The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate esophageal injury occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) dysphagia
(2) pain
Objective measures:
(1) weight loss from time of treatment
(2) stricture
(3) ulceration
(4) bleeding (melena or hematemesis)
(5) anemia
Management measures:
(1) dysphagia or stricture
(2) weight loss
(3) pain and ulceration
(4) bleeding
Analytic studies:
(1) barium esophagram: assessment of esophageal lumen, stricture and dilatation
(2) endoscopy: assessment of esophageal lumen, mucosal integrity, ulceration
(3) CT scan: assessment of esophageal wall thickness, lumen, stricture, dilatation
(4) MRI: assessment of esophageal wall thickness, lumen, stricture, dilatation
(5) ultrasonography: assessment of esophageal wall thickness, lumen, stricture, dilatation
(6) mobility esophagram: assessment of mobility of bolus and peristalsis
(7) electromyogram: assessment of mobility of bolus and peristalsis
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
|
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
dysphagia |
difficulty eating solid foods |
difficulty eating soft food |
can take liquids only |
totally unable to swallow |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
weight loss |
>= 5% to 10% |
10.1 to 20% |
20.1 to 30% |
> 30% |
|
stricture |
> two thirds normal diameter with dilatation |
one third to two thirds normal with dilatation |
<= one third normal diameter with dilatation |
complete obstruction |
|
ulceration |
superficial and <= 1 square cm |
superficial > 1 square cm |
deep ulcer |
perforation, fistula |
|
bleeding |
occult |
occasional, normal hemoglobin |
intermittent, 10-20% decrease in hemoglobin |
persistent, > 20% decrease in hemoglobin |
|
anemia |
NA |
fatigue |
exhaustion |
NA |
|
management of dysphagia or stricture |
diet modification, antacids |
diet modification and occasional dilatation |
temporary nasogastric tube or regular dilatation |
parenteral feeding, gastrostomy, permanent NG tube |
|
management of weight loss |
diet modifications |
nutritional supplements |
tube feeding |
surgical bypass, PEG tube |
|
management of pain and ulceration |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgery |
|
management of bleeding |
iron therapy |
occasional transfusion |
frequent transfusion |
surgery |
where:
• Weight loss of < 5% would be Grade 0.
total score =
= SUM(points for all 11 items)
LENT score =
= (total score) / 11
Interpretation:
• maximum total score: 43
• minimum LENT score: 0
• maximum LENT score: 3.91
Specialty: Hematology Oncology, Gastroenterology
