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Cognitive status and quality of life after treatment for primary CNS lymphoma

From the Department of Neuro-oncology (Dr. van den Bent, H. Harder and H. Holtel), Erasmus MC, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands; Department of Neurology (Dr. Bromberg), University Medical Center, Utrecht, The Netherlands; Department of Radiotherapy (Dr. Poortmans), Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands; Departments of Neurology (Dr. Haaxma-Reiche) and Hematology (Dr. Kluin-Nelemans), University Hospital Groningen, The Netherlands; and Department of Oncology and Radiotherapy (Dr. Menten), University Hospital Gasthuisberg, Leuven, Belgium.

Address correspondence and reprint requests to H. Harder, Department of Neuro-oncology, Erasmus MC, Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands; e-mail: h.harder{at}erasmusmc.nl

Objective: To evaluate the cognitive status and quality of life (QOL) in a cohort of 19 consecutive patients treated in a prospective European Organization for Research and Treatment of Cancer study (20962) for primary CNS lymphoma (PCNSL). All patients were in complete remission after combined modality treatment with IV and intrathecal high-dose methotrexate (MTX)-based chemotherapy followed by whole brain radiotherapy (WBRT).

Methods: An extensive neuropsychological assessment, including QOL measures, was conducted in 19 patients with PCNSL. The results were compared with matched control subjects with systemic hematologic malignancies treated with systemic chemotherapy or non-CNS radiotherapy. In addition, a neuroradiologic evaluation was carried out in 18 patients with PCNSL.

Results: Cognitive impairment was found in 12 patients with PCNSL (63%) despite a complete tumor response. Four patients (21%) showed severe cognitive deficits, and the percentage of impaired test indices correlated with age. In comparison, only two control subjects (11%) showed cognitive dysfunction (p = 0.002). Forty-two percent of the patients with PCNSL, in contrast to 81% of the control subjects, resumed work. White matter abnormalities were observed in 14 patients with PCNSL, and 14 had cortical atrophy. Cortical atrophy correlated with cognitive functioning, age, and Karnofsky performance score. Group differences in cognitive status and QOL could not be explained by anxiety, depression, or fatigue.

Conclusions: Combined modality treatment for primary CNS lymphoma is associated with cognitive impairment even in patients aged <60 years.

Received June 18, 2003. Accepted in final form November 18, 2003.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the February 24 issue to find the link for this article.

See also pages 532 and 548

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