The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate lung injury occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) cough
(2) dyspnea
(3) chest pain or discomfort
Objective measures:
(1) pulmonary fibrosis
(2) lung function
Management measures:
(1) pain
(2) cough
(3) dyspnea
Analytic studies:
(1) pulmonary function tests
(2) diffusing capacity of carbon monoxide (DLCO)
(3) percent oxygen and carbon dioxide saturation
(4) CT or MRI: assessment of lung volume and zones of fibrosis
(5) perfusion scan: assessment of pulmonary blood flow and alveolar filling
(6) lung lavage: assessment of cells and cytokines
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.
|
SOM |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
cough |
occasional |
intermittent |
persistent |
refractory |
|
dyspnea |
breathless on intense exertion |
breathless on mild exertion |
breathless at rest, limits activities |
unable to do any physical activity |
|
chest pain or discomfort |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
pulmonary fibrosis |
radiologic abnormality |
patchy dense abnormalities on radiograph |
dense confluent radiographic changes, limited to radiation fields |
dense fibrosis, severe scarring and major retraction of normal lung |
|
lung function |
10 - 25% reduction of respiratory volume and/or diffusion capacity |
25.1 – 50% reduction of respiratory volume and/or diffusion capacity |
50.1 - 75% reduction of respiration volume and/or diffusion capacity |
> 75% reduction of respiratory volume and/or diffusion capacity |
|
management of pain |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgery |
|
management of cough |
NA |
non-narcotic |
narcotics; intermittent corticosteroids |
respirator; continuous corticosteroids |
|
management of dyspnea |
NA |
occasional oxygen |
continuous oxygen |
NA |
total score =
= SUM(points for all 8 items)
LENT score =
= (total score) / 8
|
Analytic |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
pulmonary function tests |
decrease to 75.1 – 90% of pre-therapy level |
decrease to 50.1 – 75% of pre-therapy level |
decrease to 25.1 – 50% of pre-therapy level |
decrease to <= 25% of pre-therapy level |
|
DLCO |
decrease to 75.1 – 90% of pre-therapy level |
decrease to 50.1 – 75% of pre-therapy level |
decrease to 25.1 – 50% of pre-therapy level |
decrease to <= 25% of pre-therapy level |
|
percent saturation oxygen and carbon dioxide |
>= 70% oxygen; <= 50% carbon dioxide |
> 60% oxygen; <= 60% carbon dioxide |
> 50% oxygen; <= 70% carbon dioxide |
<= 50% oxygen; > 70% carbon dioxide |
where:
• Pulmonary function tests and DLCO in analytical relates to lung function in objective section ("x" in lung function and "100 – x" in analytical).
• A level in pulmonary function tests or diffusing capacity > 90% of pretreatment level is considered Grade 0.
• Units for DLCO are mL/min/(mm Hg).
Interpretation:
• maximum total score: 31
• minimum LENT score: 0
• maximum LENT score: 3.88
Specialty: Hematology Oncology, Pulmonology
