The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate injury to the small intestine and colon occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) stool frequency
(2) stool consistency
(3) pain
(4) constipation
Objective measures:
(1) melena
(2) weight loss from time of treatment
(3) stricture
(4) ulceration
Management measures:
(1) pain
(2) stool consistency and frequency
(3) bleeding
(4) stricture
(5) ulceration
Analytic studies:
(1) CT scan: assessment of wall thickness and sinus/fistula formation
(2) MRI: assessment of wall thickness and sinus/fistula formation
(3) absorption studies: assessment of protein and fat absorption and metabolic balance
(4) barium radiograph: assessment of lumen and peristalsis
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 |
|
stool frequency |
2-4 per day |
4-8 per day |
> 8 per day |
uncontrolled diarrhea |
|
stool consistency |
bulky |
loose |
mucous, dark and watery |
NA |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory with rebound |
|
constipation |
3 – 4 times per week |
2 times per week |
1 per week |
no stool passed in 10 days |
|
melena |
occult, occasional |
intermittent and tolerable; hemoglobin normal |
persistent, hemoglobin decreased 10-20% |
refractory, frank blood, > 20% decrease in hemoglobin |
|
weight loss |
>= 5 – 10% |
10.1 – 20% |
20.1 – 30% |
> 30% |
|
stricture |
> two thirds of normal after dilatation |
one third to two thirds of normal after dilatation |
< one third of normal diameter |
complete obstruction |
|
ulceration |
superficial, <= 1 square cm |
superficial, > 1 square cm |
deep ulcer |
perforation, fistula |
|
management of pain |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgery |
|
management of stool consistency and frequency |
diet modification |
regular use of non-narcotic antidiarrheal |
continuous use of narcotic antidiarrheal |
NA |
|
management of bleeding |
iron therapy |
occasional transfusion |
frequent transfusion |
surgery |
|
management of stricture |
occasional diet adaptation |
diet adaptation required |
medical intervention, NG suction |
surgery |
|
management of ulceration |
NA |
NA |
medical intervention |
surgical intervention |
total score =
= SUM(points for all 13 items)
LENT score =
= (total score) / 13
Interpretation:
• maximum total score: 50
• minimum LENT score: 0
• maximum LENT score: 3.85
Specialty: Hematology Oncology, Gastroenterology
