SOMA-LENT Scoring of Complications Involving the Brain Following Cancer Therapy

Description

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

Subjective measures:

(1) headache

(2) somnolence

(3) intellectual deficit

(4) functional competence

(5) memory

Objective measures:

(1) neurologic deficit in the irradiated part of the brain

(2) cognitive functions

(3) mood and personality changes

(4) seizures

Management measures:

(1) headaches, somnolence

(2) seizures

(3) cognition, memory

Analytic studies:

(1) MRI (see table below)

(2) neuropsychologic (see table below)

(3) CT: assessment of swelling, edema, atrophy

(4) MRS: assessment of chemical spectra

(5) PET scan: assessment of metabolic activity

(6) serum myelin basic protein levels

(7) CSF for total protein and myelin basic protein levels

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
headache	occasional and minimal	intermittent and tolerable	persistent and intense	refractory and excruciating
somnolence	occasional, able to work or perform normal activity	intermittent, interferes with work or normal activity	persistent; needs some assistance with self-care	refractory; prevents daily activity; coma
intellectual deficit	minor loss of ability to reason and judge	moderate loss of ability to reason and judge	major loss in ability to reason and judge	complete loss of reasoning and judgment
functional competence	perform complex tasks with minor inconvenience	cannot perform complex tasks	cannot perform simple tasks	incapable of self-care; supervision; coma
memory	decreased short term; difficulty with learning	decreased long term, loss of short term	loss of short and long term	complete disorientation
neurologic deficit in irradiated brain	barely detectable neurologic signs; able to perform normal activities	easily detectable neurologic abnormalities; interferes with normal activities	focal motor signs, disturbances in speech, vision, etc.; interferes with daily activities	hemiplegia, hemisensory deficit, aphasia, blindness, coma; requires continuous care
cognitive function	minor loss of memory, reason and/or judgment	moderate loss of memory, reason and judgment	major intellectual impairment	complex memory loss and/or incapable of rational thought
mood and personality changes	occasional and minor	intermittent and minor	persistent and minor	total disintegration
seizures	focal, without impairment of consciousness	focal with impaired consciousness	generalized, tonic-clonic or absence attack	uncontrolled with loss of consciousness > 10 minutes
management of headache	occasional non-narcotic medication	persistent non-narcotic medication; intermittent low dose steroids	intermittent high dose steroids	parenteral high dose steroids, mannitol and/or surgery
management of seizures	behavioral modification	behavioral modification and occasional oral medication	permanent oral medication	intravenous anti-convulsant medication
management of cognition and memory	minor adaptation	psychosocial and educational intervention	occupational and physical therapy	custodial care

total score =

= SUM(points for all 12 items)

LENT score =

= (total score) / 12

Analytical	Grade 1	Grade 2	Grade 3	Grade 4
MRI findings	focal white matter changes; dystrophic cerebral calcification	white matter changes affecting <= 1 cerebral lobe; limited perilesional necrosis	focal necrosis with mass effect	pronounced white matter changes; mass effect requiring surgical intervention
neuro-psychologic	minor deficits in memory, IQ and/or attention	IQ decrease 10 - 19 points	IQ decrease 20 – 29 points	>= 30 point decrease in IQ, but can learn simple tasks

Interpretation:

• maximum total score: 48

• minimum LENT score: 0

• maximum LENT score: 4.0

• maximum analytical score: 8

To read more or access our algorithms and calculators, please log in or register.

SOMA-LENT Scoring of Complications Involving the Brain Following Cancer Therapy

Description

Specialty