WHO (World Health Organization) Toxicity Criteria by Grade

Transcription

1 WHO (World Health Organization) Toxicity Criteria by Grade 化學治療以 WHO Toxicity Criteria 為主放射治療有分急性與慢性副作用以 RTOG Toxicity Criteria 為主 WHO Toxicity Criteria Category Toxicity Grade0 Grade1 Grade2 Grade3 Grade4 Haematology WBC (x103/l) < 1.0 Haematology Platelets (x103/l) WNL normal < 25.0 Haematology Haemoglobin (g/dl) WNL normal < 6.5 Haematology Granulocytes/ Bands (x103/l) < 0.5 Haematology Lymphocytes (x103/l) < 0.5 gross, 1-2 gross, 3-4 massive, > 4 Haematology Haemorrhage none mild, no units units units transfusion transfusion per transfusion per per episode episode episode Coagulatio Fibrinogen WNL x N x N x N < 0.25 x N Coagulatio Prothrombin x WNL x N time(quick) N x N > 2.00 x N Coagulatio Partial thrombo x WNL x N plastin time N x N > 3.00 x N Hyperglycaemia > 500 or < ketoacidosis Hypoglycaemia > < 30 Amylase WNL < 1.5 x N x N N > 5.0 x N Hypercalcaemia < Hypocalcaemia > Hypomagnesaemia > Gastrointestinal Nausea none able to eat intake no significant

2 reasonable intake significantly decreased but can eat Gastrointestinal Vomiting none 1 episode in 24 hrs 2-5 episodes in 24 hrs Gastrointestinal Diarrhoea Gastrointestinal Stomatitis Kidney, Kidney, Kidney, Bilirubin (N = 17 µmol/l) Transaminase (SGOT, SGPT) Alk Phos or 5 nucleotidase - clinical none none increase of 2-3 stools / day over pre-rx painless ulcers, erythema, or mild soreness intake increase of 4 - increase of 7-6 stools / day, 9 stools / day, or nocturnal or stools, or incontinence, moderate or severe cramping cramping painful painful erythema, erythema, oedema, or oedema, or ulcers and ulcers but can cannot eat eat solids solids > 10 episodes in 24 hrs or 6-10 episodes requiring in 24 hrs paren- teral support increase of > 10 stools / day or grossly bloody diarrhoea, or need for parenteral support requires parenteral or enteral support for alimentation WNL < 1.5 x N x N > 3.0 x N WNL 2.5 x N x N x N > 20.0 x N WNL < 2.5 x N x N x N > 20.0 x N No from baseline precoma hepatic coma Creatinine WNL < 1.5 x N x N x N > 6.0 x N 1 (+) or < 0.3 g% Proteinuria No or 3 g/l Haematuria Negative microscopic only 2-3 (+) or g% or 3-10 g/l 4 (+) or > 1.0 nephrotic g% or > 10g/L syndrome gross and clots requires transgross, no clots fusion or no Rx needed irrigation cystectomy Kidney, Weight gain/ loss < 5.0 % % % 20.00%

3 Pulmonary Pulmonary with dyspnoea on dyspnoea at dyspnoea at abnormal- ity in significant normal level of rest PFTs exertion activity requires moni- Cardiac recurrent or toring; or Cardiac persistent, no requires hypo- tension, none transient, requiring arrhythmias therapy treatment or ventricular no therapy required tachycardia or fibrillation Cardiac Cardiac function none decline of resting decline of resting mild CHF, ejection severe of ejection fraction by responsive to fraction by refractory CHF less than 20 % of therapy more than 20 baseline value % of baseline value Cardiac Cardiac ischaemia none ST and T angina without acute non-specific T- wave s evidence of myocardial wave flattening suggesting infraction infarction ischaemia Cardiac pericarditis symptomatic tamponade; asymptomatic Cardiac- (rub, chest effusion; drainage none effusion, no pericardial pain, ECG drainage urgently itervention required s) required required Cardiac Hypertension recurrent or persistent increase by transient increase greater than by greater than mm HG mm Hg (D) or to > requires hypertensive (D) or to > 150 / 100 if therapy crisis 150 / 100 if previously WNL. previously No treatment WNL. No required. treatment required. Cardiac Hypotension s requiring requires fluid requires requires no therapy (incl- replacement therapy and therapy and

4 uding transient orthostatic hypoor other therapy but hospitalisation; hospitalisresolves within ation for > 48 tension) not 48 hours of hrs after hospitalisation stopping the agent stopping the agent mild or severe Neurologic Neuro: sensory moderate objective mild paraesthesias; objective sensory loss or loss of deep tendon sensory loss paraesthesias reflexes moderate that interfere paraesthesias with function Neurologic Neuro: motor mild objective objektive weakness subjective weak- weak- ness without ness; no objective with paralysis significant findings impairment of impair- ment function of function severe somnolence, (>50 % Neurologic Neuro: cortical none moderate waking hours), mild somnolence coma, seizures, somnolence or agitation, or agitation toxic psychosis agitation confusion, disorientation or hallucinations intention Neurologic Neuro: cerebellar none tremor, slight dysmetria, locomotor cerebellar incoordination, slurred ataxia necrosis dysdiadochokinesia speech, nystagmus Neurologic Neuro: mood moderate mild anxiety or severe anxiety suicidal no anxiety or depression or depression ideation depression Neurologic Neuro: headache none mild moderate or unrelenting severe but and severe transient Neurologic Neuro: mild constipation moderate severe ileus > 96 hrs

5 Neurologic Neuro: hearing hearing loss interfering with function deafness not hearing loss on tinnitus but correctable correctable audiometry only with hearing aid Neurologic Neuro: vision symptomatic subtotal loss of blindness vision Pain Pain none mild moderate severe reg. narcotics scattered Skin Skin macular or generalised papular scattered macular symptomatic exfoliative eruption or ot papular eruption macular, dermatitis or erythema with or erythema that is papular or ulcerating pruritus or asymptomatic vesicular dermatitis other eruption associated symptoms Alopecia Alopecia no loss mild hair loss pronounced or total hair loss Allergy Allergy none serum urticaria, drug sickness, transient rash, drug fever 38oC bronchospasm fever < 38oC (100.4oF), anaphylaxis requiring (100.4oF) mild parenteral bronchospasm medication pain and Local Local none pain swelling with plastic surgery ulceration inflammation indicated or phlebitis > 40.0oC (>104oF) for Fever of > 40.0oC > Fever of unknown o C oC more than 24 unknown none 104.0oF for origin 98.7o o F oF hrs or origin less than 24hrs accompanied by hypotension Infection Infection none mild moderate severe life-threatening Additional Asthenia Analogous

6 Additional Additional Additional to Karnofsky index (WHO grading) Analogous Chills to fever analogous Peripheral oedema to weight gain analogous Anorexia to weight loss