The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate rectal injury occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) tenesmus
(2) mucosal loss
(3) sphincter control
(4) stool frequency
(5) pain
Objective measures:
(1) bleeding
(2) ulceration
(3) stricture
Management measures:
(1) tenesmus and stool frequency
(2) pain
(3) bleeding
(4) ulceration
(5) stricture
(6) sphincter control
Analytic studies:
(1) barium enema: assessment of lumen and peristalsis
(2) proctoscopy: assessment of lumen and mucosal surface
(3) CT scan: assessment of wall thickness and sinus/fistula formation
(4) MRI: assessment of wall thickness and sinus/fistula formation
(5) anal manometry: assessment of rectal compliance
(6) ultrasonography: assessment of wall thickness and sinus/fistula formation
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 |
|
tenesmus |
occasional urgency |
intermittent urgency |
persistent urgency |
refractory |
|
mucosal loss |
occasional |
intermittent |
persistent |
refractory |
|
sphincter control |
occasional |
intermittent |
persistent |
refractory |
|
stool frequency |
2-4 per day |
4-8 per day |
> 8 per day |
uncontrolled diarrhea |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
bleeding |
occult |
occasional, > 2 times per week |
persistent, daily |
gross hemorrhage |
|
ulceration |
superficial, <= 1 square cm |
superficial, > 1 square cm |
deep ulcer |
perforation, fistula |
|
stricture |
> two thirds of normal after dilatation |
one third to two thirds of normal after dilatation |
< one third of normal diameter |
complete obstruction |
|
management of tenesmus and stool frequency |
occasional antidiarrheal agent (<= 2 times per week) |
regular antidiarrheal agent (> 2 times per week) |
multiple daily doses antidiarreal agent (> 2 times per day) |
surgery, permanent colostomy |
|
management of pain |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgery |
|
management of bleeding |
stool softener, iron therapy |
occasional transfusion |
frequent transfusion |
surgery, permanent colostomy |
|
management of ulceration |
diet modification, stool softener |
occasional steroids |
steroid enemas; hyperbaric oxygen |
surgery, permanent colostomy |
|
management of stricture |
diet modification |
occasional dilatation |
regular dilatation |
surgery, permanent colostomy |
|
management of sphincter control |
occasional use of incontinence pads |
intermittent use of incon-tinence pads |
persistent use of incontinence pads |
surgery, permanent colostomy |
total score =
= SUM(points for all 14 items)
LENT score =
= (total score) / 14
Interpretation:
• maximum total score: 56
• minimum LENT score: 0
• maximum LENT score: 4.0
Specialty: Hematology Oncology, Gastroenterology
