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
Specialty: Hematology Oncology, Surgery, orthopedic