home care or nursing assistance; medications including steroids or anti-seizure agents may be required |
neurologic findings require hospitalization for initial management |
serious neurologic impairment that includes paralysis, coma or seizures more than 3 times a week despite medication; hospitalization required |
Grade 5: death directly due to radiation acute effect
where:
• Fully functional indicates able to work.
Late Complications
Grade 0: no change
|
Injury |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
spinal cord |
mild Lhermitte's syndrome |
severe Lhermitte's syndrome |
objective neurologic findings at or below the cord level treated |
mono-, para-, quadraplegia |
|
brain |
mild headache, slight lethargy |
moderate headache, great lethargy |
severe headache; severe CNS dysfunction |
seizures or paralytic coma |
Grade 5: death directly due to radiation late effects.
where:
• Lhermitte's syndrome: combined pyramidal and extrapyramidal system disease; a patient experiences paresthesias in the trunk or lower extremities upon flexion of the neck or thighs.
• Severe CNS dysfunction may include partial loss of power or dyskinesia.
Specialty: Hematology Oncology, Neurology
ICD-10: ,
