Scoring system of late effects of radiations on normal tissues: the SOMA-LENT scale

Département d'oncologie-radiothérapie, EA 643, centre hospitalier Lyon-Sud, Pierre-Bénite, France.
Cancer/Radiothérapie (Impact Factor: 1.41). 02/1997; 1(6):622-68.
Source: PubMed


Radiation tolerance of normal tissues remains the limiting factor for delivering tumoricidal dose. The late toxicity of normal tissues is the most critical element of an irradiation: somatic, functional and structural alterations occur during the actual treatment itself, but late effects manifest months to years after acute effects heal, and may progress with time. The optimal therapeutic ratio ultimately requires not only complete tumor clearance, but also minimal residual injury to surrounding vital normal tissues. The disparity between the intensity of acute and late effects and the inability to predict the eventual manifestations of late normal tissue injury has made radiation oncologists recognize the importance of careful patient follow-up. There is so far no uniform toxicity scoring system to compare several clinical studies in the absence of a "common toxicity language". This justifies the need to establish a precise evaluation system for the analysis of late effects of radiation on normal tissues. The SOMA/LENT scoring system results from an international collaboration. European Organization Treatment of Cancer (EORTC) and Radiation Therapy Oncology Group (RTOG) have created subcommittees with the aim of addressing the question of standardized toxic effects criteria. This effort appeared as a necessity to standardize and improve the data recording, to then describe and evaluate uniform toxicity at regular time intervals. The current proposed scale is not yet validated, and should be used cautiously.

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    • "Radiation oncologists have a long tradition of recording late toxicity after cancer treatment. Several instruments exist, for example, the Franco-Italian glossary (Sinistrero et al, 1993), the RTOG/EORTC late radiation morbidity scoring schema (Rubin et al, 1995), the SOMA-LENT system (Mornex et al, 1997) and CTCAE (Trotti et al, 2003), but many of these combine multiple signs and symptoms into a single grade leading to loss of specificity. Only rarely have the toxicity scales been developed with guidance from the survivors. "
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    • "Toxicity, graded using WHO criteria for chemotherapy and early radiotherapy toxicity, was assessed at weekly clinic and biologic examinations during chemoradiotherapy and at the end of treatment [19] (Miller et al, 1981). Late radiotherapy toxicity was graded according to the SOMA-LENT criteria [20] (Mornex et al, 1997). In the event of grade 2-4 adverse events, chemotherapy was withheld until evidence of hematologic recovery (neutrophils ≥ 1500/mm 3 and platelets ≥100 000/mm 3 ) and complete resolution of all nonhematologic adverse events (other than alopecia) to baseline or grade 1. "
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    • "Late effects on surrounding tissue were graded according to the subjective, objective and management portions of the LENT-SOMA scales, as proposed by the EORTC and RTOG Late Effects Working Group in 1995.14,20,21 Four LENT-SOMA scales were used: muscle/soft tissue, peripheral nerves, skin/subcutaneous tissue and vessels.22 "
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