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From the Departments of Neurology (Drs. Correa, DeAngelis, and Abrey, and A. Glass) and Epidemiology and Biostatistics (W. Shi and Dr. Thaler), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology and Neuroscience (Drs. Correa, DeAngelis, and Abrey), Weill Medical College of Cornell University, New York, NY.
Address correspondence and reprint requests to Dr. Denise D. Correa, ABPP-CN, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021; e-mail: corread{at}mskcc.org
Background: The standard treatment for primary CNS lymphoma (PCNSL) involves high-dose methotrexate-based (MTX) chemotherapy and whole brain radiotherapy (WBRT). This combined regimen prolongs patient survival, but also carries a substantial risk for delayed neurotoxicity particularly in the elderly. However, cognitive outcome evaluations have not been included in most clinical trials.
Objective: To assess cognitive functioning and quality of life in PCNSL survivors treated either with WBRT ± MTX-based chemotherapy or chemotherapy alone.
Methods: Twenty-eight PCNSL patients in disease remission received a post-treatment baseline neuropsychological evaluation, and a subset of patients were available for an 8-month follow-up evaluation. Assessment of quality of life and extent of white matter disease on MRI were also performed.
Results: Patients displayed mild to moderate impairments across several cognitive domains. These were of sufficient severity to reduce quality of life in half of the patient sample. Comparisons according to treatment type revealed more pronounced cognitive impairment, particularly in the memory and attention/executive domains, among patients treated with WBRT ± chemotherapy. Extent of white matter disease correlated with attention/executive, memory, and language impairment.
Conclusions: PCNSL survivors treated with WBRT ± chemotherapy displayed more pronounced cognitive dysfunction than patients treated with MTX-based chemotherapy alone.
Received August 4, 2003. Accepted in final form October 31, 2003.
Presented in part at the 2002 annual meeting of the American Academy of Neurology and at the 2003 annual meeting of the International Neuropsychological Society.
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