SOMA-LENT Scoring of Complications Involving Growing Bone Following Cancer Therapy

Description

The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with complications involving growing bone following radiation and chemotherapy.

Subjective measures:

(1) pain

(2) abnormal gait

(3) disfigurement

Objective measures:

(1) extremities

(2) sitting and standing height

(3) scoliosis

(4) kyphosis or lordosis

(5) femoral heads

(6) flat or facial bones

Management measures:

(1) extremities

(2) scoliosis

(3) femoral heads

(4) flat or facial bones

Analytic studies:

(1) measure growth

(2) radiograph or CT: assessment of bone integrity

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
pain	occasional and minimal	intermittent and tolerable	persistent and intense	refractory and excruciating
abnormal gait	slight	noticeable limp	severe limp	unable to walk
disfigurement	slight not cosmetically significant	mild cosmetic deformity	moderate cosmetic deformity	severe disfigurement
extremities	mild curvature or length discrepancy < 2 cm	moderate curvature or length discrepancy 2 – 5 cm	severe curvature or length discrepancy > 5 cm	epiphysiodesis or severe functional deformity
sitting or standing height	mild disproportion	moderate disproportion	severe disproportion	NA
scoliosis	< 5°	5 – 10°	10.1 – 20°	> 20°; interferes with cardio-pulmonary function
kyphosis or lordosis	mild radiographic changes	moderate accentuation	severe accentuation	NA
femoral heads	mild valgus or varus deformity	moderate valgus or varus deformity	mild slipped capital femoral epiphysis; epiphyseal widening	severe slipped capital femoral epiphysis > 60°; avascular necrosis
flat or facial bones	slight changes, not cosmetically significant	mild cosmetic deformity	moderate cosmetic deformity	profound hypoplasia or functional problem
management of extremities	NA	minimal shoe lift	moderate shoe lift	surgical intervention
management of scoliosis	NA	NA	brace	surgical intervention
management of femoral heads	NA	NA	pinning	hip replacement
management of flat or facial bones	NA	NA	NA	surgical intervention

total score =

= SUM(points for all 13 items)

LENT score =

= (total score) / 13

Analytical	Grade 1	Grade 2	Grade 3	Grade 4
measure growth	no growth retardation	growth retardation <= 1 percentile	growth retardation > 1 percentile	growth arrest

where:

• I am not sure why "no growth retardation" is Grade 1 rather than Grade 0.

Interpretation:

• maximum total score: 50

• minimum LENT score: 0

• maximum LENT score: 3.85

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SOMA-LENT Scoring of Complications Involving Growing Bone Following Cancer Therapy

Description

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