RTOG/EORTC Criteria for Central Nervous System Complications After Irradiation

Description

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.

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Description

Specialty

ICD-10