The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate cardiac injury occurring as a complication following radiation and chemotherapy.
Subjective measures:
(1) angina pectoris
(2) pericardial pain
(3) palpitation
(4) dyspnea
(5) pedal edema
Objective measures:
(1) pedal edema
(2) cardiomegaly
(3) cardiac dysrhythmia
(4) myocardial CHF
(5) myocardial ischemia
(6) pericardial disease
Management measures:
(1) pain (pericarditis)
(2) angina
(3) pericardial disease
(4) cardiac dysrhythmia
(5) myocardial infarction
(6) myocardial CHF
Analytic studies:
(1) equilibrium radionuclide angiography (ERNA): This has been supplanted by newer techniques.
(2) excercise tolerance test: Assessment of pulse rate, blood pressure and ECG polarization changes.
(3) cardiac catheterization: Assessment of coronary artery blood flow.
(4) thallium scintigraphy: Assessment of myocardial perfusion.
(5) coronary angiography: Assessment of number of vessels involved and extent of stenosis.
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.
|
SOM |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
angina pectoris |
occasional, only with maximal exertion |
with moderate exertion |
with mild exertion |
at rest |
|
pericardial pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
palpitation |
occasional |
intermittent |
persistent |
refractory |
|
dyspnea |
shortness of breath with intense exertion |
shortness of breath on mild exertion |
shortness of breath at rest, limits all activity |
prevents any physical activity |
|
pedal edema |
NA |
asymptomatic |
symptomatic |
prevents daily activities |
|
objective pedal edema |
1+ |
2+ |
3+ |
4+ |
|
cardiomegaly (enlargement of cardiac silhouette) |
minimal |
present, without pulmonary congestion |
present with minimal pulmonary congestion |
present with frank pulmonary edema |
|
cardiac dysrhythmia |
occasional and asymptomatic |
intermittent ECG changes |
persistent ECG changes |
refractory |
|
myocardial CHF |
asymptomatic decline of resting ejection fraction by <= 20% of baseline |
decline of resting ejection fraction by > 20% of baseline |
reversible failure |
irreversible failure |
|
myocardial ischemia |
abnormal stress test, normal resting ECG |
asymptomatic ST and T wave changes without stress testing |
angina without evidence of infarction |
acute infarction |
|
pericardial disease |
asymptomatic effusion |
pericardial rub, chest pain, ECG changes |
tamponade |
constriction |
|
management of pain (pericarditis) |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgery |
|
management of angina |
present but no therapy |
nitroglycerin PRN |
long acting agents |
coronary artery bypass |
|
management of pericardial disease |
NA |
|
pericardio-centesis |
pericard-ectomy |
|
management of cardiac dysrhythmia |
NA |
NA |
medical intervention |
requires monitoring or cardioversion |
|
management of myocardial infarction |
NA |
NA |
medical intervention |
coronary bypass |
|
management of myocardial CHF |
NA |
NA |
medical intervention |
cardiac transplant |
total score =
= SUM(points for all 17 items)
LENT score =
= (total score) / 17
|
Analytic |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
left ventricular ejection fraction (by ERNA) |
abnormal, with < 20% decrease |
20 – 40% decrease |
> 40% decrease |
NA |
Interpretation:
• maximum total score: 85
• minimum LENT score: 0
• maximum LENT score: 4.00
Specialty: Hematology Oncology, Cardiology
