title: Lower cognitive performance and white matter changes in testicular cancer survivors 10 years after chemotherapy.
abstract: OBJECTIVE
  Chemotherapy (CT) is associated with adverse effects on cognition. Only few studies have investigated cognition in testicular cancer (TC) patients and studies on very late effects of CT on cognition are absent. Further, brain changes in relation to treatment have not been investigated in TC. The objective of the present study is to compare psychosocial functioning, cognitive performance and brain (micro)structure following surgery and CT for TC, against surgery (S)-only.
  
  
  METHODS
  Twenty-eight CT (43.1±7.5 y) and 23 S-only (48.2±9.5y) TC survivors on average 14 yr post-treatment were examined using questionnaires, neurocognitive tests, and 3T-MRI [Diffusion Kurtosis Imaging (DKI), T1-weighted and Fluid Attenuated Inversion Recovery]. A multivariate cognitive performance score (Mahalanobis distance) was calculated to indicate the grade of cognitive performance. Kurtosis parameters, gray matter, and white matter (WM) volume were calculated from MRI data.
  
  
  RESULTS
  Overall, the CT group showed lower cognitive performance (5.35±1.7) compared with the S-only group (4.4±0.9; P=0.03; d=0.70). Further, TC patients reported more memory problems after CT. DKI revealed a significantly higher radial kurtosis after CT in several anterior and posterior brain areas (P<0.05, corrected), but this was unrelated to cognitive performance.
  
  
  CONCLUSIONS
  This cross-sectional study suggests that men receiving CT for TC are at risk for long-term lower cognitive performance. Although CT affected WM microstructure, this was unrelated to cognitive performance. More extensive, preferably prospective studies are warranted to confirm these results and to provide more insight into the possible mechanisms behind the observed cognitive sequelae after treatment for TC.
authors: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.|Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors: Myrle M
authors: MM
authors: Stouten-Kemperman
authors: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.|Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors: Michiel B
authors: MB
authors: de Ruiter
authors: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors: Matthan W A
authors: MW
authors: Caan
authors: Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Willem
authors: W
authors: Boogerd
authors: Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Martijn J
authors: MJ
authors: Kerst
authors: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors: Liesbeth
authors: L
authors: Reneman
authors: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Sanne B
authors: SB
authors: Schagen
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017741:Survivors; D013736:Testicular Neoplasms / Q000188:drug therapy*; D066127:White Matter / Q000187:drug effects / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents
keywords: MRI; cognition; late effects; oncology; testicular cancer