Cognitive functions in survivors of primary central nervous system lymphoma.
BACKGROUND
The standard treatment for primary CNS lymphoma (PCNSL) involves high-dose methotrexate-based (MTX) chemotherapy and whole brain radiotherapy (WBRT). This combined regimen prolongs patient survival, but also carries a substantial risk for delayed neurotoxicity particularly in the elderly. However, cognitive outcome evaluations have not been included in most clinical trials.


OBJECTIVE
To assess cognitive functioning and quality of life in PCNSL survivors treated either with WBRT +/- MTX-based chemotherapy or chemotherapy alone.


METHODS
Twenty-eight PCNSL patients in disease remission received a post-treatment baseline neuropsychological evaluation, and a subset of patients were available for an 8-month follow-up evaluation. Assessment of quality of life and extent of white matter disease on MRI were also performed.


RESULTS
Patients displayed mild to moderate impairments across several cognitive domains. These were of sufficient severity to reduce quality of life in half of the patient sample. Comparisons according to treatment type revealed more pronounced cognitive impairment, particularly in the memory and attention/executive domains, among patients treated with WBRT +/- chemotherapy. Extent of white matter disease correlated with attention/executive, memory, and language impairment.


CONCLUSIONS
PCNSL survivors treated with WBRT +/- chemotherapy displayed more pronounced cognitive dysfunction than patients treated with MTX-based chemotherapy alone.
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York 10021, USA. corread@mskcc.org
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Correa
L M
LM
DeAngelis
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Shi
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Thaler
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Glass
L E
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Abrey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001284:Atrophy; D001288:Attention / Q000187:drug effects / Q000528:radiation effects; D001921:Brain / Q000473:pathology; 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; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000187:drug effects / Q000528:radiation effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009186:Myelin Sheath / Q000473:pathology; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life; D012074:Remission Induction; D017741:Survivors
D008727:Methotrexate