The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate gastric injury occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) epigastric distress
(2) emesis
(3) pain
Objective measures:
(1) hematemesis
(2) weight loss from time of treatment
(3) melena
(4) ulceration
(5) stricture (antro-pyloric region): gastric outlet obstruction
Management measures:
(1) epigastric distress/emesis
(2) pain
(3) bleeding
(4) ulceration
(5) stricture
Analytic studies:
(1) barium radiography: assessment of lumen and peristalsis
(2) endoscopy: assessment of lumen and mucosal surface
(3) CT scan: assessment of wall thickness, sinus and fistula formation
(4) MRI: assessment of wall thickness, sinus and fistula formation
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 |
|
epigastric distress |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
emesis |
occasional |
intermittent |
persistent |
refractory |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
hematemesis |
occasional |
intermittent |
persistent |
refractory |
|
weight loss |
5-10% |
10.1-20% |
20.1-30% |
> 30% |
|
melena |
occult / occasional with normal hemoglobin |
intermittent, < 10% decrease in hemoglobin |
persistent, 10-20% decrease in hemoglobin |
refractory or frank blood, > 20% decrease in hemoglobin |
|
ulceration |
superficial, <= 1 square cm |
superficial, >1 square cm |
deep ulcer |
perforation, fistulae |
|
stricture |
> 2/3 rd normal diameter |
1/3 to 2/3rd normal diameter |
< 1/3rd normal diameter |
complete obstruction |
|
management of epigastric distress/emesis |
diet modification, antacids |
intermittent prescription medications |
persistent medical management |
surgical intervention |
|
management of pain |
occasional non-narcotics |
regular non-narcotic |
regular narcotic |
surgical intervention |
|
management of bleeding |
iron therapy |
occasional transfusion |
frequent transfusions |
embolization, coagulation or surgical intervention |
|
management of ulceration |
NA |
NA |
medical intervention |
surgical intervention |
|
management of stricture |
NA |
NA |
medical intervention |
surgical intervention |
where:
• Weight loss of < 5% would be Grade 0.
total score =
= SUM(points for all 13 items)
LENT score =
= (total score) / 13
Interpretation:
• maximum total score: 52
• minimum LENT score: 0
• maximum LENT score: 4.00
Specialty: Hematology Oncology, Gastroenterology
