Table 6.
Comparison of description of radiation-induced oral mucositis scales.
| Scale | Grade 0 | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
|---|---|---|---|---|---|---|
| WHO [78]. | No change | Oral soreness/erythema | Erythema, ulcers, can eat solids | Ulcers; requires liquid diet only | Alimentation not possible | N/A |
| EORTC/RTOG [79]. | No change over baseline | mild pain, not requiring analgesic | Patchy mucositis, serosanguinous discharge. May experience pain requiring analgesics, lesion <1.5 cm, noncontiguous | Confluent fibrinous mucositis/may include severe pain requiring narcotics, lesion > 1.5 cm, contiguous |
Necrosis or deep ulceration, ±bleeding | Death |
| CTCAE 5.0 [80]. | N/A | Asymptomatic or mild symptoms; intervention not indicated | Moderate pain or ulcer that does not interfere with oral intake; modified diet indicated | Severe pain; interfering with oral intake | Life-threatening consequences; urgent intervention indicated | Death |
| OMAS [81]. | Lesions = none erythema = none |
Lesions = < 1 cm2 erythema = not severe |
Lesions = 1–3 cm2 erythema = severe |
Lesions = > 3 cm2 | N/A | N/A |
| OMI [82]. | Assesses clinically evident oral mucosal changes (atrophy, erythema, ulceration, pseudomembranous ulcerations, and edematous changes) and consists of 34 items, each scaled from 0 to 3 (normal to severe). | |||||
| WCCNR [83]. | Lesions = none erythema = 50% or more pink bleeding = none |
Lesions = none erythema = 50% or more slightly red bleeding = none |
Lesions = none erythema = 50% or more moderately red bleeding = with eating or mouth care |
Lesions = none erythema = 50% or more very red bleeding = spontaneous |
N/A | N/A |
| SWOG[84]. | None | Painless ulcers, erythema or mild soreness | Painful erythema, oedema, or ulcers, but can eat | Painful erythema, oedema, or ulcers, and cannot eat | Requires parenteral or enteral support | - |
WHO—World Health Organisation Oral Toxicity Scale, RTOG/EORTC—Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer, CTCAE—Common Terminology Criteria for Adverse Events; OMAS—Oral mucositis Assessment Score; OMI—Oral Mucositis Index; WCCNR—Western Consortium for Cancer Nursing Research Scale; SWOG—Southwest Oncology Group.