Long-term cognitive function, neuroimaging, and quality of life in primary CNS lymphoma.
Doolittle, Nancy D. PhD; Korfel, Agnieszka MD; Lubow, Meredith A. PhD; Schorb, Elisabeth MD; Schlegel, Uwe MD; Rogowski, Sabine MA; Fu, Rongwei PhD; Dosa, Edit MD, PhD; Illerhaus, Gerald MD; Kraemer, Dale F. PhD; Muldoon, Leslie L. PhD; Calabrese, Pasquale PhD; Hedrick, Nancy BS; Tyson, Rose Marie ANP; Jahnke, Kristoph MD; Maron, Leeza M. PhD; Butler, Robert W. PhD; Neuwelt, Edward A. MD
81(1):84-92, July 2, 2013.
(Format: HTML, PDF)
Objective: To describe and correlate neurotoxicity indicators in long-term primary CNS lymphoma (PCNSL) survivors who were treated with high-dose methotrexate-based regimens with or without whole-brain radiotherapy (WBRT).
Methods: Eighty PCNSL survivors from 4 treatment groups (1 with WBRT and 3 without WBRT) who were a minimum of 2 years after diagnosis and in complete remission underwent prospective neuropsychological, quality-of-life (QOL), and brain MRI evaluation. Clinical characteristics were compared among treatments by using the [chi]2 test and analysis of variance. The association among neuroimaging, neuropsychological, and QOL outcomes was assessed by using the Pearson correlation coefficient.
Results: The median interval from diagnosis to evaluation was 5.5 years (minimum, 2 years; maximum, 26 years). Survivors treated with WBRT had lower mean scores in attention/executive function (p = 0.0011), motor skills (p = 0.0023), and neuropsychological composite score (p = 0.0051) compared with those treated without WBRT. Verbal memory was better in survivors with longer intervals from diagnosis to evaluation (p = 0.0045). On brain imaging, mean areas of total T2 abnormalities were different among treatments (p = 0.0006). Total T2 abnormalities after WBRT were more than twice the mean of any non-WBRT group and were associated with poorer neuropsychological and QOL outcomes.
Conclusions: Our results suggest that in patients treated for PCNSL achieving complete remission and surviving at least 2 years, the addition of WBRT to methotrexate-based chemotherapy increases the risk of treatment-related neurotoxicity. Verbal memory may improve over time.
Classification of evidence: This study provides Class III evidence that in patients treated for PCNSL achieving complete remission and surviving at least 2 years, the addition of WBRT to methotrexate-based chemotherapy increases the risk of treatment-related neurotoxicity.
(C) 2013 American Academy of Neurology