Table 1 National Cancer Institute Common Toxicity Criteria, version 2.0
Adverse event | Grade 0 | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|---|
Skin/radiation dermatitis | None | Faint erythema/dry desquamation | Moderate to brisk erythema or patchy desquamation mostly confined to skin folds | Confluent moist desquamation ≥1.5 cm diameter, not confined to skin folds, pitting edema | Skin necrosis, ulceration of full thickness, bleeding not induced by trauma or abrasion |
Alopecia | Normal | Mild hair loss | Pronounced hair loss | - | - |
Cough | Absent | Mild, relieve by non-prescription medication | Requiring narcotic antitussive | Severe cough or coughing spasms, poorly controlled or unresponsive to treatment | - |
Voice changes (hoarseness, loss of voice) | Normal | Mild or intermittent hoarseness | Persistent hoarseness but able to vocalize, may have mild to moderate edema | Whispered speech, not able to vocalize, may have marked edema | Marked dyspnea/stridor requiring tracheostomy or intubation |
Conjunctivitis | None | Ophthalmologic changes but asymptomatic (pain/irritation) or without visual impairment | Symptomatic/interfering with function but not interfering with activities of daily living | Symptomatic/interfering with activities of daily living | - |
Anorexia | None | Loss of appetite | Oral intake significantly decreased | Requiring IV fluids | Requiring feeding tube or parenteral nutrition |
Dysphagia | None | Mild, can eat regular diet | Requiring pureed, soft or liquid diet | Requiring feeding tube, IV hydration/alimentation | Complete obstruction, cannot swallow saliva |
Vomiting | None | 1x/24 h | 2-5x/24 h | ≥6x/24 h or need for IV fluids | Requiring parenteral nutrition, hemodynamic collapse, I.C.U. |
Diarrhea | None | Increase ≤4x/24 h | 4-6x/24 h or nocturnal stools | ≥7x/24 h or incontinence, or need for parenteral support for dehydration | Hemodynamic collapse, I.C.U. |
Constipation | None | Requiring stool softener or dietary modification | Requiring laxatives | Requiring manual evacuation or enema | Obstruction or megacolon |
Abdominal pain or cramping | None | Mild; not interfering with function | Moderate; pain or analgesics, interfering with function but not with activities of daily living | Severe; pain or analgesics interfering with activities of daily living | - |
Headache | None | Mild; non interfering with function | Moderate; pain or analgesics, interfering with function but not with activities of daily living | Severe; pain or analgesics interfering with activities of daily living | - |
Fatigue/malaise | None | Increased fatigue, not altering normal activities | Moderate (decrease of performance status - 20 % in Lansky or Karnofsky); difficulty in performing some activities | Severe (decrease of performance status—40 % in Lansky or Karnofsky); loss of ability to perform some activities | Disabling |