The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate changes to the female breast occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) pain, hypersensitive, pruritis
Objective measures:
(1) edema
(2) fibrosis, fat necrosis (compare affected area with comparable area of non-irradiated skin)
(3) telangiectasia
(4) lymphedema of the arm (based on the circumference at standard points)
(5) retraction and/or atrophy (volume lose due to surgery and/or radiation therapy, as compared to opposite breast or to the breast prior to therapy)
(6) ulcer
Management measures:
(1) pain
(2) edema
(3) lymphedema of the arm
(4) atrophy
(5) ulcer
Analytic studies:
(1) Color photography: Assessment of skin changes such as atrophy, retraction, fibrosis or ulcer.
(2) Tape measurements: Assessment of breast size and forearm diameter.
(3) Mammogram: Assessment of skin thickness and breast density.
(4) CT and/or MRI: Assessment of breast size, fat atrophy and fibrosis density.
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 |
|
edema |
asymptomatic |
symptomatic |
secondary dysfunction |
NA |
|
fibrosis, fat necrosis |
barely palpable; increased density |
definite increased density and firmness |
very marked density, retraction, fixation |
NA |
|
telangiectasia |
< 1 square cm |
1 – 4 square cm |
> 4 square cm |
NA |
|
lymphedema of the arm |
2 – 4 cm increase |
4.1 – 6.0 cm increase |
> 6.0 cm increase |
useless arm, angiosarcoma |
|
retraction and/or atrophy |
10 – 25% |
25.1 – 40% |
40.1 – 75% |
whole breast (> 75%) |
|
ulcer |
epidermal only, <= 1 square cm |
dermal, > 1 square cm |
subcutaneous |
bone exposed, necrosis |
|
management of pain |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgery |
|
management of edema |
NA |
NA |
medical intervention |
surgery, mastectomy |
|
management of lymphedema of the arm |
NA |
elevate arm, elastic stocking |
compression wrapping, physiotherapy |
surgery, amputation |
|
management of atrophy |
NA |
NA |
NA |
surgery, mastectomy |
|
management of ulcer |
NA |
medical intervention |
surgery with wound debridement |
surgery, mastectomy |
total score =
= SUM(points for all 12 items)
LENT score =
= (total score) / 12
Interpretation:
• maximum total score: 45
• minimum LENT score: 0
• maximum LENT score: 3.75
Specialty: Hematology Oncology, Dermatology
