Cognitive functions in primary CNS lymphoma after single or combined modality regimens

Area of Science:

• Neuro-oncology
• Cognitive Neuroscience
• Radiation Oncology

Background:

• Standard primary CNS lymphoma (PCNSL) treatment combines high-dose methotrexate chemotherapy (HD-MTX) with whole brain radiotherapy (WBRT).
• This combined approach carries significant neurotoxicity risks, prompting increased use of HD-MTX alone to mitigate cognitive impairment.

Purpose of the Study:

• To compare cognitive functioning and quality of life in PCNSL survivors treated with either WBRT + HD-MTX or HD-MTX alone.

Main Methods:

• Neuropsychological evaluations were conducted on 50 PCNSL patients in remission.
• Quality of life, MRI-assessed white matter disease, and atrophy were analyzed.
• Cognitive scores were compared between treatment groups, controlling for age and time since treatment.

Main Results:

• Patients receiving HD-MTX alone demonstrated significantly better selective attention and memory scores than those treated with WBRT + HD-MTX.
• WBRT + HD-MTX led to widespread cognitive impairments affecting quality of life, with over 50% unable to work.
• HD-MTX alone patients performed near normative levels, while WBRT + HD-MTX patients showed more prevalent cognitive dysfunction.

Conclusions:

• HD-MTX alone is associated with better cognitive outcomes and quality of life in PCNSL survivors compared to combined WBRT + HD-MTX therapy.
• Treatment modality significantly impacts long-term cognitive function and daily living in PCNSL survivors.
• White matter disease severity correlates with poorer performance in specific cognitive domains, including set-shifting and memory.