The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with a peripheral nerve complication following radiation and chemotherapy.
Subjective measures:
(1) pain
(2) strength
(3) sensory
(4) motor paresis
Objective measures:
(1) motor dysfunction
(2) sensory dysfunction
(3) reflex
Management measures:
(1) pain
(2) motor dysfunction
(3) sensory dysfunction
(4) sensory
Analytic studies:
(1) MRI: To assess associated muscle atrophy and changes in nerve intensity.
(2) Nerve conduction studies: To assess the speed of the electrical impulse and to detect the absence of conduction.
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 |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
strength |
|
detectable weakness |
persistent weakness |
paralysis; transverse myelitis |
|
sensory |
occasional paresthesia, hyperethesia |
intermittent paresthesia |
persistent paresthesia |
paralysis |
|
motor paresis |
occasional |
< 50% decrease from baseline capabilities |
>= 50% decrease from baseline capabilities |
paralysis |
|
motor dysfunction |
< 20% loss |
20-30% loss |
31 – 50% loss |
> 50% loss |
|
sensory dysfunction |
paresthesia |
vibration decrease |
decrease to pin prick |
complete anesthesia |
|
reflex |
decreased deep tendon reflexes |
absent deep tendon reflexes |
NA |
NA |
|
pain management |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgical intervention |
|
motor dysfunction management |
NA |
NA |
physical or medical intervention |
surgical intervention |
|
sensory dysfunction management |
NA |
NA |
physical or medical intervention |
surgical intervention |
|
sensory management |
NA |
NA |
NA |
neurosurgical intervention |
total score =
= SUM(points for all 11 items)
LENT score =
= (total score) / 11
Interpretation:
• maximum total score: 44
• minimum LENT score: 0
• maximum LENT score: 4.0
Specialty: Hematology Oncology, Neurology
