The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a woman for vulvar complications following radiation and chemotherapy.
Subjective measures:
(1) dyspareunia
(2) dryness
(3) bleeding
(4) pain
Objective measures:
(1) stenosis/length
(2) dryness
(3) ulceration or necrosis
(4) atrophy
(5) appearance
(6) synechiae (adhesions)
(7) bleeding
Management measures:
(1) dyspareunia and pain
(2) atrophy
(3) bleeding
(4) stenosis
(5) dryness
(6) ulceration
Analytic studies:
(1) MRI: assessment of wall thickness, sinus and fistula formation
(2) ultrasound: assessment of wall thickness, sinus and fistula formation
(3) EUA (?examination under anesthesia), with cytology and biopsy: assessment of wall diameter and length and mucosal surface
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 |
|---|---|---|---|---|
|
dyspareunia |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
dryness |
occasional |
intermittent |
persistent |
refractory |
|
bleeding |
occasional |
intermittent |
persistent |
refractory |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
stenosis and length |
> two thirds length |
one to two thirds length |
less than one third length |
obliteration |
|
dryness |
asymptomatic |
symptomatic |
secondary dysfunction |
NA |
|
ulceration or necrosis |
superficial, <1 square cm |
superficial, > 1 square cm |
deep ulcer |
fistula |
|
atrophy |
patchy |
confluent |
nonconfluent |
diffuse |
|
appearance |
telangiectasia without bleeding |
telangiectasia with gross bleeding |
NA |
NA |
|
synechiae |
NA |
partial |
complete |
NA |
|
bleeding |
NA |
on contact |
intermittent |
persistent |
|
management of dyspareunia or pain |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgical intervention |
|
management of pruritis or atrophy |
occasional hormone cream |
intermittent hormone cream |
regular hormone cream |
NA |
|
management of bleeding |
iron therapy |
occasional transfusion |
frequent transfusion |
surgical intervention |
|
management of stenosis |
occasional dilatation |
intermittent dilation |
persistent dilation |
surgical reconstruction |
|
management of dryness |
hormone replacement |
artificial lubricants |
NA |
NA |
|
management of ulceration |
conservative |
wound care |
debridement |
graft |
total score =
= SUM(points for all 17 items)
LENT score =
= (total score) / 17
Interpretation:
• maximum total score: 63
• minimum LENT score: 0
• maximum LENT score: 3.71
Specialty: Hematology Oncology, Obstetrics & Gynecology
