| Toxicity | Grade0 | Grade1 | Grade2 | Grade3 | Grade4 |
| SKIN | No change over baseline | Follicular, faint or dull erythema/epilation/dry desquamation decreased sweating | Tender or bright erythema,patchy moist desquamation/moderate edema | Confluent moist desquamation other than skin folds, pitting edema | Ulceration, hemorrhage, necrosis |
| MUCOUS MEMBRANE | No change over baseline | Injection/may experience mild pain not requiring analgesic | Patchy mucositis which may produce an inflammatory serosanguinous discharge/may experience moderate pain requiring analgesia | Confluent fibrinous mucositis/may include severe pain requiring narcotic | Ulceration, hemorrhage, or necrosis |
| EYE | No change | Mild conjunctivitis with or without scleral injection/increased tearing | Moderate conjunctivitis with or without keratitis requiring steroids and/or antibiotics/dry eye requiring artificial tears/iritis with photophobia | Severe keratitis with corneal ulceration/objective decrease in visual acuity or in visual fields/acute glaucoma/panopthalmitis | Loss of vision (unilateral or bilateral) |
| EAR | No change over baseline | Mild external otitis with erythema, pruritis, 2* to dry desquamation not requiring medication. Audiogram unchanged from baseline | Moderate external otitis requiring topical medication/serous otitis medius/hypoacusis on testing only | Severe external otitis with discharge or moist desquamation, symptomatic hypoacusis/tinnitus not drug related | Deafness |
| SALIVARY GLAND | No change over baseline | Mild mouth dryness/slightly thickened saliva/may have slightly altered taste such as metallic taste/these changes not reflected in alteration in baseline feeding behaviour, such as increased use of liquids with meals | Moderate to complete dryness/thick, sticky saliva/markedly altered taste | ------------------ | Acute salivary gland necrosis |
| PHARYNX & ESOPHAGUS | No change over baseline | Mild dysphagia or odynophagia/may require topical anesthetic or non narcotic analgesics/may require soft diet | Moderate dysphagia or odynophagia/may require narcotic analgesics/may require puree or liquid diet | Severe dysphagia or odynophagia with dehydration or weight loss > 15% from pretreatment baseline) requiring NG feeding tube, IV fluids, or hyperalimentation | Complete obstruction, ulceration, perforation, fistula |
| LARYNX | No change over baseline | Mild or intermittent hoarseness/cough not requiring antitussive erythema of mucosa | Persistent hoarseness but able to vocalise/referred car pain, sore throat, patchy fibrinous exudate or mild arytenoid edema not requiring narcotictcough requiring antitussive | Whispered speech, throat pain, or referred car pain requiring narcotic/confluent fibrinous exudate, marked arytenoid edema | Marked dyspnea, stridor or hemoptysis with tracheostomy or intubation necessary |
| UPPER GI | No change | Anorexia with <-5% weight loss from pretreatment baseline/nausea not requiring antiemetics abdominal discomfort not requiring parasympatholytic drugs or analgesics | Anorexia with <- 15% weight loss from pretreatment baseline/nausea and/or vomiting requiring antiemetics abdominal pain requiring analgesics | Anorexia with > 15% weight loss from pretreatment baseline or requiring NG tube or parenteral support. Nausea and/or vomiting requiring tube or parenteral support/ abdominal pain, severe despite meds/hematemesis or melena/abdominal distension (flat plate radiograph shows distended bowel loops) | lleus subacute or acute obstruction, perforation, GI bleeding requiring transfusion/ abdominal pain requiring tube decompression or bowel diversion |
| LOWER GI INCLUDING PELVIS | No change | Increased frequency or change in quality of bowel habits not requiring medication/rectal discomfort not requiring analgesics | Diarrhoea requiring parasympatholytic drugs (e.g. Lomotil)/mucous discharge not necessitating sanitary pads/rectal or abdominal pain requiring analgesics | Diarrhoea requiring parenteral support/severe mucous or blood discharge necessitating sanitary padstabdominal distension (flat plate radiograph demonstrated distended bowel loops) | Acute or subacute obstruction, fistula or perforation; GI bleeding requiring transfusion; abdominal pain or tenesmus requiring tube decompression or bowel diversion |
| LUNG | No change | Mild Symptoms of dry cough or dyspnea on exertion | Persistent cough requiring narcotic, antitussive agents/dyspnea with minimal effort but not at rest | Severe cough unresponsive to narcotic antitussive agent or dyspnea at rest/clinical or radiologic evidence of acute pneumonitis/intermiittent oxygen or steroids may be required | Severe respiratory insufficiency/continuous oxygen or assisted ventilation |
| GENIT0 URINARY | No change | Frequency of urination or nocturia twice pretreatment habit/dysuria, urgency not requiring medication | Frequency of urination of nocturia which is less frequent than every hour. Dysuria urgency, bladder spasm requiring local anesthetic (e.g. Pyridium) | Frequency with urgency and nocturia hourly or more frequently/dysuria, pelvis pain or bladder spasm requiring regular, frequent narcoticlgross hematuria with/without clot passage | Hematuria requiring transfusion/ acute bladder obstruction not secondary to clot passage, ulceration or necrosis |
| HEART | No change over baseline | Asymptomatic but objective evidence of ECG changes or pericardial abnormalities without evidence of other heart disease | Symptomatic with ECG changes and radiologic findings of congestive heart failure or pericardial disease/no specific treatment required | Congestive heart failure, angina pectoris, pericardial disease responding to therapy | Congestive heart failure, angina pectoris, pericardial disease, arrhythmias not responsive to non surgical measurements |
| CNS | No change | Fully functional status (i.e. able to work) with minor neurologic findings, no medication needed | Neurologic findings present sufficient to require home care/nursing assistance may be required/ medications including steroids/anti-seizure agents may be required | Neurologic findings. requiring hospitalisation for initial management | Serious neurologic impairment which includes paralysis, coma or seizures >3 per week despite medication/ hospitalisation required |
| HEMATOLOGIC WBC (X 1000) | > 4.0 | 3.0-<4.0 | 2.0-4*.0 | 1.0-<2.0 | < 1.0 |
| PLATELETS (X 10 3 /cu mm3 | > 100 | 75-<100 | 50-<73 | 25-<50 | <25 or spontaneous bleeding |
| NEUTROPHILS (X 1000) | -> 1.9 | 1.3-<1.9 | 1.0-<1.5 | 0.5-<1.0 | <0.5 or sepsis |
| HEMOGLOBIN (GM %) | >11 | 11-9.5 | <9.5-7.5 | <7.5-5.0 | --- |
| HEMATOCRIT (%) | ->32 | 28-<32 | <28 | Packed cell transfusion required | --- |
