The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a woman with cervical or uterine complications following radiation and chemotherapy.
Subjective measures:
(1) amenorrhea
(2) dysmenorrhea
(3) pain
(4) bleeding
Objective measures:
(1) pyometra
(2) hematometra
(3) necrosis
(4) ulceration
(5) cervical incompetence
(6) cervical os stenosis
Management measures:
(1) pain
(2) amenorrhea, dysmenorrhea, hematometra
(3) pyometra
(4) necrosis
(5) bleeding
(6) cervical os stenosis
(7) ulceration
(8) cervical incompetence
Analytic studies:
(1) MRI: assessment of wall thickness,
(2) ultrasound: assessment of wall thickness,
(3) EUA (?examination under anesthesia), with cytology and biopsy: assessment of mucosal surfaces and ulcers
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 |
---|---|---|---|---|
amenorrhea |
asymptomatic |
symptomatic |
NA |
infertility |
dysmenorrhea |
asymptomatic |
symptomatic |
NA |
NA |
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
bleeding |
occasional with normal hemoglobin |
intermittent with < 10% decrease hemoglobin |
persistent with 10-20% decrease in hemoglobin |
refractory with > 20% decrease in hemoglobin |
pyometra |
asymptomatic |
symptomatic |
NA |
NA |
hematometra |
asymptomatic |
symptomatic |
NA |
NA |
necrosis |
asymptomatic |
symptomatic |
NA |
NA |
ulceration |
superficial, <1 square cm |
superficial, > 1 square cm |
deep ulcer |
fistula |
cervical incompetence |
NA |
NA |
NA |
infertility |
cervical os stenosis |
asymptomatic |
symptomatic |
NA |
NA |
management of pain |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgical intervention |
management of amenorrhea, dysmenorrhea, hematometra |
occasional hormone replacement |
intermittent hormone replacement |
regular hormone replacement |
NA |
management of pyometra |
NA |
D&C, antibiotics |
NA |
NA |
management of necrosis |
NA |
debridement |
D&C |
hysterectomy |
management of bleeding |
iron therapy |
occasional transfusion |
frequent transfusion |
surgical intervention |
management of cervical os stenosis |
NA |
NA |
D&C |
hysterectomy |
management of ulceration |
conservative |
antibiotics |
debridement, surgical management |
hysterectomy |
management of cervical incompetence |
NA |
NA |
NA |
obstetrical management |
total score =
= SUM(points for all 18 items)
LENT score =
= (total score) / 18
Interpretation:
• maximum total score: 59
• minimum LENT score: 0
• maximum LENT score: 3.28
Specialty: Hematology Oncology, Obstetrics & Gynecology