(a) A child is defined for the purpose of this section as an individual who is not physiologically mature as determined by the physician using the appropriate medical parameters.
(b) Head and neck.
  (1) Early reactions.
    (A) Reduced and sticky saliva, loss of taste and appetite, altered sense of smell, nausea.
    (B) Sore throat, difficulty swallowing, weight loss, fatigue.
    (C) Skin changes: redness, irritation, scaliness, blistering or ulceration, color change, thickening, hair loss.
    (D) Hoarseness, cough, loss of voice, and swelling of airway.
    (E) Blockage and crusting of nasal passages.
    (F) Inflammation of ear canal, feeling of "stopped up" ear, hearing loss, dizziness.
    (G) Dry and irritable eye(s).
    (H) In children, these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.
    (I) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Dry mouth and altered sense, or loss, of taste.
    (B) Tooth decay and gum changes.
    (C) Bone damage, especially in jaws.
    (D) Stiffness and limitation of jaw movement.
    (E) Changes in skin texture and/or coloration, permanent hair loss, and scarring of skin.
    (F) Swelling of tissues, particularly under the chin.
    (G) Throat damage causing hoarseness, pain or difficulty breathing or swallowing.
    (H) Eye damage causing dry eye(s), cataract, loss of vision, or loss of eye(s).
    (I) Ear damage causing dryness of ear canal, fluid collection in middle ear, hearing loss.
    (J) Brain, spinal cord or nerve damage causing alteration of thinking ability or memory, and/or loss of strength, feeling or coordination in any part of the body.
    (K) Pituitary or thyroid gland damage requiring long-term hormone replacement therapy.
    (L) In children, there may be additional late reactions.
      (i) Disturbance of bone and tissue growth.
      (ii) Bone damage to face causing abnormal development.
      (iii) Brain damage causing a loss of intellectual ability, learning capacity, and reduced intelligence quotient (IQ).
      (iv) Second cancers developing in the irradiated area.
(c) Central nervous system.
  (1) Early reactions.
    (A) Skin and scalp reaction with redness, irritation, scaliness, blistering, ulceration, change in color, thickening, hair loss.
    (B) Nausea, vomiting, headaches.
    (C) Fatigue, drowsiness.
    (D) Altered sense of taste or smell.
    (E) Inflammation of ear canal, feeling of "stopped-up" ear, hearing loss, dizziness.
    (F) Depression of blood count leading to increased risk of infection and/or bleeding.
    (G) In children, these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.
    (H) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Permanent hair loss of variable degrees, altered regrowth, texture and color of hair.
    (B) Persistent drowsiness and tiredness.
    (C) Brain damage causing a loss of some degree of thinking ability or memory, or personality changes.
    (D) Scarring of skin.
    (E) Spinal cord or nerve damage causing loss of strength, feeling or coordination in any part of the body.
    (F) Damage to eye(s), or optic nerve(s) causing loss of vision.
    (G) Ear damage causing dryness of ear canal, fluid collection in middle ear, hearing loss.
    (H) Pituitary gland damage requiring long-term hormone replacement therapy.
    (I) In children, there may be additional late reactions.
      (i) Disturbances of bone and tissue growth.
      (ii) Bone damage to spine, causing stunting of growth, curvature and/or reduction in height.
      (iii) Bone damage to face, or pelvis causing stunting of bone growth and/or abnormal development.
      (iv) Brain damage causing a loss of intellectual ability, learning capacity, and reduced intelligence quotient (IQ).
      (v) Second cancers developing in the irradiated area.
(d) Thorax.
  (1) Early reactions.
    (A) Skin changes: redness, irritation, scaliness, ulceration, change in color, thickening, hair loss.
    (B) Inflammation of esophagus causing pain on swallowing, heartburn, or sense of obstruction.
    (C) Loss of appetite, nausea, vomiting.
    (D) Weight loss, weakness, vomiting.
    (E) Inflammation of the lung with pain, fever and cough.
    (F) Inflammation of the heart sac with chest pain and palpitations.
    (G) Bleeding or creation of a fistula resulting from tumor destruction.
    (H) Depression of blood count leading to increased risk of infection and/or bleeding.
    (I) Intermittent electric shock-like feelings in the lower spine or legs on bending the neck.
    (J) In children, these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.
    (K) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Changes in skin texture and/or coloration, permanent hair loss and scarring of skin.
    (B) Lung scarring or shrinkage causing shortness of breath.
    (C) Narrowing of esophagus causing swallowing problems.
    (D) Constriction of heart sac which may require surgical correction.
    (E) Damage to heart muscle or arteries leading to heart failure.
    (F) Fracture of ribs.
    (G) Nerve damage causing pain, loss of strength or feeling in arms.
    (H) Spinal cord damage causing loss of strength or feeling in arms and legs, and/or loss of control of bladder and rectum.
    (I) In children, there may be additional late reactions.
      (i) Disturbances of bone and tissue growth.
      (ii) Bone damage to spine, causing stunting of growth, curvature and/or reduction in height.
      (iii) Underdevelopment or absence of development of female breast.
      (iv) Second cancers developing in the irradiated area.
(e) Breast.
  (1) Early reactions.
    (A) Skin changes: redness, irritation, scaliness, blistering, ulceration, coloration, thickening, and hair loss.
    (B) Breast changes including swelling, tightness, or tenderness.
    (C) Inflammation of the esophagus causing pain or swallowing, heartburn, or sense of obstruction.
    (D) Lung inflammation with cough.
    (E) Inflammation of heart sac with chest pain and palpitations.
  (2) Late reactions.
    (A) Changes in skin texture and/or coloration, permanent hair loss, scarring of skin.
    (B) Breast changes including thickening, firmness, tenderness, shrinkage.
    (C) Swelling of arm.
    (D) Stiffness and discomfort in shoulder joint.
    (E) Rib or lung damage causing pain, fracture, cough, shortness of breath.
    (F) Nerve damage causing pain, loss of strength or feeling in arm.
    (G) Damage to heart muscle or arteries or heart sac leading to heart failure.
(f) Abdomen.
  (1) Early reactions.
    (A) Skin changes: redness, irritation, scaliness, ulceration, coloration, thickening, hair loss.
    (B) Loss of appetite, nausea, vomiting.
    (C) Weight loss, weakness, fatigue.
    (D) Inflammation of stomach causing indigestion, heartburn, and ulcers.
    (E) Inflammation of bowel causing cramping and diarrhea.
    (F) Depression of blood count leading to increased risk of infections and/or bleeding.
    (G) In children, these reactions are likely to be intensified by chemotherapy before, during and after radiation therapy.
Cont'd...
(H) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Changes in skin texture and/or coloration, permanent hair loss, scarring of skin.
    (B) Stomach damage causing persistent indigestion, pain, and bleeding.
    (C) Bowel damage causing narrowing or adhesions of bowel with obstruction, ulceration, or bleeding which may require surgical correction, chronic diarrhea, or poor absorption of food elements.
    (D) Kidney damage leading to kidney failure and/or high blood pressure.
    (E) Liver damage leading to liver failure.
    (F) Spinal cord or nerve damage causing loss of strength or feeling in legs and/or loss of control of bladder and/or rectum.
    (G) In children, there may be additional late reactions.
      (i) Disturbances of bone and tissue growth.
      (ii) Bone damage to spine causing stunting of growth, curvature and/or reduction in height.
      (iii) Bone damage to pelvis causing stunting of bone growth and/or abnormal development.
      (iv) Second cancers developing in the irradiated area.
(g) Female pelvis.
  (1) Early reactions.
    (A) Inflammation of bowel causing cramping and diarrhea.
    (B) Inflammation of rectum and anus causing pain, spasm, discharge, bleeding.
    (C) Bladder inflammation causing burning, frequency, spasm, pain, bleeding.
    (D) Skin changes: redness, irritation, scaliness, blistering or ulceration, coloration, thickening, hair loss.
    (E) Disturbance of menstrual cycle.
    (F) Vaginal discharge, pain, irritation, bleeding.
    (G) Depression of blood count leading to increased risk of infection and/or bleeding.
    (H) In children, these reactions are likely to be intensified by chemotherapy before, during, or after radiation therapy.
    (I) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Bowel damage causing narrowing or adhesions of the bowel with obstruction, ulceration, bleeding, chronic diarrhea, or poor absorption of food elements and may require surgical correction or colostomy.
    (B) Bladder damage with loss of capacity, frequency of urination, blood in urine, recurrent urinary infections, pain, or spasm which may require urinary diversion and/or removal of bladder.
    (C) Changes in skin texture and/or coloration, permanent hair loss, scarring of skin.
    (D) Bone damage leading to fractures.
    (E) Ovarian damage causing infertility, sterility, or premature menopause.
    (F) Vaginal damage leading to dryness, shrinkage, pain, bleeding, or sexual dysfunction.
    (G) Swelling of the genitalia or legs.
    (H) Nerve damage causing pain, loss of strength or feeling in legs, and/or loss of control of bladder or rectum.
    (I) Fistula between the bladder and/or bowel and/or vagina.
    (J) In children, there may be additional late reactions.
      (i) Disturbances of bone and tissue growth.
      (ii) Bone damage to pelvis and hips causing stunting of bone growth and/or abnormal development.
      (iii) Second cancers developing in the irradiated area.
(h) Male pelvis.
  (1) Early reactions.
    (A) Inflammation of bowel causing cramping and diarrhea.
    (B) Inflammation of rectum and anus causing pain, spasm, discharge, bleeding.
    (C) Bladder inflammation causing burning, frequency, spasm, pain, and/or bleeding.
    (D) Skin changes: redness, irritation, scaliness, blistering or ulceration, coloration, thickening, hair loss.
    (E) Depression of blood count leading to increased risk of infection and/or bleeding.
    (F) In children, these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.
    (G) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Bowel damage causing narrowing or adhesions of the bowel with obstruction, ulceration, bleeding, chronic diarrhea, or poor absorption of food elements and may require surgical correction or colostomy.
    (B) Bladder damage with loss of capacity, frequency of urination, blood in urine, recurrent urinary infections, pain, or spasm which may require urinary diversion and/or removal of bladder.
    (C) Changes in skin texture and/or coloration, permanent hair loss, scarring of skin.
    (D) Bone damage leading to fractures.
    (E) Testicular damage causing reduced sperm counts, infertility, sterility, or risk of birth defects.
    (F) Impotence (loss of erection) or sexual dysfunction.
    (G) Swelling of the genitalia or legs.
    (H) Nerve damage causing pain, loss of strength or feeling in legs, and/or loss of control of bladder or rectum.
    (I) Fistula between the bowel and other organs.
    (J) In children, there may be additional late reactions.
      (i) Disturbances of bone and tissue growth.
      (ii) Bone damage to pelvis and hips causing stunting of bone growth and/or abnormal development.
      (iii) Second cancers developing in the irradiated area.
(i) Skin.
  (1) Early reactions.
    (A) Redness, irritation, or soreness.
    (B) Scaliness, ulceration, crusting, oozing, discharge.
    (C) Hair loss.
    (D) These reactions are likely to be intensified by chemotherapy.
  (2) Late reactions.
    (A) Changes in skin texture causing scaly or shiny smooth skin, thickening with contracture, puckering, scarring of skin.
    (B) Changes in skin color.
    (C) Prominent dilated small blood vessels.
    (D) Permanent hair loss.
    (E) Chronic or recurrent ulcerations.
    (F) Damage to adjacent tissues including underlying bone or cartilage.
    (G) In children, second cancers may develop in the irradiated area.
(j) Extremities.
  (1) Early reactions.
    (A) Skin changes: redness, irritation, scaliness, ulceration, coloration, thickening, hair loss.
    (B) Inflammation of soft tissues causing tenderness, swelling, and interference with movement.
    (C) Inflammation of joints causing pain, swelling and limitation of joint motion.
    (D) In children, these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.
    (E) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Changes in skin reaction and/or coloration, permanent hair loss and scarring of the skin.
    (B) Scarring or shrinkage of soft tissues and muscle causing loss of flexibility and movement, swelling of the limb.
    (C) Nerve damage causing loss of strength, feeling or coordination.
    (D) Bone damage causing fracture.
    (E) Joint damage causing permanent stiffness, pains and arthritis.
    (F) Swelling of limb below the area treated.
    (G) In children, there may be additional late reactions.
      (i) Disturbances of bone and tissue growth.
      (ii) Bone damage to limbs causing stunting of bone growth and/or abnormal development.
      (iii) Second cancers developing in the irradiated area.
(k) Total body irradiation.
  (1) Early reactions.
    (A) Loss of appetite, nausea, vomiting.
    (B) Diarrhea.
    (C) Reduced and sticky saliva, swelling of the salivary gland(s), loss of taste.
    (D) Hair loss.
    (E) Sore mouth and throat, difficulty swallowing.
    (F) Permanent destruction of bone marrow leading to infection, bleeding, and possible death.
    (G) Inflammation of the lung with fever, dry cough and difficulty breathing with possible fatal lung failure.
    (H) Damage to liver with possible fatal liver failure.
    (I) In children, these reactions are likely to be intensified by chemotherapy before, during or after radiation therapy.
    (J) In children, depression of blood count leading to increased risk of infection and/or bleeding is more common.
  (2) Late reactions.
    (A) Lung scarring causing shortness of breath, infection, and fatal lung failure.
    (B) Cataract formation in the eyes, possible loss of vision.
    (C) Testicular damage in males causing sterility.
    (D) Ovarian damage in females causing premature menopause and sterility.
    (E) Increased risk of second cancer.

Source Note: The provisions of this §602.18 adopted to be effective December 26, 2023, 48 TexReg 7985