The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate oral and pharyngeal injury occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) pain
(2) dysphagia
(3) taste alteration
Objective measures:
(1) mucosal integrity
(2) weight
Management measures:
(1) management of pain
(2) management of ulcer
(3) management of dysphagia
(4) management of taste alterations
Analytic studies:
(1) color photo: for assessment of changes in appearance
(2) cytology, biopsy, imaging: rule out persistent tumor
(3) smear, culture, trial of antifungal therapy: rule out candidiasis
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 |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
dysphagia |
occasional, slight |
difficulty eating soft food |
can take liquids only |
totally unable to swallow |
|
taste alteration |
occasional slight |
intermittent |
persistent |
NA |
|
mucosal integrity |
patchy atrophy or telangiectasia |
diffuse atrophy or telengiec-tasia, super-ficial ulcer |
deep ulcer with no exposure of bone or cartilage |
deep ulcer with bone or cartilage exposure |
|
weight |
<= 5% loss |
5.1 – 10% loss |
10.1 – 15% loss |
> 15% loss |
|
management of pain |
occasional non-narcotics |
regular non-narcotic |
regular narcotic |
surgical intervention |
|
management of ulcer |
NA |
cleanse |
antibiotics or oxidants |
debridement and other surgical intervention |
|
management of dysphagia |
lubricants, diet modification |
non-narcotic |
narcotic |
PEG tube and/or surgical intervention |
|
management of taste alteration |
minor diet changes (non-acidic) |
minor diet change (semisoft) |
major diet change (soft) |
major diet change (liquid) |
total score =
= SUM(points for all 9 items)
LENT score =
= (total score) / 9
Interpretation:
• maximum total score: 35
• minimum LENT score: 0
• maximum LENT score: 3.89
Specialty: Hematology Oncology, Otolaryngology
