Long-term cognitive function, neuroimaging, and quality of life in primary CNS lymphoma

Doolittle, Nancy D. and Korfel, Agnieszka and Lubow, Meredith A. and Schorb, Elisabeth and Schlegel, Uwe and Rogowski, Sabine and Fu, Rongwei and Dósa, Edit and Illerhaus, Gerald and Kraemer, Dale F. and Muldoon, Leslie L. and Calabrese, Pasquale and Hedrick, Nancy and Tyson, Rose Marie and Jahnke, Kristoph and Maron, Leeza M. and Butler, Robert W. and Neuwelt, Edward A. (2013) Long-term cognitive function, neuroimaging, and quality of life in primary CNS lymphoma. Neurology, 81 (1). pp. 84-92. ISSN 1526-632X

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Abstract

Abstract 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 χ(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.

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