Table 2 Overview about grading scales for radiation-induced lung fibrosis
Grading scale | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
|---|---|---|---|---|---|
CTCAE v5.0 | Radiologic pulmonary fibrosis < 25% of lung volume associated with hypoxia | Evidence of pulmonary hypertension; radiographic pulmonary fibrosis 25–50% associated with hypoxia | Severe hypoxia; evidence of right-sided heart failure; radiographic pulmonary fibrosis > 50–75% | Life-threatening consequences (e.g., hemodynamic/pulmonary complications); intubation with ventilatory support indicated; radiographic pulmonary fibrosis > 75% with severe honeycombing | Death |
RTOG | Asymptomatic or mild symptoms (dry cough); slight radiographic appearances | Moderate symptomatic fibrosis (severe cough); low grade fever; patchy radiographic appearances | Severe symptomatic fibrosis; dense radiographic changes | Severe respiratory insufficiency/ Continuous O2/ Assisted ventilation | Death |
LENT-SOMA (EORTC) | Asymptomatic or mild symptoms; radiological abnormalities; 10–25% reduction of respiration volume and/or diffusion capacity | Moderate symptoms; patchy dense abnormalities in imaging; > 25–50% reduction of respiration volume and/or diffusion capacity | Severe symptoms; dense confluent radiographic changes limited to irradation field; > 50–75% reduction of respiration volume and/or diffusion capacity | Severe symptoms requiring continuous O2 or assisted ventilation; dense fibrosis, severe scarring & major retraction of normal lung; > 75% reduction of respiration volume and/or diffusion capacity | Death |