Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy.
Chemoradiotherapy for primary central nervous system lymphoma (PCNSL) is associated with a considerable risk of long-term neurotoxicity. The present study aimed to assess the health-related quality of life (HRQOL) of outpatients with PCNSL who have received radiotherapy and high-dose methotrexate (HDMTX) chemotherapy, and to determine the factors that cause a decline in HRQOL and interfere with home living. A total of 37 patients were surveyed 0.9-14.2 years after their initial diagnosis and treatment. Each patient completed a multi-part HRQOL questionnaire that was used to examine the associations of HRQOL scores with leukoencephalopathy, Karnofsky performance status (KPS) scores, age, history of recurrence and HDMTX-based chemoradiotherapy. The results demonstrated that the history of recurrence, number of cycles of MTX chemotherapy and age affected the development of leukoencephalopathy. Reductions in KPS score were associated with a history of recurrence (P=0.03), but not with leukoencephalopathy (P=0.8). KPS score, leukoencephalopathy and age were significantly associated with a decline in HRQOL score. A decline in the HRQOL associated with a reduction in KPS score was also observed by multivariate analyses. Deterioration of the HRQOL among outpatients with PCNSL post-chemoradiotherapy was significantly associated with older age (≥66 years) and decreased KPS score. Older patients with a history of recurrence had a higher risk for deteriorated QOL due to development of leukoencephalopathy. Therefore, it is recommended that clinicians monitor the KPS score among outpatients with PCNSL. QOL examination for older patients with a lower KPS score was found to be particularly important for identifying any obstacles for home living.
Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan.
Yoshiko
Y
Okita
Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Yoshitaka
Y
Narita
Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Yasuji
Y
Miyakita
Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Ruriko
R
Miyahara
Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Makoto
M
Ohno
Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Masamichi
M
Takahashi
Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan; Department of Neurosurgery, Kansai Medical University, Osaka 573-1191, Japan.
Masahiro
M
Nonaka
Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan; Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan.
Yonehiro
Y
Kanemura
Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan.
Shin
S
Nakajima
Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan.
Toshiyuki
T
Fujinaka
Karnofsky performance status score; health-related quality of life; leukoencephalopathy; outpatients; primary central nervous system lymphoma