title: Cognitive performance and magnetic resonance imaging findings after high-dose systemic and intraventricular chemotherapy for primary central nervous system lymphoma.
abstract: BACKGROUND
  Long-term neurotoxicity is a frequent complication of combined radiotherapy and chemotherapy in patients with primary central nervous system lymphoma. Treatment protocols without radiotherapy have been implemented to avoid this; however, little detailed neuropsychologic and neuroradiologic data exist to assess the frequency of long-term treatment sequelae in this patient group.
  
  
  OBJECTIVE
  To determine whether a polychemotherapy regimen based on high-dose methotrexate results in cognitive impairment and/or changes detectable by magnetic resonance imaging of the brain during long-term follow-up.
  
  
  METHODS
  Twenty patients with histologically proven primary central nervous system lymphoma were treated with a novel chemotherapy protocol that included systemic and intraventricular administration of methotrexate and cytarabine (ara-C). Standardized neuropsychologic testing and magnetic resonance imaging investigations were performed prior to therapy and prospectively during a median follow-up period of 36 months (range, 21-69 months).
  
  
  RESULTS
  Ten patients achieved durable remissions without relapse for more than 1 year after completion of chemotherapy. There was no gross cognitive decline in any of these patients during the follow-up period. In contrast, magnetic resonance imaging revealed therapy-induced white matter changes in 5 of these patients.
  
  
  CONCLUSIONS
  We conclude that chemotherapy alone is associated with a low risk of long-term neurotoxicity in primary central nervous system lymphoma. Methotrexate-induced white matter lesions detectable on magnetic resonance imaging are not inevitably associated with significant cognitive decline.
authors.affiliation: Department of Neurology, University of Bonn, Bonn, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Fliessbach
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Christoph
authors.initials: C
authors.lastname: Helmstaedter
authors.forename: Hendrik
authors.initials: H
authors.lastname: Pels
authors.forename: Axel
authors.initials: A
authors.lastname: Glasmacher
authors.forename: Jürgen A
authors.initials: JA
authors.lastname: Kraus
authors.forename: Thomas
authors.initials: T
authors.lastname: Klockgether
authors.forename: Ingo
authors.initials: I
authors.lastname: Schmidt-Wolf
authors.forename: Uwe
authors.initials: U
authors.lastname: Schlegel
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000523:psychology; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced / Q000473:pathology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007276:Injections, Intraventricular; D008223:Lymphoma / Q000188:drug therapy / Q000473:pathology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009483:Neuropsychological Tests
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate