The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a woman with complications following radiation and chemotherapy that affect the hypothalamic-pituitary-ovarian axis.
Subjective measures:
(1) hot flashes
(2) dysmenorrhea
(3) menstruation
(4) libido
Objective measures:
(1) ovulation
(2) involuntary infertility
(3) osteoporosis
Management measures:
(1) dysmenorrhea, hot flashes
(2) menstruation
(3) osteoporosis
Analytic studies:
(1) FSH, LH and estradiol: assessment of hypothalamic-pituitary-ovarian axis integrity
(2) bone densitometry: quantify bone density
(3) stimulated FSH and LH: assessment of pituitary responsiveness (Should this be ovarian responsiveness and integrity of the hypothalamic-pituitary-ovarian axis?)
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 |
|
hot flashes |
occasional |
intermittent |
persistent |
NA |
|
dysmenorrhea |
occasional |
intermittent |
persistent |
NA |
|
menstruation |
NA |
oligomenorrhea |
amenorrhea |
NA |
|
libido |
occasionally suppressed |
intermittently suppressed |
persistently suppressed |
NA |
|
ovulation |
NA |
NA |
anovulation in a premeno-pausal woman |
NA |
|
involuntary infertility |
NA |
NA |
NA |
infertile |
|
osteoporosis |
NA |
NA |
radiographic evidence |
fracture |
|
management of hot flashes and dysmenorrhea |
NA |
persistent hormone replacement |
NA |
NA |
|
management of menstruation |
NA |
hormone replacement |
NA |
NA |
|
management of osteoporosis |
NA |
hormone replacement and calcium supplement |
NA |
NA |
total score =
= SUM(points for all 10 items)
LENT score =
= (total score) / 10
Interpretation:
• maximum total score: 29
• minimum LENT score: 0
• maximum LENT score: 2.9
Specialty: Hematology Oncology, Endocrinology
