APPENDIX 1.
MODIFIED RTOG RADIATION TOXICITY SCALE
| Lower GI toxicity | |
|---|---|
| Acute GI toxicity | |
| I | Increased frequency or change in quality of bowel habits needing ≤2 antidiarrheals/wk |
| Rectal discomfort not requiring analgesics | |
| Mild rectal bleeding needing occasional steroid suppositories or other medications | |
| II | Diarrhea needing > 2 antidiarrheals/wk. |
| Mucous discharge requiring ≤ 1 sanitary pad/d | |
| Rectal pain needing occasional narcotics | |
| Rectal bleeding needing regular steroid suppositories or other medication. | |
| Rectal bleeding or other GI symptoms requiring a treatment break ≤1 week | |
| III | Diarrhea needing > 2 antidiarrheals/d or parenteral support |
| Severe mucous discharge requiring >1 sanitary pad/d | |
| Rectal pain requiring regular narcotics | |
| GI bleeding requiring 1 transfusion | |
| Rectal bleeding or other GI symptoms requiring a treatment break > 1 wk | |
| IV | Acute or subacute obstruction |
| Fistula or perforation | |
| GI bleeding requiring > 1 transfusion | |
| Abdominal pain or tenesmus requiring bowel diversion | |
| Late GI toxicity | |
| I | Excess bowel movements twice baseline or need for occasional antidiarrheal use |
| Slight rectal discharge or bleeding not requiring pads | |
| Temporary steroids per suppositories or enemas for proctitis/ulceration of ≤ 1 mo | |
| II | Regular antidiarrheal use |
| Coagulations ≤ 2 for bleeding | |
| Steroids per suppositories or enema for proctitis/ulceration > 1 mo | |
| Mucous discharge requiring sanitary pads < 2/d | |
| Occasional narcotic for pain | |
| III | Hospitalization for treatment-related dehydration |
| One blood transfusion or > 2 coagulations for bleeding | |
| Hyperbaric oxygen treatment for ulceration or bleeding | |
| Sanitary pads ≥ 2/d for > 1 mo | |
| Regular narcotic use | |
| IV | Fistula or obstruction requiring surgery |
| More than 1 blood transfusion | |
| Urinary toxicity | |
| Acute GU toxicity | |
| I | Frequency or nocturia twice pretreatment habit or medication (e.g., α-blocker) over baseline |
| Dysuria or pain requiring non-narcotic medication | |
| Microscopic or infrequent gross hematuria not needing intervention | |
| II | Frequency or nocturia hourly |
| Pain requiring anesthetic or occasional narcotics | |
| Regular use of antispasmodic | |
| Hematuria or GU symptoms requiring a treatment break ≤ 1 wk | |
| Urinary obstruction requiring temporary catheterization (including Foley or self-catheterization) for ≤ 1 wk | |
| III | Frequency or nocturia > 1 time/h |
| Requiring regular narcotics | |
| Hematuria or GU symptoms requiring a treatment break > 1 wk | |
| Gross hematuria requiring 1 transfusion | |
| Urinary obstruction requiring catheterization (including Foley, self-catheterization, or suprapubic) for > 1 wk | |
| IV | Hematuria needing > 1 transfusion |
| Hospitalization for sepsis due to obstruction, ulceration, and/or necrosis of the bladder | |
| Late GU toxicity | |
| I | Nocturia twice baseline or medication (e.g., α-blocker) increase over baseline |
| Hematuria not requiring intervention | |
| Light mucosal atrophy and minor telangiectasia | |
| Dysuria or pain requiring occasional non-narcotic medication | |
| Incontinence or dribbling not requiring sanitary pad (over baseline) | |
| II | Frequency less than every hour, nocturia > 2 times baseline |
| Generalized telangiectasias | |
| Hematuria requiring ≤ 2 cauterizations | |
| Pain requiring regular anti-inflammatory agent, anesthetic or antispasmodic, or occasional narcotic | |
| Stricture requiring ≤ 2 dilatations | |
| Foley or self-catheterization for ≤ 2 wk; incontinence requiring ≤ 2 sanitary pads (over baseline) | |
| III | Frequency or nocturia hourly or more |
| Dysuria and/or pain requiring regular narcotic use | |
| Reduction in bladder capacity (150 ml) | |
| At least 1 blood transfusion or > 2 cauterizations for bleeding | |
| Hyperbaric oxygen treatment | |
| Foley or self-catheterization for > 2 wk | |
| Urethrotomy, TURP, or > 2 dilatations | |
| Incontinence requiring > 2 sanitary pads (over baseline) or artificial sphincter | |
| IV | Gross hematuria requiring > 1 blood transfusion |
| Severe hemorrhagic cystitis or ulceration requiring urinary diversion and/or cystectomy | |