Cognitive status and quality of life after treatment for primary CNS lymphoma.
OBJECTIVE
To evaluate the cognitive status and quality of life (QOL) in a cohort of 19 consecutive patients treated in a prospective European Organization for Research and Treatment of Cancer study (20962) for primary CNS lymphoma (PCNSL). All patients were in complete remission after combined modality treatment with IV and intrathecal high-dose methotrexate (MTX)-based chemotherapy followed by whole brain radiotherapy (WBRT).


METHODS
An extensive neuropsychological assessment, including QOL measures, was conducted in 19 patients with PCNSL. The results were compared with matched control subjects with systemic hematologic malignancies treated with systemic chemotherapy or non-CNS radiotherapy. In addition, a neuroradiologic evaluation was carried out in 18 patients with PCNSL.


RESULTS
Cognitive impairment was found in 12 patients with PCNSL (63%) despite a complete tumor response. Four patients (21%) showed severe cognitive deficits, and the percentage of impaired test indices correlated with age. In comparison, only two control subjects (11%) showed cognitive dysfunction (p = 0.002). Forty-two percent of the patients with PCNSL, in contrast to 81% of the control subjects, resumed work. White matter abnormalities were observed in 14 patients with PCNSL, and 14 had cortical atrophy. Cortical atrophy correlated with cognitive functioning, age, and Karnofsky performance score. Group differences in cognitive status and QOL could not be explained by anxiety, depression, or fatigue.


CONCLUSIONS
Combined modality treatment for primary CNS lymphoma is associated with cognitive impairment even in patients aged <60 years.
Department of Neuro-oncology, Erasmus MC, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. h.harder@erasmusmc.nl
H
H
Harder
H
H
Holtel
J E C
JE
Bromberg
P
P
Poortmans
H
H
Haaxma-Reiche
H C
HC
Kluin-Nelemans
J
J
Menten
M J
MJ
van den Bent
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001284:Atrophy; D001921:Brain / Q000473:pathology; D002330:Carmustine / Q000008:administration & dosage; D016022:Case-Control Studies; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy; D003072:Cognition Disorders / Q000209:etiology*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007278:Injections, Spinal; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009186:Myelin Sheath / Q000473:pathology; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life; D013713:Teniposide / Q000008:administration & dosage
D003561:Cytarabine; D013713:Teniposide; D002330:Carmustine; D006854:Hydrocortisone; D008775:Methylprednisolone; D008727:Methotrexate