The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with hepatic complications following radiation and chemotherapy.
Subjective measures:
(1) pain in right upper quadrant (RUQ)
Objective measures:
(1) abdominal findings
(2) edema
(3) weight gain
(4) alertness
(5) bleeding
Management measures:
(1) pain management
(2) management of abdominal findings
(3) management of bleeding
Analytic studies:
(1) liver function tests (AST, ALT and alkaline phosphatase)
(2) bilirubin
(3) PT and PTT
(4) serum albumin
(5) platelet count
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.
|
Items |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
pain in RUQ |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
abdominal findings |
hepatomegaly |
soft ascites |
tense ascites |
NA |
|
edema |
occasional leg edema |
intermittent leg edema |
anasarca responsive to diuretics |
anasarca unresponsive to diuretics |
|
weight gain |
NA |
<= 5% |
5.01 – 10% |
> 10% |
|
alertness |
NA |
change in attentiveness & sleep pattern |
confusion |
coma |
|
bleeding |
|
|
correctable |
unresponsive |
|
pain management |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
continuous narcotic |
|
management of abdominal findings |
NA |
intermittent diuretics |
permanent diuretics |
|
|
management of bleeding |
NA |
iron therapy |
occasional transfusion of fresh frozen plasma |
frequent transfusions |
total score =
= SUM(points for all 9 items)
LENT score =
= (total score) / 9
|
Analytic Items |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
AST, ALT and alkaline phosphatase |
< 2.5 times upper limit of normal (ULN) |
2.5 – 5.0 times ULN |
5.0 – 20 times ULN |
> 20 times ULN |
|
bilirubin |
< 1.5 times ULN |
1.5 – 5.0 times ULN |
5.1 – 10.0 times ULN |
> 10.0 times ULN |
|
PT and PTT |
< 1.25 times ULN |
1.25 – 1.5 times ULN |
1.51 – 2.0 times ULN |
> 2.0 times ULN |
|
serum albumin g/dL |
> 3.0 g/dL |
2.51 - 3.0 g/dL |
2.01 – 2.5 g/dL |
<= 2.0 g/dL |
|
platelet count |
> 75,000 per µL |
50,001 – 75,000 per µL |
25,001 – 50,000 per µL |
<= 25,000 per µL |
Interpretation:
• maximum total score: 34
• minimum LENT score: 0
• maximum LENT score: 3.78
• maximum analytic score: 20
Specialty: Hematology Oncology, Gastroenterology
