Topographic documentation of acute radiation morbidity

Abstract

Background: The clinical knowledge on the frequency and severity of acute radiation morbidity is very sparse. With established morbidity recording, only severe side effects are revealed. The lower morbidity (I/II degree) as a major part of the data base is neglected. Another problem may be the lack of interdisciplinary and international compatibility in other systems. For these reasons, our intention was to create an easily acceptable, international and interdisciplinary compatible documentation form for routine use in radiotherapy.

Methods: A detailed topographic documentation sheet for each major topographic site of clinical radiation oncology has been developed (CNS, head and neck, thorax, female breast, abdomen, extremities). It is based upon existing toxicity codes and documentation systems (CTC[WHO], RTOG and EORTC, DEGRO, ADT, KIEL). Furthermore, basic oncological data like TNM, previous surgery or chemotherapy, drugs and more are included. For each topographic body site, one DIN A4 format is required for documentation of a 6 to 7-week treatment course. The toxicity prescription is coded according to the "DEGRO/RTOG Coding System for acute side effects" and to the "EORTC Acute Toxicity Code" to achieve optimal international and interdisciplinary compatibility.

Results: Complete documentation of toxicities level 0 to 4 is to be performed within 2 to 5 minutes per week/patient within preformed marks. The clinical performance has proven excellent. Not only level III/IV toxicities are recorded, but also level I/II morbidity.

Conclusions: The topographic documentation system improves recording of acute morbidity in radiation oncology not only by time, but also in quality. Experimental, radiobiological and former clinical data may be proved for their actual plausibility.