The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate laryngeal injury occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) pain
(2) voice and hoarseness
(3) breathing
Objective measures:
(1) edema
(2) mucosal integrity
(3) respiration
Management measures:
(1) pain
(2) hoarseness
(3) respiration
Analytic studies:
(1) indirect and/or direct laryngoscopy: assessment of edema, mucosal integrity, vocal cord motion, ulcer and necrosis
(2) CT and/or MRI: assessment of edema, necrosis and asymmetry
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 |
|
hoarseness |
occasional with prolonged use |
intermittent, voice unreliable, varies |
persistent, incapable of normal communication |
complete loss of voice |
|
breathing |
occasional difficulty |
intermittent difficulty |
labored breathing |
stridor |
|
edema |
arytenoids only |
arytenoids and aryepiglottic folds |
diffuse of supraglottis, airway adequate |
diffuse with narrowing of airway to < 50% of normal |
|
mucosal integrity |
patchy atrophy and telangiectasia |
complete atrophy, extensive telangiectasia |
ulcer, cartilage not exposed |
necrosis with cartilage exposed |
|
respiration |
NA |
dyspnea on exertion |
labored at rest |
stridor at rest |
|
pain management |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgery |
|
hoarseness management |
NA |
rest voice, or whisper only |
no talking or whispering |
laryngectomy |
|
respiration management |
NA |
humidifier, steroids |
temporary tracheostomy |
permanent tracheostomy |
total score =
= SUM(points for all 9 items)
LENT score =
= (total score) / 9
Interpretation:
• maximum total score: 36
• minimum LENT score: 0
• maximum LENT score: 4.00
Specialty: Hematology Oncology, Pulmonology
