Description

The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with complications involving growing bone following radiation and chemotherapy.


 

Subjective measures:

(1) pain

(2) abnormal gait

(3) disfigurement

 

Objective measures:

(1) extremities

(2) sitting and standing height

(3) scoliosis

(4) kyphosis or lordosis

(5) femoral heads

(6) flat or facial bones

 

Management measures:

(1) extremities

(2) scoliosis

(3) femoral heads

(4) flat or facial bones

 

Analytic studies:

(1) measure growth

(2) radiograph or CT: assessment of bone integrity

 

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

pain

occasional and minimal

intermittent and tolerable

persistent and intense

refractory and excruciating

abnormal gait

slight

noticeable limp

severe limp

unable to walk

disfigurement

slight not cosmetically significant

mild cosmetic deformity

moderate cosmetic deformity

severe disfigurement

extremities

mild curvature or length discrepancy < 2 cm

moderate curvature or length discrepancy 2 – 5 cm

severe curvature or length discrepancy > 5 cm

epiphysiodesis or severe functional deformity

sitting or standing height

mild disproportion

moderate disproportion

severe disproportion

NA

scoliosis

< 5°

5 – 10°

10.1 – 20°

> 20°; interferes with cardio-pulmonary function

kyphosis or lordosis

mild radiographic changes

moderate accentuation

severe accentuation

NA

femoral heads

mild valgus or varus deformity

moderate valgus or varus deformity

mild slipped capital femoral epiphysis; epiphyseal widening

severe slipped capital femoral epiphysis > 60°; avascular necrosis

flat or facial bones

slight changes, not cosmetically significant

mild cosmetic deformity

moderate cosmetic deformity

profound hypoplasia or functional problem

management of extremities

NA

minimal shoe lift

moderate shoe lift

surgical intervention

management of scoliosis

NA

NA

brace

surgical intervention

management of femoral heads

NA

NA

pinning

hip replacement

management of flat or facial bones

NA

NA

NA

surgical intervention

 

total score =

= SUM(points for all 13 items)

 

LENT score =

= (total score) / 13

 

Analytical

Grade 1

Grade 2

Grade 3

Grade 4

measure growth

no growth retardation

growth retardation <= 1 percentile

growth retardation > 1 percentile

growth arrest

 

where:

• I am not sure why "no growth retardation" is Grade 1 rather than Grade 0.

 

Interpretation:

• maximum total score: 50

• minimum LENT score: 0

• maximum LENT score: 3.85

 


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