The bone marrow is sensitive to radiation and cytopenias are a common complication of excessive irradiation. The Radiation Therapy Oncology Group (RTOG) has specified criteria for scoring acute radiation morbidity.
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.
(3) Any toxicity resulting in death = grade 5.
|
Parameter |
Finding |
Grade |
|
WBC per µL |
>= 4,000 |
0 |
|
|
3,000 to 3,999 |
1 |
|
|
2,000 to 2,999 |
2 |
|
|
1,000 to 1,999 |
3 |
|
|
< 1,000 |
4 |
|
neutrophils per µL |
>= 1,900 |
0 |
|
|
1,500 to 1,899 |
1 |
|
|
1,000 to 1,499 |
2 |
|
|
500 to 999 |
3 |
|
|
< 500 or sepsis |
4 |
|
platelet count per µL |
>= 100,000 |
0 |
|
|
75,000 to 99,999 |
1 |
|
|
50,000 to 74,999 |
2 |
|
|
25,000 to 49,999 |
3 |
|
|
< 25,000 or spontaneous bleeding |
4 |
|
hemoglobin in g/dL |
> 11.0 |
0 |
|
|
9.5 to 11.0 |
1 |
|
|
7.5 to 9.4 |
2 |
|
|
5.0 to 7.4 |
3 |
|
|
< 5.0 |
4 |
|
hematocrit in percent |
>= 32 |
0 |
|
|
28.0 to 31.9 |
1 |
|
|
21.0 to 27.9 |
2 |
|
|
14.8 to 20.9, or packed red cell transfusion required |
3 |
|
|
< 14.8 |
4 |
where:
• The criteria for grade 2 hematocrit toxicity is given in the table as "28".
• Based on the equation for estimating hematocrit from hemoglobin [estimated hematocrit (percent) = ((hemoglobin in g/dL) * 2.8) + 0.8] the entries for grade 2 hematocrit toxicity were determined.
• No values are given for grade 4 hemoglobin toxicity in the original table.
• The "< 14.8" for grade 4 hematocrit toxicity is not in the original table.
Specialty: Hematology Oncology
