Hoeller U, Tribius S, Kuhlmey A, Grader K, Fehlauer F, Alberti W, et al.
International journal of radiation oncology, biology, physics. Date of publication 2003 Mar 15;volume 55(4):1013-8.
1. Int J Radiat Oncol Biol Phys. 2003 Mar 15;55(4):1013-8.
Increasing the rate of late toxicity by changing the score? A comparison of
RTOG/EORTC and LENT/SOMA scores.
Hoeller U(1), Tribius S, Kuhlmey A, Grader K, Fehlauer F, Alberti W.
Author information:
(1)Department of Radiation Oncology, University Hospital Eppendorf, Hamburg,
Germany.
PURPOSE: The Radiation Therapy Oncology Group (RTOG) and Late Effects Normal
Tissue Task Force subjective, objective, management, and analytic (LENT/SOMA)
scores were compared in a group of breast cancer patients. The impact of the
classification system on grading late effects was evaluated.
MATERIALS AND METHODS: Telangiectasia, skin pigmentation, and fibrosis were
scored according to both LENT/SOMA and RTOG criteria. The results were compared
with respect to up- or downgrading and correlated (Spearman's rho). Other side
effects were recorded using LENT/SOMA criteria. Interobserver variability was
calculated with Cohen's kappa. Two hundred fifty-nine subsequent relapse-free
patients who underwent breast-conserving therapy between 1981 and 1995 were
examined. The median dose of radiotherapy to the breast was 55 Gy. Adjuvant
chemotherapy was given to 31 patients and tamoxifen to 52 patients. The median
follow-up was 8 years. RTOG skin and s.c. tissue scales and LENT/SOMA breast and
pigmentation scales were used. Two doctors examined 45 patients jointly.
RESULTS: Of all patients, 20% had telangiectasia, 22% pigmentation, 43% fibrosis,
4% breast edema, 77% retraction/atrophy, and 54% pain. In comparison, when
LENT/SOMA criteria were used, telangiectasia and pigmentation were upgraded in
34% and 36%, respectively, and telangiectasia was downgraded in 45%. Fibrosis
correlated well (Spearman's rho 0.78, p = 0.01). An additional 356 side effects,
mainly retraction/atrophy were observed in 226 patients using LENT/SOMA criteria.
Interobserver variability was similar for both classification systems and ranged
from Cohen's kappa 0.3 (retraction) to 0.91 (telangiectasia).
CONCLUSIONS: LENT/SOMA criteria seem to be the better tool in grading and
recording late radiation toxicity compared with the RTOG scale. There was some
upgrading with the RTOG score when skin toxicity is evaluated. In contrast,
fibrosis scores correlated very well. Adjustments of the LENT/SOMA scoring system
should be considered to standardize reporting of late radiation morbidity.
PMID: 12605981 [Indexed for MEDLINE]
